T2DM Flashcards
what is the pathophysiology of T2DM?
- chronic hyperinsulinaemia from excess dietary sugar intake (and other factors such as obesity) cause these organs (e.g. liver, skeletal muscle) to develop resistance to the effects of insulin, meaning that more insulin is needed to lower glucose to the same degree
- this leads to chronic hyperglycaemia
- initially, insulin levels remain very high to try to ‘override’ the resistance. however, as the condition progresses, the pancreas begins to ‘tire’ and stops producing insulin
- insulin deficiency is the end-stage of T2DM
what are the risk factors for T2DM?
- > 40
- male
- south asian/black african/black-caribbean
- genetic
- obesity
- alcoholism
- smoking
- stress
- PCOS
- GDM
what is the classic triad of symptoms associated with T2DM?
- polyuria
- polydipsia
- weight loss
what are the other symptoms of T2DM?
- tired all the time (e.g. TATT)
- frequent/resistant infections (e.g. UTI, thrush)
- poor-healing wounds
- blurred vision (e.g. retinopathy)
what are the investigations for T2DM?
- capillary blood glucose
- urinalysis (e.g. glycosuria, ketonuria, proteinuria)
- HbA1C
- U&Es
- LFTs
- cholesterol/lipids
- urine albumin-creatinine ratio (e.g. UACR)
what are the normal ranges for capillary blood glucose (e.g. BM)?
pre-meal: 4-5.9 mmol/L
2 hours post-meal: ≤7.8 mmol/L
what is HbA1C?
- a measure of average blood glucose concentration (e.g. using glucose bound to haemoglobin/Hb as a surrogate marker) in the preceding 3 months (e.g. average lifespan of a RBC)
- it cannot be used in circumstances where Hb is abnormal (e.g. haemoglobinopathies) or where RBCs are broken down early (e.g. haemolytic anaemia)
- alternative tests include the original fasting or random plasma venous glucose (PVG) test or serum fructosamine
what is urine albumin-creatinine ratio (e.g. UACR)?
- an early morning urine sample which detects microalbuminuria and compares it with creatinine
- in diabetic nephropathy, glomerular basement membrane damage allows small proteins like albumin to leak abnormally through the filtration system into the urine – leading to a raised UACR
T2DM is diagnosed with an HbA1C of what?
HbA1C ≥48 mmol/mol
what is prediabetes?
- a condition where there is hyperglycaemia that does not reach the above threshold but has a significantly increased risk of progression to T2DM
- is defined as HbA1C 42-47 mmol/mol
what are the lifestyle modifications recommended for the management of T2DM?
- diet
- exercise
- reduction of alcohol consumption
- smoking cessation
- avoidance of stress
when may insulin be required in the management of T2DM?
- if treatment fails (i.e. already on “triple therapy” or established complications) or rapid control is required (e.g. due to very high HbA1C or osmotic symptoms), then subcutaneous insulin injections may be needed
- comes in many forms and is often started as a twice-daily intermediate-acting preparation, alongside metformin
what are the risks associated with insulin use in T2DM?
- hypoglycaemia
- weight gain
- lipodystrophy from recurrent subcutaneous injections
what is the target blood pressure in a patient with T2DM?
<140/90mmHg in clinic (<135/85mmHg for home/ambulatory monitoring)
what should be offered to a patient with T2DM if their QRISK is >10%?
statin (e.g. atorvastatin 20mg)
what should be offered to a patient with T2DM if an MI or stroke occurs?
statin (e.g. atorvastatin 80mg)
what are the macrovascular complications of T2DM?
- MI
- IHD
- stroke/TIA
- PVD
what are the microvascular complications of T2DM?
- diabetic nephropathy
- diabetic retinopathy
- diabetic neuropathy
what are the other complications associated with T2DM?
- charcot’s foot/arthropathy
- frozen shoulder
- carpal tunnel syndrome
- de quervain’s tenosynovitis
