T2DM

Question 1

T2DM progression on pancreas

Answer 1

Starts as insulin resistance in the muscle and liver and progresses to secretory deficit

Question 2

diabetes complications

Answer 2

• Retinopathy (leading cause)
• Cardiovascular disease (2-3x)
• 10 fold ERSD increase
• every 30sec amputation
• trans generational effects
• erectile dysfunction
• depression and anxiety

Question 3

diabetes mortality ratios

Answer 3

Heart disease and stroke = 0.6
Cancer = 0.15
All other = 0.25
Shortens life span by 6 years

Question 4

Does diabetes diagnosis decrease mortality?

Answer 4

NO
even people with impaired glucose tolerance have twice the mortality rate

Question 5

Core ominous octect

Answer 5

Decreased insulin production
decreased glucose uptake

Question 6

Additional ominous octect

Answer 6

• Increased glucagon
• decreased incretin effect
• increased lipolysis
• increased glucose reabsorption
• nerotransmitter dysfunction
• increased hepatic glucose production

Question 7

extra ominous octect

Answer 7

inflammation
vascular insulin resistance

Question 8

Life style impact

Answer 8

can reduce progression by 58% and increase insulin resistance but hard to keep up

Question 9

Alpha-glucosidase inhibitors

Answer 9

Acarbose, 25% RR but 90% of people can’t tolerate GI A/E

Question 10

Pioglitazone

Answer 10

72% RR but heart failure change (still used some places)

Question 11

Rosiglitazone

Answer 11

62% RR but massive cardiac side effects

Question 12

sulfonylureas

Answer 12

Work too well and cause hypoglycaemia
still use glicazide MR

Question 13

thiazolidinediones TZD

Answer 13

cause heart attacks and heart failure

Question 14

ACE inhibitors

Answer 14

Ramipril has no effect on T2DM progression

Question 15

Metformin

Answer 15

31% RR decrease with manageable side effects

Question 16

Treatment of <1.5% over target

Answer 16

start metformin and lifestyle

Question 17

Treatment of >1.5 over target

Answer 17

Two agents, Metformin + SGLT2 is preferable

Question 18

Treatment initiation with metabolic decompensation

Answer 18

(Very high glucose, ketosis, weight loss, polyuria, polydipsia, volume depletion), start insulin and +/- metformin till regulated then drop to metformin or metformin +

Question 19

Ideal diabetes drug dose

Answer 19

Best at middle dose, high doses don’t increase glycemic control and only serve adverse effects

Question 20

Metformin dosing

Answer 20

Start slow as GI side effects are common in the first two weeks 250mg BID, 250mg TID, 500mg BID, 500mg TID

Question 21

metformin evidence

Answer 21

only about 600 people tested, and only controls sugars, provides no complication risk benefit