T2DM Flashcards
What are examples of microvascular complications?
Retinopathy
Nephropathy
Neuropathy
What are examples of macrovascular complications?
IHD
CVD
PVD
Which countries have the highest incidence of T2DM?
China
India
USA
What % of inpatients have T2DM?
20-30%
What is the diagnostic criteria for T2DM?
Random glucose =/> 11.1 + symptoms
Random glucose =/> 11.1 x2
HbA1c =/> 48mmol/L
Which oral test can be done for T2DM?
Oral glucose tolerance test
What would glucose levels be during a oral glucose tolerance test for someone with T2DM?
Fasting >7
2 hour >11.1
What happens to the pancreas in T2DM?
Decreased insulin secretion
Increased beta cell apoptosis
Decreased beta cell mass
Hyperglucagonemia (excess glugacon secretion)
What happens to adipocytes in T2DM?
Increase in circulation fatty acids –> hyperlipidemia
What happens to the gut in T2DM?
Impaired incretin effect (hormones that stimulate a decrease in blood glucose after eating)
What happens to the liver in T2DM?
Insulin resistance
Increased hepatic glucose output
What happens to muscles in T2DM?
Insulin resistance
What modifiable risk factors are there for T2DM?
Obesity
HTN
Hyperlipidaemia
Which ethnicity has a higher risk of developing T2DM?
South asian
What are the three stages to T2DM?
Normal glucose tolerance
Pre-diabetes = impaired glucose tolerance
T2DM
Which medications can increase the risk of developing T2DM?
Glucocorticoids
Beta blockers
Statins
Thiazides
Anti-psychotics
What happens to beta cells as T2DM progresses?
Beta cell dysfunction + insulin resistance leads to beta cell destruction = beta cell mass loss = less able to produce enough insulin.
What is released from adipose tissue that increases insulin resistance?
Free fatty acids
Adipokines - causes inflammation
How does insulin resistance occur?
Increase in free fatty acids + aggravating factors (age, chronic disease, inactivity, excess lipid intake) –> impaired oxidative capacities –> accumulation of lipid derivatives –> Lipotoxicity –> Insulin resistance
What is ectopic fat?
Deposition of triglycerides within non-adipose cells that usually would have very little
What can ectopic fat lead to in cells?
Adipocyte hypertrophy
Reduction in adipogenic and lipogenic genes
Increased inflammation through macrophage activation.
What are the consequences of ectopic fat?
Inflammation
Atherosclerosis
HTN
Atherogenic dyslipidemia
T2DM
Thrombosis
What is metabolic syndrome?
Metabolic syndrome is the medical term for a combination of diabetes, high blood pressure (hypertension) and obesity. It puts you at greater risk of getting coronary heart disease, stroke and other conditions that affect the blood vessels.
What is the diagnosis criteria for metabolic syndrome?
Central obesity
Plus two of the following four;
- Raised triglycerides
- Reduced HDL
- HTN
- Raised fasting plasma glucose
How doe exercise affect the pancreas?
Increased glucagon
Reduces insulin
How does exercise affect the liver?
Increases gluconeogenesis
Increases fat oxidation
Increases glucogenesis
How does exercise increase vasodilation?
Increased fat oxidation, glycolysis and glucose uptake = increased muscle permeability. This + increased O2 delivery = vasodilation.
Can T2DM be reversed?
Yes but incidence only 1.47%.
Defined as remission if <48mmol/L for at least 3 months without glucose lowering medications.
What is the most common cause of death in diabetic patients?
IHD
How does diabetes cause atherogenesis?
Diabetes causes hyperglycaemia, fatty acid excess + insulin resistance.
These lead to oxidative stress, PKC activation + production of advanced glycation end products.
These leads to changes in the endothelium.
What happens to the endothelium in atherogenesis?
Decreased NO + Prostacyclin
Increased Endothelin 1, NF-KB, AT II + Tissue factor.
Which type of diet should those with T2DM have?
High fibre, low GI sources of carbs
Reduced saturated and trans fatty acids
Which medications can help with weight management in T2DM?
GLP1
When would someone with T2DM be eligible for bariatric surgery?
BMI >35, has T2DM + undergoing tier 3 weight management
BMI 30-34.9 if Asian ethnicity
In which type of diabetes would DKA occur?
Type 1
In which type of diabetes would HHS occur?
Type 2
