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brs2 > Type 2 Diabetes > Flashcards

Type 2 Diabetes Flashcards

1
Q

what is a normal fasting glucose

A

< 6 mmol/L

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2
Q

how can we diagnose type 2 diabetes using fasting glucose

A

if fasting glucose > 7 mmol/L

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3
Q

what is impaired fasting glycaemia

A

fasting glucose in between 6 and 7

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4
Q

what is oral glucose tolerant test

A

2 hour test
take fasting glucose
give glucose solution
measure glucose levels again

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5
Q

how can we use an oral glucose tolerance test to check for diabetes

A

if > 11 mmol/L after OGTT

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6
Q

what is an impaired oral glucose test value

A

when blood glucose is in between 7.7 and 11 after OGTT

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7
Q

what is a normal blood glucose after oral glucose tolerance test

A

< 7.7 mmol/L

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8
Q

what is a normal hba1c

A

<42 mmol/mol

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9
Q

what is the hba1c range for prediabetes

A

between 42 and 48

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10
Q

how can we use hba1c to to check if a patient has type 2 diabetes

A

> 48 mmol/mol

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11
Q

what should a random glucose be if normal

A

below 11.1 and no symptoms

if above 11.1 with symptoms = diabetes

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12
Q

what is the problem in type 2 diabetes

A

the tissues i.e muscles, fat and liver are resistant to insulin
= relative insulin deficiency

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13
Q

would you typically see ketoacidosis in type 2

A

no unless accompanied with something else eg. sepsis,infective

or when long duration of type2dm

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14
Q

what is the pathophysiology of type 2 diabetes

A

storm between internal adiposity, pro inflammatory state and production of adipose cytokines
= makes tissue resistant

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15
Q

what is type 2 diabetes caused by

A

involved with genes, intrauterine environment and adult environment
causes insulin resistance and insulin secretion defects
fatty acids are also important in pathogenesis and complications

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16
Q

what does reduced action of insulin do to skeletal muscle

A

causes less uptake of glucose

17
Q

what does reduced action of insulin do to liver

A

produce lots of glucose = hepatic glucose production

18
Q

why does liver continue to make glucose

A

gluconeogenesis still takes place
not inhibited by insulin

increased glycogenolysis

19
Q

what happens to adipocytes in t2dm

A

increased fatty acid uptake from gut

and unhealthy lipids produced which usually inhibited by insulin

20
Q

what are some inflammatory adipokines produced

A 
Tnf alpha
Il6
adinopectin
fatty acids
apelin
glucocorticoids
leptin
resistin
visfatin
endocannabinoids
21
Q

what does the presentation of t2dm look like

A

hyperglycaemia
overweight
dyslipidaemia
complications

22
Q

what are some risk factors of t2dm

A 
age
high bmi
pcos
family hx
ethnicity
inactivity
23
Q

what is the first line test for diagnosis of t2dm

A

hba1c:
1 hba1c > 48 mmol/l with symptoms
2 x hba1c if asymptomatic

24
Q

symptoms of t2dm

A

osmotic symptoms
polyphagia
polydispsia polyuria

25
Q

what is hyperosmolar hyperglycaemic state

A

= diabetic emergency
presents commonly with renal failure
osmotic diuresis leads to dehydration
other complication has tipped them over

26
Q

how can we manage t2dm

A 
diet
oral med
structured ed
may need insulin later
remission/reversal

also prevention of diabetes related complications

27
Q

principle sof t2dm consultations

A 
hba1c, glucose monitoring
weight assessment
bp
cholesterol profile
screening for complications e.g foot and retinal screening
28
Q

dietary recs for t2dm

A

total calorie control
reduce fat calories
increase soluble fibre

29
Q

what are some drugs we can use for t2dm

A

metformin, sulphonylureas, pioglitazone

30
Q

what is action of metformin

A

biguanide - insulin sensitiser
reduces insulin resistance
= reduced hepatic glucose output
increased peripheral glucose disposal

31
Q

cons of metformin

A

gi side effects

contraindicated in severe liver, severe cardiac or moderate renal failure

32
Q

what do sulphonyureas do

A

boost insulin production

binds to atp sensitive potassium channel and close it - help insulin prod

33
Q

how does pioglitazone work

A

peroxisome proliferator activated receptor agonist
is an insulin sensitiser
makes insulin more efficacious

34
Q

what can pioglitazone do

A

improvement in glycaemia and lipids

adipocyte differentiation modified

35
Q

side effects of pioglitazone

A

hepatitis

heart failure

36
Q

what is Glucagon like peptide agonist

- new drug

A 
gut hormone
stimulates insulin, suppresses glucagon
increase satiety
short half life 
used in dm
37
Q

what are some examples of glp1 agonists

A

liraglutide
semaglutide
injectable - daily or weekly

38
Q

how do sglt2 inhibitors work

A 
loss of glucose via kidneys
reduce hba1c
weightloss
improve ckd
lower risk heart failure
39
Q

examples of sglt2 inhibitors

A

empagliflozin
dapagliflozin
canagliflozin

brs2 (65 decks)

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