Type 2 Diabetes Flashcards

1
Q

What is the definition of type 2 diabetes?

A

Peripheral insulin resistance with partial insulin deficiency (CHO/lipid/b amyloid deposits in pancreas)

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2
Q

Who are at risk of T2DM?

A

40+, males (south Asian)

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3
Q

What causes T2DM?

A

Reduced insulin secretion +/- increased insulin resistance
Gestational diabetes, steroids, Cushings, chronic pancreatitis

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4
Q

What are some risk factors of T2DM?

A

Lifestyle: obesity, lack of exercise, smoking, alcohol excess, hypertension
Late onset

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5
Q

What is the pathology of T2DM?

A

Peripheral insulin resistance (eg. Malfunctional insulin extracellular activation pathway)

Therefore decreased GLUT4 expression + minor destruction to pancreatic islets (amyloid + CHO/lipid)

Result= hyperglycemia with increased insulin demand from a depleted B cell population

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6
Q

What are some signs and symptoms of T2DM?

A

Central obesity
Hypertensive
Older patient with polydipsia, polyuria (+ nocturia), glycosuria
Slower onset, blurred vision

Ancanthosis nigricans = dark pigmented skin folds - severe insulin deficiency

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7
Q

What tests would you do to diagnose someone with T2DM?

A

Same as T1DM
FPG, RPG, HbA1C

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8
Q

What are the pre diabetic states? And tests?

A

Impaired glucose tolerance (IGT)
normal FPG <6 mmol/L + 2 hour OGTT (75g): 7.8 - 11.1

Impaired fasting glycaemia (IFG)
FPG: 6.1 - 6.9 mmol/L
2h OGTT (75g) <7.8

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9
Q

What are the normal, pre diabetic and diabetic ranges for OGTT and FPG?

A

OGTT:
Normal = <7.8
Prediabetic = 7.8 - 11
Diabetic = 11<

FPG:
Normal = <6
Prediabetes = 6.1 - 6.9
Diabetes = >7

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10
Q

What is the treatment for prediabetes?

A

1st line management: Lifestyle changes
Diet, exercise, decreased alcohol and smoking, regular HbA1C monitoring

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11
Q

What is the treatment for diabetes?

A

2nd line management- medications
1. Metformin (biguanide - increase insulin sensitivity)
2. Dual therapy - SGLT-2 inhibitor, GLP1 analogues or DPP4-i
3. Triple therapy -sulphonylureas (glicazide) - increase insulin secretion
4. Last resort - insulin

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12
Q

What do SGLT-2 inhibitors do?
Side effects?

A

Inhibit reabsorption of glucose in kidneys therefore increased excreted

Side effects: euglycaemia, ketoacidosis, thrush

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13
Q

Why are Thiazolidinediones rarely used?

A

Increased weight, risk of heart failure and risk of fracture

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14
Q

What is MODY?
Who does it effect?

A

Maturity onset diabetes of youths
Rate auto dominant T2DM presentation in young patient
Treatment= Sulfonylureas

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