Type 2 Diabetes

Question 1

Type 2 Diabetes

Answer 1

multi-system disease related to abnormal insulin production and/or impaired insulin utilization.

Question 2

Causes of Type 2 Diabetes

Answer 2

obesity - most common
genetic mutations - that lead to insulin resistance or increase risk of obesity
metabolic syndrome - hypertension, dyslipidemia, insulin resistance

Question 3

Diabetes Patho

Answer 3

insulin resistance - body tissues do not respond to insulin.
pancreas decreased ability to produce insulin - B cells fatigued from compensating.
inappropriate glucose production from the liver.
alterations in production of hormones and adipokines.

Question 4

Diabetes CM

Answer 4

asymptomatic in early phases - recommended high risk individuals are screened regularly.
fatigue, recurrente infection, reoccurent vaginal yeast, prolonged wound healing, visual changes.

Question 5

A1c dx

Answer 5

Recommended - shows the amount of glucose attached to hemoglobin molecules over RBC lifespan (120 days).
dx is >6.5%

Question 6

Other dx for diabetes

Answer 6

fasting plasma glucose level >7mmol/L.
random or casual plasma glucose measurement >11.1 plus classic symptoms.
2 hour oral glucose tolerance test level >11.1 when a glucose load of 75g is used.

Question 7

Medication Therapy 3 defects that they work on

Answer 7

insulin resistance
decreased insulin production
increased hepatic glucose production

Question 8

Sulphonylureas

Answer 8

increase insulin production from pancreas.
decrease chance of prolonged hypoglycaemia.

Question 9

Meglitinides

Answer 9

increase insulin production from pancreas.
taken 30mins before each meal, do not take if meal skipped.

Question 10

Biguanides

Answer 10

reduce glucose production by liver.
enhances insulin sensitivity at tissues.
do not promote weight gain.
GI upset common side effects.
E.g. metformin

Question 11

Metformin accumulation

Answer 11

can cause lactic acidosis (serious complication)
alcohol is not advised as it increases the risk for lactic acidosis.
ongoing monitoring required.

Question 12

Thiazolidinediones

Answer 12

most effective in people with insulin resistance

Question 13

DDP-4 inhibitor

Answer 13

slows inactivation of incretin hormones.
potential for hypoglycaemia

Question 14

GLP -1 receptor agonists

Answer 14

stimulate release of insulin from B cells
synthetic peptide

Question 15

Benefits of Exercise

Answer 15

increase insulin sensitivity
lowers blood glucose levels
contributes to weight loss
several small carb snacks can be taken every 30 mins during exercise to prevent hypoglycaemia.

Question 16

Acute Complications

Answer 16

hyperosmolar hyperglycemic syndrome (HHS) - life threatening syndrome. often occurs in older people. nuerological manifestations occur because of increased serum osmolality

Question 17

Chronic Complications

Answer 17

stroke, hypertension, dermopathy, atheroschlerosis, nephropathy, islet cell loss, gastroparesis, CAD,

Question 18

Angiopathy: Macrovascular

Answer 18

chronic complication. disease of large and medium sized blood vessels. leading cause of diabetes death.
development promoted by altered lip metabolism (screen for dyslipidemia).
tight glucose control may delay the atherosclerotic process.