T2DM Flashcards
What is T2DM
Relative insulin deficiency leading to hyperglycaemia
What causes T2DM
Ageing
Being overweight
Genetic predisposition
What are the risk factors for T2DM
Age
Obesity
Ethnicity
FHx
PCOS
Hypertension
High cholesterol
CVD
What is the relative insulin deficiency in T2DM
Beta cells produce insulin however not enough to overcome resistance expressed by liver muscles and fat -this is why we don’t see ketosis in T2DM. However, as T2DM progresses, there is a gradual failure of B cells leading to an absolute deficiency too
Why do we get hyperglycaemia in T2DM
- Reduced glucose uptake into tissues
- HGO increased due to reduced action of insulin and increased action of glucagon
What is the presentation of T2DM
Fatigue
Polyuria
Polydipsia
Overweight
Blurred vision
Paraesthesia
Skin infection
Acanthosis nigricans
UTIs
What is used for the diagnosis of T2DM
- Fasting glucose ≥ 7
- OGTT/Random glucose ≥11.1
- HbA1c ≥ 48
How do we diagnose symptomatic patients
One positive test needed
How do we diagnose asymptomatic patients
Two positive tests needed on 2 separate occasions
Describe the role of HbA1c for diagnosing T2DM
Can be used - however if below 48 then this doesn’t exclude T2DM. Misleading HbA1c results may be due to increased RBC turnover
What is impaired fasting glucose
less than 7 however glucose ≥ 6.1
What is impaired glucose tolerance
less than 11.1 however ≥ 7.8
What is the HbA1c target in T2DM
48 - however we only intervene if HbA1c reaches 58
What is first line in T2DM
Lifestyle advice + metformin
Nb - should try modified release metformin if causing GI upset
When do we consider dual therapy in T2DM
If metformin has been titrated up to the maximum dose but HbA1c is still at 58 or above
