T2DM Flashcards
Patients tend to present with T2DM in youth/middle/late-age and are usually lean/obese?
Middle/late aged patients who are usually obese
Ketonuria is strongly evident in T2DM. True/false?
False - it’s minimal or absent (strong = T1DM)
Microvascular complications are typically present upon diagnosis of T2DM. True/false?
True - around 20% of patients will have evidence of microvascular changes
List the risk factors for developing T2DM (8)
1) Obesity 2) Family history 3) Presence of gestational diabetes 4) Age 5) Ethnicity (Asian, African) 6) PMH of MI/stroke 7) Medications (e.g. antipsychotics) 8) Impaired glucose tolerance
Type 4 diabetes is associated with which condition?
Pregnancy (gestational diabetes)
True/false: Beta-cell failure occurs early in development of T2DM?
False - first insulin resistance, then beta cell hyperplasia, then failure.
Is there a direct correlation between BMI and T2DM development?
Yes - acceleration
T2DM is purely beta-cell related. True/false?
False - there are also genetic and environmental factors at play.
Microvascular complications are generally present at stage of T2DM diagnosis.
True (30% of cases)
What’s the HbA1c target for T2DM patients (<70)?
48-53mmol/L
What’s the HbA1c target for older diabetics (>70)?
53-75mmol/L
Close glycaemic control in T2DM can reduce macrovascular complications. True/false?
Unclear - limited evidence.
Diabetics should have what areas screened & how often?
Kidneys, eyes, feet. Annually.
What is the screening test for diabetic nephropathy?
Urinary albumin: creatinine ratio (dipstick)
Urinary screening of albumin: creatinine ratio should be taken on what type of urine sample?
Random (not a 1st pass)
Which other biochemistry should be checked when assessing urinary albumin: creatinine function?
U&E
What are the risk factors for progression of diabetic nephropathy (4)?
1) Hypertension 2) High cholesterol 3) Smoking 4) Poor glycaemic control
Which therapy should all patients with microalbuminuria be commenced on?
ACE inhibitor
Which eye conditions are diabetics more prone to developing? (3)
Diabetic retinopathy, cataracts, glaucoma (2x more common in diabetes)
Is blurry vision in diabetes always irreversible?
No, acute hyperglycaemia can cause blurred vision but is reversible.
What’s the most severe form of retinopathy?
Proliferative
What treatments are available for diabetic retinopathy? (3)
Laser ablation, vitrectomy, anti-VEGF injection
ED presents in which % of diabetic men?
50%
This fundoscopy shows what abnormality?
Proliferative retinopathy (notice the new blood vessels forming)
Is T2DM preventable?
Yes (in 90% of cases) - by diet and physical activity
Good glycaemic control has been shown to reduce microvascular complications by which % at 10 years?
25% at 10 years
True/false: T2DM is generally less milder than T1DM.
False - there is no mild form of DM. T2DM can be as severe as T1DM if uncontrolled.
What’s the primary nutritional strategy for controlling T2DM?
Weight management
Which % of T2DM are overweight?
80-90%
In nutrition of T2DM, it’s more important to consider what sources of energy are in the diet over the total amount of energy in the diet. True/false?
False
How many calories in a calorie-deficit diet can safely be prescribed?
600kcal
What’s a reasonable expected weight-loss following consultation?
5-10%
Sugars contribute more than other forms of carbohydrate in the development of DM. True/false?
False - no evidence for this.
How often should diabetics have eye screening?
Low risk: every 12 months
If retinopathy observable or maculopathy early: every 6 months
If any macula haemorrhage OR >4 retinal haemorrhage: urgent referal for opthalmology
BP target in T2DM
<130/80mmHg
Risk factors for progression of nephropathy in diabetes?
Smoking, poor glycaemic control, hypertension, high cholesterol.
SGLT drugs act how
Example drug
Block glucose reabsorption in PCT.
Example: flozin drugs
What are the insulin secretagogue drugs
SUR
GLP-1 agonists
DPP-IV inhibitors
Example TZD
Pioglitazone
Example DPP-IV
Gliptin
Example GLP-1
Exenatide/ Liraglutide
Side-effects of SUR drugs
Deranged LFTs, weight gain
Side effects of SLGT2s inhibitors
Thrush, UTI
Side effect of TZDs
Fracture risk, osteoporosis, heart failure, weight gain
Side effect of metformin
Lactic acidosis, GI upset
What are the weight-neutral or loss diabetes drugs
Metformin (loss), SGLT2 inhibitors (loss), GLP1, DPP-IV (loss)
What are the weight-gaining diabetes drugs?
SURs (e.g. gliclazide), TZDs (e.g. pioglitazone)
What is the average BMI the typical non-insulin dependent T2DM presents at?
28
At BMI of 30, the risk of developing T2DM is increased how much
40-fold
What is acarbose
Alpha-glucoside inhibitor (prevents absorption of glucose across lumen of GI tract)
