Type 2 Diabetes Flashcards
When is type 2 diabetes diagnosed?
Adulthood - early (rare < 25)
How likely is it that a person with type 2 diabetes will have a family history?
Frequent, around 30%
Describe the duration and severity of symptoms in type 2 diabetes?
Long duration (months-years) of mild symptoms
Will patients with type 2 diabetes present with complications?
Yes, this is likely
Is weight loss a feature of type 2 diabetes?
No
Do patients with type 2 diabetes usually have ketonuria?
Unlikely
In order for the pathophysiology of T2DM to occur, what must there be?
Genetic susceptibility
What is the simple explanation of T2DM?
The body makes insulin but the tissues don’t respond as well to it
At the beginning of Type 2 diabetes, the beta cells still produce insulin. What happens to this insulin?
It binds to its receptor, but in response to this the GLUT4 transporter is not moved to the cell membrane so no glucose can get into the cell
The process of the insulin binding with its receptor, but no transporter being moved to the cell surface is known as what?
Insulin resistance
In type 2, because the cells don’t respond to insulin, what must the body do?
Produce more insulin, in order to have the same effect a it did before
How do the beta cells produce more insulin in response to insulin resistance? How long does this last?
Beta cell hypertrophy/hyperplasia. This manages to compensate for a while but will eventually wear out.
What is the phase in type 2 diabetes where the beta cells undergo hyperplasia to keep producing more insulin known as?
Normoglycaemia (this compensation manages to keep the BG normal)
What happens when the act of beta cell hyperplasia/hypertrophy wears out?
The beta cells undergo hypotrophy and hypoplasia until they die off
What happens when the beta cells die in type 2?
Insulin decreases, so the blood glucose starts to rise, leading to similar clinical signs as type 1
In type 2 diabetes, there is generally still some circulating insulin when compared with type 1. What is the significance of this?
DKA is not likely to occur
When is the process of type 2 diabetes actually classed as diabetes?
When the beta cells begin to fail. (insulin resistance is not diabetes)
What are the 4 major determinants of type 2 diabetes risk?
Increased age, obesity, ethnicity and family history
Type 2 diabetes are associated with what variables which make up part of metabolic syndrome?
Central obesity, hypertension, hypertriglyceridaemia, low HDL
If an individual’s identical twin has type 2 diabetes, what is their chance of getting it?
> 50%
If an individual’s non-identical twin has type 2 diabetes, what is their chance of getting it?
25%
Is type 2 diabetes a monogenic or polygenic disease?
Polygenic
Why is low birth weight a risk factor for type 2 diabetes?
Poor nutrition early in life is said to impair beta cell development and function, pre-disposing to diabetes later in life
In terms of ethnicity, what populations are more at risk of type 2 diabetes?
Asian, African, Afro-Caribbean
In European individuals, what BMI implies an increased risk of diabetes?
> 25
In Asian individuals, what BMI implies an increased risk of diabetes?
> 19/20
In terms of macrovascular complications in type 2, how is CV risk best treated?
Statins and anti-hypertensives
In terms of control, what will help decrease the risk of complications of diabetes?
Tight glycaemic control and avoidance of hypoglycaemia
What types of type 2 drugs are insulin secretagogues?
Sulphonylureas, DDP-IV inhibitors and GLP-1 agonists
What is the normal first line drug?
Metformin
When should a sulphonylurea be used as the first line drug?
In underweight type 2’s or those intolerant of metformin
What is the normal second line drug, in addition to metformin?
Sulphonylurea
If there is a type 2 diabetic who is on metformin and requiring a second line drug but they are overweight and have a high CV risk, what could be used?
SGLT2 inhibitor
When should a thiozolinedione be used second line?
If hypoglycaemia is a concern, and there is no heart failure
When should a DDP-IV inhibitor be used second line?
If weight gain is a concern
What is the normal 3rd line drug?
Thiazolinediones
When should a DDP-IV inhibitor be used 3rd line?
If weight gain is a concern
When should a GLP-1 agonist be used 3rd line?
If BMI > 30
If there are osmotic symptoms and a rapidly rising HbA1c, what should be used as 3rd line treatment?
Insulin
What forms the foundation of type 2 diabetes treatment?
Diet, exercise and education
