Type 2 Diabetes Flashcards
What is type 2 diabetes?
A condition in which the combination of insulin resistance and beta-cell failure result in hyperglycaemia
What condition is associated with type 2 diabetes a lot?
Obesity
How is type 2 diabetes initially managed?
Lifestyle measures: diet changes and weight loss
Who typically presents with T2DM?
Usually late adulthood but can present in youth
What is a typical feature of T2DM?
Diabetic ketoacidosis
How much does T2DM reduce life expectancy?
A lot when you are younger but less as you get older
Where is T2DM most prevalent?
Ethnic groups that move from rural to urban lifestyle
What is the biggest contributory factor to developing T2DM?
Can be insulin resistance mainly, but beta cell failure contributes
What is fasting glucose for a diagnosis of diabetes?
> 7 mmol/L
What is HbA1c for a diagnosis of diabetes?
> 48 mmol/L
What is OGTT for a diagnosis of diabetes?
> 11 mmol/L
What is fasting glucose in the intermediate stage of diabetes development?
Greater than 6 but less than 7 mmol/L
What is OGTT in the intermediate stage of diabetes development?
Greater than 7.7 but less than 11 mmol/L
What is HbA1c in the intermediate stage of diabetes development?
Greater than 42 but less than 48 mmol/L
How does insulin resistance change as someone is developing diabetes?
It curves up and plateaus before diabetes has even been diagnosed
What are the 3 ways of diagnosing diabetes?
Fasting glucose
OGTT
Random glucose
What level do beta cells function at diagnosis of T2DM?
Around 50%
Does diabetic ketoacidosis occur in T2DM? Explain your answer
Not usually, there is a small amount of circulating insulin (not enough to overcome resistance), which is enough to suppress the synthesis of ketone bodies from the breakdown of fat
What is long duration type 2 diabetes? What feature of diabetes becomes more prominent once this develops?
Beta cell failure may progress to complete insulin deficiency (this is where diabetic ketoacidosis may occur)
Does T2DM have a genetic risk?
Yes
How can risk of T2DM be increased in utero?
Foetal growth retardation
How is beta cell function assessed?
Hyperglycaemic clamp
What is hyperglycaemic clamp?
Glucose levels are elevated, in normal people insulin will shoot up, fall and then steadily rise, with T2 diabetics there will be hardly any rise in insulin
When is hyperglycaemic clamp used?
To assess beta cell function
What happens to glucose uptake in skeletal muscles in T2DM?
Reduced uptake of glucose due to reduced insulin
What happens to hepatic glucose output in T2DM? How?
Increased due to reduced insulin action and increased glucagon action
What happens to insulin sensitivity when we put on weight (in normal people)?
Insulin becomes less sensitive so more is secreted
What happens in the liver, adipocytes and muscle when theres insulin resistance?
Liver: less glycogen synthesis and greater hepatic glucose output
Adipocytes: less glucose uptake, less triglyceride synthesis
Muscle: less glucose uptake
What happens to inflammatory adipokines in T2DM?
Levels are high
Is T2DM monogenic or polygenic?
Polygenic- you have a higher risk depending on your genetic makeup
Is MODY monogenic or polygenic?
Monogenic
What type of adiposity increases T2DM risk most?
Visceral adiposity increases risk a lot more than central
How does T2DM present?
Hyperglycaemia Overweight Dyslipidaemia Fewer osmotic symptoms With complications Insulin resistance Later insulin deficiency
What are risk factors for T2DM?
Age High BMI Ethnicity PCOS Family history
What is the first line test for the diagnosis of type 2 diabetes?
HbA1c
When will random glucose work as a diagnostic test?
If there are symptoms
How is HbA1c used as a diagnostic test?
If symptomatic 1 test can confirm diagnosis
If asymptomatic, 2 positive tests confirm diagnosis
What is hyperosmolar hyperglycaemic state? What does it commonly present with?
Presents commonly with renal failure. Insufficient insulin (NOT ABSENT) for prevention of hyperglycemia but sufficient insulin for suppression of lipolysis and ketogenesis. Absence of significant acidosis.
How is type 2 managed?
Diet Oral medication Structured education May need insulin later Remission / reversal
How does a T2DM consultation go?
Glycaemia: HbA1c, glucose monitoring if on insulin, medication review
Weight assessment
Blood pressure
Dyslipidaemia: cholesterol profile
Screening for complications: foot check, retinal screening
What dietary changes are recommended in T2DM?
Total calories control Reduce calories as fat Reduce calories as refined carbohydrate Increase calories as complex carbohydrate Increase soluble fibre Decrease sodium
What drug is given to reduce hepatic glucose production?
Metformin
What drug is given to improve insulin sensitivity?
Metformin
Thiozolidinediones
What drug is given to boost insulin secretion?
Sulphonylureas
DPP4-inhibitors
GLP-1 Agonists
What drug is given to inhibit carb absorption in gut and inhibit renal glucose absorption?
Alpha glucosidase inhibitor
SGLT-2 inhibitor (renal)
What is the first line drug is lifestayle changes have no effect?
Metformin
How do sulphonyureas work?
Bing to ATP sensitive K+ channel and close it independant to glucose so insulin production is boosted
How does pioglitazone wrk? What is a side effect?
Modifies insulin sensitivity but can cause weight gain
How does metformin effect weight?
Lowers it
How does GLP-1 work?
Stimulates insulin and supresses glucagon
What is the incretin effect?
Oral glucose increases insulin almost double as much as intravenous glucose
How do DPP-4 inhibitors work?
Inhibits DPP-4 enzyme which metabolises GLP-1
How do SGLT-2 inhibitors work?
Encourages urinary glucose excretion
Do drugs work for diabetes?
Yes but eventually insulin will be needed and beta cell function will always decline
What surgery can remit diabetes?
Gastric bypass surgery
What lifestyle change can remit diabetes?
Very low calorie diet (800-900 cals a day) for 3-6 months
