Type 2 Diabetes Flashcards

1
Q

What is required to develop? Proportion of DM pts?

A

Insulin resistance AND decreased insulin secretion

T2DM accounts for 90% of DM patients, 5th leading cause of death in US

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2
Q

Insulin pathophys?

A

Insulin acts via P13K to ocnfer a metabolic signal (distinct from MAPK which is growth/mitogenic)
Insulin resistance disrupts this signal –> leads to lipolysis –> FFA released, trigger hepatic production of glcuose AND damage of beta cells –> HYPERGLYCEMIA

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3
Q

Glucagon dysfxn?

A

Yes - b/c alpha cells depend on beta cell secretion to regulate:
so decr insulin –> decr inhibition of glucagon secretion –> continued glucagon stimulation of liver glucose secretion –> HYPERGLYCEMIA

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4
Q

Incretin effect?

A

potentiates effect of insulin and suppresses glucagon

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5
Q

Diagnx/labs

A

NO evidence of beta cell autoimmunity
Fasting glucose >126 (on 2 occasion)
OGTT >200
HbA1c >6.5% on 2 occasions
Random blood sugar >200 AND symptoms of DM
FPIR (first insulin phase response) LOST completely (1st and 3rd minute following IV glucose with SECOND PAHSE NL OR EXAGGERATED
[50% of beta cells damaged at time of diagnx)

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6
Q

Risk factors

A

family hx, HTN, dyslipidemia
central obesity, gest diabetes, birth weight >9 lbs
SGA, ethnicity (AA, hispanic, native American, pacific islander)

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7
Q

Assoc genetics/co-morbidities

A

NO ASSOC WITH ANY HLA types
obesity, hyperlipidemia, polycystic ovary dz
fatty liver dz

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8
Q

Pres (when/who/sx)

A

Usually post puberty
Usually overweight/obese, and NO assoc with ketoacidosis
Sx: polyuria/nocturia/polydipsia, weight loss, blurry vision
50% HAVE POSITIVE FAMILY HX

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9
Q

Treatment

A

Diet and exercise, statins, anti-HTN
Oral agents: METFORMIN first line (2 meds if A1c is 8-10%)
USUALLY REQUIRE INSULIN AFTER ABOUT 10 YEARS OF DZ (OR WHEN A1C >10% WHICHEVER FIRST)
Aggressive management early can prevent or delay complications

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