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RE > T2DM > Flashcards

T2DM Flashcards

1
Q

What are examples of microvascular complications?

A

Retinopathy
Nephropathy
Neuropathy

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2
Q

What are examples of macrovascular complications?

A

IHD
CVD
PVD

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3
Q

Which countries have the highest incidence of T2DM?

A

China
India
USA

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4
Q

What % of inpatients have T2DM?

A

20-30%

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5
Q

What is the diagnostic criteria for T2DM?

A

Random glucose =/> 11.1 + symptoms
Random glucose =/> 11.1 x2
HbA1c =/> 48mmol/L

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6
Q

Which oral test can be done for T2DM?

A

Oral glucose tolerance test

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7
Q

What would glucose levels be during a oral glucose tolerance test for someone with T2DM?

A

Fasting >7
2 hour >11.1

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8
Q

What happens to the pancreas in T2DM?

A

Decreased insulin secretion
Increased beta cell apoptosis
Decreased beta cell mass
Hyperglucagonemia (excess glugacon secretion)

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9
Q

What happens to adipocytes in T2DM?

A

Increase in circulation fatty acids –> hyperlipidemia

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10
Q

What happens to the gut in T2DM?

A

Impaired incretin effect (hormones that stimulate a decrease in blood glucose after eating)

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11
Q

What happens to the liver in T2DM?

A

Insulin resistance
Increased hepatic glucose output

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12
Q

What happens to muscles in T2DM?

A

Insulin resistance

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13
Q

What modifiable risk factors are there for T2DM?

A

Obesity
HTN
Hyperlipidaemia

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14
Q

Which ethnicity has a higher risk of developing T2DM?

A

South asian

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15
Q

What are the three stages to T2DM?

A

Normal glucose tolerance
Pre-diabetes = impaired glucose tolerance
T2DM

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16
Q

Which medications can increase the risk of developing T2DM?

A

Glucocorticoids
Beta blockers
Statins
Thiazides
Anti-psychotics

17
Q

What happens to beta cells as T2DM progresses?

A

Beta cell dysfunction + insulin resistance leads to beta cell destruction = beta cell mass loss = less able to produce enough insulin.

18
Q

What is released from adipose tissue that increases insulin resistance?

A

Free fatty acids
Adipokines - causes inflammation

19
Q

How does insulin resistance occur?

A

Increase in free fatty acids + aggravating factors (age, chronic disease, inactivity, excess lipid intake) –> impaired oxidative capacities –> accumulation of lipid derivatives –> Lipotoxicity –> Insulin resistance

20
Q

What is ectopic fat?

A

Deposition of triglycerides within non-adipose cells that usually would have very little

21
Q

What can ectopic fat lead to in cells?

A

Adipocyte hypertrophy
Reduction in adipogenic and lipogenic genes
Increased inflammation through macrophage activation.

22
Q

What are the consequences of ectopic fat?

A

Inflammation
Atherosclerosis
HTN
Atherogenic dyslipidemia
T2DM
Thrombosis

23
Q

What is metabolic syndrome?

A

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.

24
Q

What is the diagnosis criteria for metabolic syndrome?

A

Central obesity
Plus two of the following four;
- Raised triglycerides
- Reduced HDL
- HTN
- Raised fasting plasma glucose

25
Q

How doe exercise affect the pancreas?

A

Increased glucagon
Reduces insulin

26
Q

How does exercise affect the liver?

A

Increases gluconeogenesis
Increases fat oxidation
Increases glucogenesis

27
Q

How does exercise increase vasodilation?

A

Increased fat oxidation, glycolysis and glucose uptake = increased muscle permeability. This + increased O2 delivery = vasodilation.

28
Q

Can T2DM be reversed?

A

Yes but incidence only 1.47%.
Defined as remission if <48mmol/L for at least 3 months without glucose lowering medications.

29
Q

What is the most common cause of death in diabetic patients?

A

IHD

30
Q

How does diabetes cause atherogenesis?

A

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.

31
Q

What happens to the endothelium in atherogenesis?

A

Decreased NO + Prostacyclin
Increased Endothelin 1, NF-KB, AT II + Tissue factor.

32
Q

Which type of diet should those with T2DM have?

A

High fibre, low GI sources of carbs
Reduced saturated and trans fatty acids

33
Q

Which medications can help with weight management in T2DM?

A

GLP1

34
Q

When would someone with T2DM be eligible for bariatric surgery?

A

BMI >35, has T2DM + undergoing tier 3 weight management
BMI 30-34.9 if Asian ethnicity

35
Q

In which type of diabetes would DKA occur?

A

Type 1

36
Q

In which type of diabetes would HHS occur?

A

Type 2

RE (18 decks)

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