Type 2 Diabetes

Question 1

Simplified pathophysiology of diabetes 2?

Answer 1

Repeated exposure to glucose & insulin makes body cells resistant to effects of insulin and more and more insulin is required to produce cellular response & get them to take up & use glucose

-Over time Beta cells get tired by producing too much insulin

Question 2

Risk factors of T2DM?

Answer 2

Age 
Ethnicity (black, chinese, South Asian)
Fam Hx 
Obesity 
Sedentary lifestyle 
High carbs diet

Question 3

Presnetation of T2DM?

Answer 3

• Fatigue
• Polydipsia & polyuria
• Unintentional wt loss
• Opportunistic infections
• Slow healing
• Glucose in urine

Question 4

Investigation of T2DM?

Answer 4

Oral glucose test (OGTT)
-In morning prior to breakfast

• Take baseline fasting plasma glucose result, giving 75mg glucose drink & then measuring plasma glucose 2hs later
• Tests ability of body to cope with carb meal

Question 5

Pre-diabetes diagnosis?

Answer 5

Diagnosed with Hba1c or impaired fasting glucose (6,.1-6.9mmol/L)/tolerance (7.8-11.1mmol/L)

Question 6

Diagnosis of T2DM?

Answer 6

HbA1c >48 mmol/mol

Random glucose >11mmol/L

Fasting glucose >7mmol/L

OGTT >11mmol/L

Question 7

Management of T2DM?

Answer 7

Education

Monitor comps

Question 8

Targets for treatment?

Answer 8

48mmol/mol for new T2DM

53mmol/mol for diabetics beyond metformin alone

Question 9

Medical management of diabetes T2?

Answer 9

1st line: Metformin (500mg once daily)

2nd line: Add Sulphonylurea, pioglitazone, DPP-4 Inhibitor, SGLT2 Inhibitor

3rd line: Triple therapy with metformin & 2 of 2nd line drugs combo
OR
Metformin and insulin