Type 2 Diabetes Flashcards
What is the definition of type 2 diabetes?
Peripheral insulin resistance with partial insulin deficiency (CHO/lipid/b amyloid deposits in pancreas)
Who are at risk of T2DM?
40+, males (south Asian)
What causes T2DM?
Reduced insulin secretion +/- increased insulin resistance
Gestational diabetes, steroids, Cushings, chronic pancreatitis
What are some risk factors of T2DM?
Lifestyle: obesity, lack of exercise, smoking, alcohol excess, hypertension
Late onset
What is the pathology of T2DM?
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
What are some signs and symptoms of T2DM?
Central obesity
Hypertensive
Older patient with polydipsia, polyuria (+ nocturia), glycosuria
Slower onset, blurred vision
Ancanthosis nigricans = dark pigmented skin folds - severe insulin deficiency
What tests would you do to diagnose someone with T2DM?
Same as T1DM
FPG, RPG, HbA1C
What are the pre diabetic states? And tests?
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
What are the normal, pre diabetic and diabetic ranges for OGTT and FPG?
OGTT:
Normal = <7.8
Prediabetic = 7.8 - 11
Diabetic = 11<
FPG:
Normal = <6
Prediabetes = 6.1 - 6.9
Diabetes = >7
What is the treatment for prediabetes?
1st line management: Lifestyle changes
Diet, exercise, decreased alcohol and smoking, regular HbA1C monitoring
What is the treatment for diabetes?
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
What do SGLT-2 inhibitors do?
Side effects?
Inhibit reabsorption of glucose in kidneys therefore increased excreted
Side effects: euglycaemia, ketoacidosis, thrush
Why are Thiazolidinediones rarely used?
Increased weight, risk of heart failure and risk of fracture
What is MODY?
Who does it effect?
Maturity onset diabetes of youths
Rate auto dominant T2DM presentation in young patient
Treatment= Sulfonylureas