T2DM

Question 1

describe the pathophysiology of T2DM

Answer 1

Typically progresses from a preliminary phase of impaired glucose tolerance or impaired fasting glucose.

Question 2

what are the effects of insulin resistance

Answer 2

Question 3

what happens to risk of T2DM as BMI increases

Answer 3

increases

Question 4

are females or males at greater risk of diabetes

Answer 4

females

Question 5

describe the development of T2DM, including B cell mass, glucose levels, weight and insulin resistance

under the titles susceptibility, adaption and failure

Answer 5

Typically progresses from a preliminary phase of impaired glucose tolerance or impaired fasting glucose.

Question 6

describe the changes in T2DM that lead to hyperglycaemia

Answer 6

Question 7

describe the pattern of presentation

Answer 7

Question 8

describe the synthesis of insulin

Answer 8

synthesised in the RER of pancreatic B cells, as a larger single chain preprohormone called preproinsulin

it is cleaved to form insulin which contains two polypeptide chains linked by disulphide bonds

there is a connecting C peptide which is a by product of cleavage and has no known physiological function

Question 9

C peptide

Answer 9

amounts of it are generally found to be equal to that of insulin as they are linked during synthesis

can be used as a marker of insulin production

Question 10

what effect does obesity have on the presentation of T2DM

Answer 10

accelerates it

Question 11

how much function of B cells must be lost to develop DM

Answer 11

90% in T1DM to become hyperglycaemia

only 50% in T2DM

Question 12

how can the incidence and progression of microvascular complications be reduced

Answer 12

intensive glucose control

weight loss

Question 13

is there a stronger genetic influence on T1 or T2

Answer 13

T2 - ≥80% concordance in identical twins

Question 14

microvascular disease and T2DM

Answer 14

T2DM is for most people predominantly a disease of the B cell, the rate of progression and severity of B cell dysfunction is affected by genetics and environment

B cell dysfunction leads to hyperglycaemia, which chronically can lead to microvascular disease

Question 15

macrovascular disease and T2DM

Answer 15

There are lipid abnormalities, which include reduced HDL cholesterol, increased triglycerides and a predominance of small dense LDL particles. These are all associated with an increased risk of CV disease. Increase hepatic secretion of triglyceride rich VLDL and impaired clearance of this VLDL appears to be of central importance to the pathophysiology of this dyslipidaemia.

Question 16

how is CVD risk managed

Answer 16

use of statins and anti-hypertensives (ACE)

Question 17

new onset diabetes in older people

Answer 17

not always T2DM

if patient is ketotic ± poor response to oral hypoglycaemics (and patient is slim or has a family/personal history of autoimmunity), think of latent autoimmune diabetes in adults (LADA) and measure islet cell antibodies.