Type 2 Diabetes

Question 1

Epidemiology

Answer 1

Older (>30 years)
Males
Obese
More common in racial groups = Asian, African, Polynesian
More prevalent in affluent areas

Question 2

Risk Factors

Answer 2

Increases with age
Male
Family history
Smoking
Obesity
Sedentary lifestyle
Hypertension
PCOS

Question 3

T2DM IS A BIG RISK FACTOR FOR:
HTN
SILENT MI
NEPHROTIC SYNDROME
CKD
AND MORE

Answer 3

DAMN

Question 4

Pathophysiology

Answer 4

Peripheral insulin resistance (i.e malfunctional insulin intracellular activation pathway) therefore decrease GLUT 4 expression + minor destruction to pancreatic islets (amyloid + CHO/lipid deposition)
= HYPERGLYCAEMIA with increase insulin demand from a depleted B cell population
Also accumulation of intracellular triglycerides in muscle and liver
* at first there will be beta cell hyperplasia = increase insulin to remove glucose) *

Question 5

Signs

Answer 5

Acanthosis Nigricans
Glycosuria
Central obesity
Loss of the 1st phase of the normal biphasic response to insulin = early sign

Question 6

Symptoms

Answer 6

Typical presentation: OBESE HYPETENSIVE OLDER PX W/ POLYURIA (+ NOCTURIA), POLYDIPSIA, GLYCOSURIA
- Lethargy
- Candida infections
- UTI
- Blurred vision
- Polyphagia
- Paraesthesia

Question 7

Diagnosis

Answer 7

FIRST LINE =
- Random Plasma Glucose > 11.1 mmol/L = Glucose taken randomly
- Fasting Plasma Glucose > 7.0 mmol/L = Glucose taken after 8hs fasting
(1 test diagnostic in symptomatic patients - 2 required in asymp)
For borderline cases =
- 2 hour plasma glucose (75 oral glucose) > 11.1 mmol/L
GOLD STANDARD =
- HbA1c > 6.5% or 48mmol/l = measures amount of glycated haemoglobin = suggests hyperglycaemia over the preceding 3 months
PRE-DIABETES
- impaired glucose tolerance (igt)= normal FPG < 6mmol/L + 2 h OGTT (75g glucose) = 7.8 - 11.1mmol/L
- impaired fasting glycaemia (ifg) = FPG - 6.1-6.9 mmol/L + normal 2 h OGTT (75g glucose) < 7.8 mmol/L

Question 8

Determination of normal, pre, and diabetes levels
(OGTT, FPG)

Answer 8

OGTT
- normal = < 7.8 mmol/L
- pre = 7.8 - 11.1 mmol/L
- diabetic = > 11 mmol/L
FPG
- normal = < 6 mmol/L
- pre = 6.1 - 6.9 mmol/L
- diabetic = > 7 mmol/L

Question 9

Pre diabetic Treatment

Answer 9

Pre-diabetic -
- lifestyle changes,
- give ACE-i (ramipril) + statins (simvastatin) = treat htn
- antiplatelet therapy = aspirin, clopidogrel to reduce risk of stroke, MI

Question 10

Diabetic Treatment

Answer 10

Diabetic -
FIRST LINE = metformin (biguanide = increases preipheral sensitivity to insulin)
2. If HbA1c > 58 mmol/L (7.5%) = + SULFONYLUREA (glicazide = increase insulin secretion)
3. Persistantly high = third drug = DPP4 inhibitor (sitagliptin) or SGLT-2 inhibitor
4. last result = consider giving insulin