Type 2 diabetes Flashcards
What is the pathophysiology of Type 2 DM?
Genetic predisposition and Obesity lifestyle factors lead to:
INsulin resistance
-Compensatory beta cell hyperplasia (Normoglycemia)
Beta cell failure - Impaired glucose tolerance
Beta cell failure - Diabetes
Primary beta cell failure
What is the ominous octet?
Decreased insulin secretion Increased lipolysis Increased glucose reabsorption Decreased glucose uptake Neurotransmitter dysfunction Increased hepatic glucose production Increased glucagon secretuin Decreased incretin effect
which gender has an increased risk of diabetes?
Females
What are the 3 factors important in T2DM development?
Susceptibilty
Adaptation
Failure
What is strongly associated with the development of macrovascular complications?
Insulin resistance
How is CVD risk treated?
Statins/Anti-hypertensives
What does chronic hyperglycemia lead to?
Microvascular disease
What other condition has insulin resistance?
PCOS
If a patient is symptomatic what can be diagnostic?
One test (RBG>11.1)
What is the relationship between insulin secretion and sensititvity?
As Secretion decreases, senstivity increases
What is the mechanism of metformin?
Decreased hepatic gluconeogenesis
Increased peripheral glucose uptakes
What does metaformin do?
Decreased HbA1C
Weight neutral
No hypoglycaemic when monotherapy
Decreased Ca and CHD risk
What are some side effects of metformin?
GI
Lactic acidosis
what is the target for HBA1C?
48-53mol/mol
What factors lead to failure to reach glycaemic targets?
Younger Female Obese Not at BP or lipid targets More complex glucose lowering therapties Poor compliance with meds, lifestyle etc
Sign guidlines for diabetes?
Metformin/Sulphonylurea if MF intolerant - Weight loss
Sulphonylurea - Thiazide diuretic if hypoglycemic, DPPIV if Weight gain
TZD, DPPIV, INsulin, GLP-1
What is the mechanism of sulphonylurea?
Blocks beta cell Katp channel
Increase insulin secretion
What does sulphonylurea do to diabetes?
Decreased HBA1C
Increased Weight gain
Increased Hypoglycaemia
What are the adverse affects of sulphonylurea?
Abnormal LFTs
Increased CHD
What is the mechanism of Glitazone?
PPARgamma activator
Increased peripheral glucose uptake
What is the outcome of glitazone?
Decreased Hba1c
Increased weight gain
What are the adverse effects of glitazone?
Increased fracture risk 2-3x
Hepatotoxicity
Fluid retention
