Type 2 Diabetes Flashcards
what is a normal fasting glucose
< 6 mmol/L
how can we diagnose type 2 diabetes using fasting glucose
if fasting glucose > 7 mmol/L
what is impaired fasting glycaemia
fasting glucose in between 6 and 7
what is oral glucose tolerant test
2 hour test
take fasting glucose
give glucose solution
measure glucose levels again
how can we use an oral glucose tolerance test to check for diabetes
if > 11 mmol/L after OGTT
what is an impaired oral glucose test value
when blood glucose is in between 7.7 and 11 after OGTT
what is a normal blood glucose after oral glucose tolerance test
< 7.7 mmol/L
what is a normal hba1c
<42 mmol/mol
what is the hba1c range for prediabetes
between 42 and 48
how can we use hba1c to to check if a patient has type 2 diabetes
> 48 mmol/mol
what should a random glucose be if normal
below 11.1 and no symptoms
if above 11.1 with symptoms = diabetes
what is the problem in type 2 diabetes
the tissues i.e muscles, fat and liver are resistant to insulin
= relative insulin deficiency
would you typically see ketoacidosis in type 2
no unless accompanied with something else eg. sepsis,infective
or when long duration of type2dm
what is the pathophysiology of type 2 diabetes
storm between internal adiposity, pro inflammatory state and production of adipose cytokines
= makes tissue resistant
what is type 2 diabetes caused by
involved with genes, intrauterine environment and adult environment
causes insulin resistance and insulin secretion defects
fatty acids are also important in pathogenesis and complications
what does reduced action of insulin do to skeletal muscle
causes less uptake of glucose
what does reduced action of insulin do to liver
produce lots of glucose = hepatic glucose production
why does liver continue to make glucose
gluconeogenesis still takes place
not inhibited by insulin
increased glycogenolysis
what happens to adipocytes in t2dm
increased fatty acid uptake from gut
and unhealthy lipids produced which usually inhibited by insulin
what are some inflammatory adipokines produced
Tnf alpha Il6 adinopectin fatty acids apelin glucocorticoids leptin resistin visfatin endocannabinoids
what does the presentation of t2dm look like
hyperglycaemia
overweight
dyslipidaemia
complications
what are some risk factors of t2dm
age high bmi pcos family hx ethnicity inactivity
what is the first line test for diagnosis of t2dm
hba1c:
1 hba1c > 48 mmol/l with symptoms
2 x hba1c if asymptomatic
symptoms of t2dm
osmotic symptoms
polyphagia
polydispsia polyuria
what is hyperosmolar hyperglycaemic state
= diabetic emergency
presents commonly with renal failure
osmotic diuresis leads to dehydration
other complication has tipped them over
how can we manage t2dm
diet oral med structured ed may need insulin later remission/reversal
also prevention of diabetes related complications
principle sof t2dm consultations
hba1c, glucose monitoring weight assessment bp cholesterol profile screening for complications e.g foot and retinal screening
dietary recs for t2dm
total calorie control
reduce fat calories
increase soluble fibre
what are some drugs we can use for t2dm
metformin, sulphonylureas, pioglitazone
what is action of metformin
biguanide - insulin sensitiser
reduces insulin resistance
= reduced hepatic glucose output
increased peripheral glucose disposal
cons of metformin
gi side effects
contraindicated in severe liver, severe cardiac or moderate renal failure
what do sulphonyureas do
boost insulin production
binds to atp sensitive potassium channel and close it - help insulin prod
how does pioglitazone work
peroxisome proliferator activated receptor agonist
is an insulin sensitiser
makes insulin more efficacious
what can pioglitazone do
improvement in glycaemia and lipids
adipocyte differentiation modified
side effects of pioglitazone
hepatitis
heart failure
what is Glucagon like peptide agonist
- new drug
gut hormone stimulates insulin, suppresses glucagon increase satiety short half life used in dm
what are some examples of glp1 agonists
liraglutide
semaglutide
injectable - daily or weekly
how do sglt2 inhibitors work
loss of glucose via kidneys reduce hba1c weightloss improve ckd lower risk heart failure
examples of sglt2 inhibitors
empagliflozin
dapagliflozin
canagliflozin
