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Year 2 Medicine > Type 2 Diabetes Mellitus > Flashcards

Type 2 Diabetes Mellitus Flashcards

1
Q
  • Is T2 Diabetes common?
  • Is it serious?
A
  • Yes - common
  • very serious problem
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2
Q

Lifetime cost of diabetes in USA is … billion

A

815 billion dollars

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3
Q

What is diabetes mellitus?

A

A condition where the blood glucose is above an internationally accepted level

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4
Q

Diabetes - Diagnostic terms: Usual clinical diagnosis:

  • ​Blood:
    • Glucose = or > … mmol/l + symptoms
    • Glucose = or > …mmol/l x 2
    • HbA1c = or > 48 mmol/mol (…%)
      • Lower value does not exclude diabetes
A
  • Glucose = or > 11.1 mmol/l + symptoms
  • Glucose = or > 11.1 mmol/l x 2
  • HbA1c = or > 48 mmol/mol (6.5%)
    • Lower value does not exclude diabetes
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5
Q

Diabetes - Diagnostic terms: 75 Glucose Tolerance Test

  • Diabetes Mellitus:
    • Fasting plasma glucose = / > … mmol/l
    • 2 hour plasma glucose = / > … mmol/l
  • Impaired glucose tolerance
    • 2 hour glucose between …-… mmol/l
  • Impaired fasting glucose
    • fasting glucose between …-… mmol/l
A
  • Diabetes Mellitus:
    • Fasting plasma glucose = / > 7 mmol/l
    • 2 hour plasma glucose = / > 11.1 mmol/l
  • Impaired glucose tolerance
    • 2 hour glucose between 7-11 mmol/l
  • Impaired fasting glucose
    • fasting glucose between 6-6.9mmol/l
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6
Q

What is the gold standard test for diabetes?

A

75g Glucose Tolerance test

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7
Q

What exactly is Type 2 diabetes?

  • “A … condition where there is a … cells abnormality resulting in insuffient … to keep the … … normal in the context of … resistance”
A

“A common condition where there is a Beta cells abnormality resulting in insuffient insulin to keep the blood glucose normal in the context of insulin resistance”

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8
Q

What cells are in the pancreas? (shown on histological slide)

A

Islet cells

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9
Q

In the picture the islet cells are stained, what condition does this happen in?

A

T2 diabetes

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10
Q

Cause of B cell problems in Type 2 diabetes

  • Genetics
    • … (+ / - 60 genes)
  • … programming (epigenetics)
    • maternal hyper…
    • intrauterine growth …
A
  • Genetics
    • polygenic (+ / - 60 genes)
  • Fetal programming (epigenetics)
    • maternal hyperglycaemia
    • intrauterine growth retardation
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11
Q

Type 2 diabetes is seen in a high percentage of …

A

identical twins

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12
Q

Other possible aetiological factors of Type 2 diabetes include… (3)

A
  • old age
  • change in the gut microbiota
  • glucotoxicity and lipotoxicity (later effects)
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13
Q

What is this showing? (what condition)

A

Type 2 diabetes

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14
Q

Why are people insulin resistant?

  • relates to …
  • Many years of coping to deal with …
  • Now, we have plenty of … available
A
  • relates to obesity
  • Many years of coping to deal with famine
  • Now, we have plenty of calories and food sources available
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15
Q
  • Fat in the … laid down as it should be = no harm
  • If it spills out (‘run out of room’) it spills and becomes … fat
A
  • Fat in the buttocks laid down as it should be = no harm
  • If it spills out (‘run out of room’) it spills and becomes visceral fat
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16
Q

… fat is a strong risk factor for vascular disease

A

epicardial fat is a strong risk factor for vascular disease

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17
Q

Excess fat in the diabetic … is specific to type … diabates and important in preventing normal … production

A

Excess fat in the diabetic pancreas is specific to type 2 diabates and important in preventing normal insulin production

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18
Q

Ectopic fat - a problem

  • It is acting like an … organ producing
    • free … …
      • causing … resistance
      • … lipids
    • cytokines
      • causing … resistance
      • pro … situation
    • pro… factors (PAI1)
A
  • It is acting like an endocrine organ producing
    • free fatty acids
      • insulin resistance
      • atherogenic lipids
    • cytokines
      • insulin resistance
      • pro inflammatory situation
    • procoagulant factors (PAI1)
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19
Q

This shows the problems caused by what type of fat?

A

ectopic fat

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20
Q

Study - looking at CVS disease - 3 patients

  • P1 - Individual of normal body weight - not much visceral. CVS issues at follow up?
  • P2 - Lots of non visceral fat - fat in places designed to be lad down (some visceral fat) CVS issues at follow up?
  • P3 - lots of visceral fat - (also ectopic fat in abdomen) - also fat around muscle - CVS issues at follow up?
A
  • P1 - Individual of normal body weight - not much visceral. CVS issues at follow up? - no
  • P2 - Lots of non visceral fat - fat in places designed to be lad down (some visceral fat) CVS issues at follow up? - no
  • P3 - lots of visceral fat (ectopic fat in abdomen) - also fat around muscle - CVS issues at follow up? - yes - risk of developing hypoglycaemia because of their insulin resistance and this also compounds the whole situation
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21
Q

This graph shows people with … syndrome vs people without it

A

metabolic syndrome

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22
Q

Metabolic syndrome: other associations

  • Fatty liver disease with …
  • Hepatocellular carcinoma and intrahepatic cholangiocarcinoma
  • Chronic … disease
  • Polycystic … …
  • …-disordered breathing
  • Hyperuricemia and g…
  • An increased risk of … decline and …
A
  • Fatty liver disease with steatosis
  • Hepatocellular carcinoma and intrahepatic cholangiocarcinoma
  • Chronic kidney disease
  • PCOS - polycystic ovarian syndrome
  • Sleep-disordered breathing
  • Hyperuricemia and gout
  • An increased risk of cognitive decline and dementia
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23
Q

Diagnosis of metabolic syndrome and insulin resistance

  • Important physical sign is what?
  • How do we measure it?
A

Important physical sign is what? - substantial abdominal obesity - measure and record via waist circumference

24
Q

Type 2 diabetes - UK prevalence 2017 (Diabetes UK)

  • … million persons + … million at risk
A

4.6 million persons + 12.3 million at risk

25
Q

Adult obesity in england - risen from …% in 1993 to …% in 2016

A

Adult obesity in england - risen from 15% in 1993 to 26% in 2016

26
Q

The age group most likely to be overweight or obese is age …-…, but only by a small margin

A

The age group most likely to be overweight or obese is age 55-64 but only by a small margin

27
Q

Prevalence of overweight and obesity: (20 march 2018)

  • above …% among from 45 upwards
A

above 70% among from 45 upwards

28
Q

What is this graph showing? (increasing … in young people)

A

What is this graph showing? (increasing obesity in young people)

29
Q

Nurses health study (JCEM 2002 87:2784) - Diabetes

  • …% Type 2 diabetes attributed to …
    • BMI > …
    • Lack of …
    • … diet
A
  • 96% Type 2 diabetes attributed to …
    • BMI > 23
    • Lack of exercise
    • Unhealthy diet
30
Q

Type 2 diabetes is not “… diabetes” it’s “… …” diabetes

A

Type 2 diabetes is not “mild diabetes” it’s “very bad” diabetes

31
Q

Type 2 diabetes - what’s the problem?

  • … side effects / morbidity related
    • …glucaemia per se
    • Dysregulation of Lipid …
    • High levels of … cytokines
    • High levels of Free …
    • Increased susceptibility to …
A
  • Serious side effects / morbidity related
    • Hyperglycaemia per se
    • Dysregulation of Lipid Metabolism
    • High levels of proinflammatory cytokines
    • High levels of Free radicals
    • Increased susceptibility to infections
32
Q

Microvascular damage to small blood vessels in the eye and the retina - leading to haemorrhages and exudate - macula - enables you to see clearly - if these get into centre person may lose vision

  • What condition may this happen in?
  • Why does this happen?
A
  • What condition may this happen in? - Type 2 diabetes
  • Why does this happen? - blood glucose too high for too long
33
Q
  • … shown in the image are much more common in individuals with …
  • There is an increased generation of polyols from …
  • 1% reduction in … reduces … risk by 19%
A
  • Cataracts - common in diabetes
  • There is an increased generation of polyols from glucose
  • 1% reduction in HBA1c reduces cataract risk by 19%
34
Q
  • Renal disease in type … diabetes
  • result of blood glucose being …
A
  • Renal disease in type 2 diabetes
  • result of blood glucose being too high for too long
35
Q

Another tissue which is damaged in T2 diabetes is the … - longest ones suffer most - these are where? what develops? Do you notice it easily?

A
  • Another tissue which is damaged in T2 diabetes are the nerves - longest ones suffer most - in the feet
  • develop neuropathic ulcer
  • dont always notice it
36
Q

Another problem with blood sugar being too high for too long in T2 diabetes is … of connective tissue

A

Another problem with blood sugar being too high for too long in T2 diabetes is glucosylation of connective tissue

37
Q

Bone in T2 diabetes

  • Mechanically …
  • increased fractures x …
    • in spite of normal bone …
A
  • Mechanically weaker
  • increased fractures x 2
    • in spite of normal bone density
38
Q

Treatment of hyperglycaemia reduces … disease

A

microvascular disease

39
Q

Treatment of hyperglycaemia reduces larger blood vessel diseases such as …. and …. by a much smaller amount

A

Treatment of hyperglycaemia reduces larger blood vessel diseases such as stroke and myocardial infarction by a much smaller amount

40
Q

The major cause of death of people with T2 diabetes is what?

A

heart attacks

41
Q

Type 2 diabetes - UKPDS study - prevention of complications

  • Long term follow up showed that good glycemic control reduces both … and …. complications
A

micro and macrovascular complications reduced

42
Q

Why do people with T2 diabetes have heart attacks?

  • Many people with diabetes have a lot of these inflammatory type …. particles circulating (more than those with normal BG)
  • ‘Bad’ cholesterol (called …) - when you glycosalate it - with high BG this happens - becomes more …genic and pro-…
  • Good cholesterol - known as … - is lower in these individuals
A
  • Many people with diabetes have a lot of these inflammaotry type lipoprotein particles circulating (more than those with normal BG)
  • Low density lipoprotein‘bad’ cholesterol - glycosalate - with high BG this happens - becomes more atherogenic and pro-inflammatory
  • ‘Good’ cholesterol - HDL - lower in these individuals
43
Q

Atherosclerotic lesion - how does a MI happen?

  • … plaque - if stable what happens?
  • If you have pro-inflammatory like proteins and other inflammatory substances being produced by the … fat - inflammatory reaction inside the plaque - dissolves the cap - pro inflammatory material leaks into … … causing blood …
  • How do we fix this?
A
  • atheromatous plaque - if stable what happens? - not much
  • If you have pro-inflammatory like proteins and other inflammatory substances being produced by the ectopic fat - inflammatory reaction inside the plaque - dissolves the cap - nasty pro inflammatory material leaks into coronary artery causing blood clot
  • Give clot blusters - restore blood flow and prevent MI
45
Q

Large blood vessels in feet are affected by pro-inflammatory process (in T2 Diabetes)

  • What disease?
A

What disease? - Peripheral vascular disease

46
Q

Type 2 Diabetes - what to do?

  • … the diabetes
  • Improve the …
  • Reduce the CVS risk factors (which are… 4)
  • … for complication + … early
A
  • Prevent the diabetes
  • Improve the hyperglycaemia
  • Reduce the CVS risk factors (which are… 4)
    • Dyslipemia
    • Hypertension
    • Smoking
    • Obesity
  • Screen for complication + treat early
47
Q

Treating Type 2 diabetes - Stage 1 is changing peoples …

  • How?
A

Treating Type 2 diabetes - Stage 1 is changing peoples lifestyle

  • Via diet (less food, more healthy food), exercise (walk dog etc)
48
Q

Telling Diabetes patients to eat better and exercise is not enough - what has been developed to support them?

A
  • Diabetes eduaction programmes e.g. Desmond
49
Q

Type 2 Diabetes & Macrovascular Disease

  • Prevention / Treatment
    • Lifestyle manouvres (3 things, which are …)
    • Treatment of … (3)
    • Use of … (drug)
      • if known, or very high risk for CAD
A
  • Prevention / Treatment
    • Lifestyle manouvres (3 things, which are diet/exercise/smoking)
    • Treatment of:
      • Dyslipaemia
        • with statins
      • Hypertension
      • Hyperglycemia
  • Use of aspirin (drug)
    • if known, or very high risk for CAD
50
Q

Type 2 diabetes - Screening to enable early treatment

  • Eyes:
    • … photography
    • … treatment when required
  • Kidneys:
    • Measure urine … (EMU)
      • Control Blood Pressure & …
      • … inhibitors & ARBs
    • Feet:
      • Screen for …pathy & … disease
A
  • Eyes:
    • Retinal photography
    • Laser treatment when required
  • Kidneys:
    • Measure urine albumin (EMU)
      • Control Blood Pressure & Glucose
      • ACE inhibitors & ARBs
    • Feet:
      • Screen for Neuropathy & Vascular disease
51
Q
  • What is this device for (left)? (Screening for…)
  • What about right device?
  • How often should we examine this area?
A
  • Microfilament - screen for Neuropathy (use on feet)
  • Right - feel pedal pulses - absent - check with handheld doppler - if absent pulses and peripheral vascular disease - at risk for ulcers and amputation - serious coronary artery disease
  • How often should we examine this area - feet examined once a year - avoid these issues
52
Q

Type 2 Diabetes - Goals

  • … modification
  • Screen for …
  • Special … for complications
    • check 3 things: (which parts of body?)
  • HbA1c … % (48-55 mmol/mol)
  • Blood pressure of around …-…/80
  • LDL
  • Non HDL cholesterol
A
  • Lifestyle modification
  • Screen for complications
  • Special clinics for complications
    • foot, renal, eye
  • HbA1c 6.5-7.5 % (48-55 mmol/mol)
  • BP 120-140/80
  • LDL <2.0 mmol/l
  • Non HDL cholesterol <2.78
53
Q

Treating Type 2 Diabetes

  • Pharmacological interventions
    • Reduce … resistance
    • Increase … production/ secretion
    • Provide … replacement
  • Metabolic/ Obesity …
    • Sleeve …
    • … en Y Bypass
    • … Band
A
  • Pharmacological interventions
    • Reduce Insulin resistance
    • Increase Insulin production/ secretion
    • Provide Insulin replacement
  • Metabolic/ Obesity Surgery
    • Sleeve Gastrectomy
    • Roux en Y Bypass
    • Gastric Band
54
Q

Treating Type 2 Diabetes - Goals must be tailored to the individual

  • Elderly
    • Less … treatment
    • Avoid …
  • … women
    • Tight control
A
  • Elderly
    • Less aggressive treatment
    • Avoid hypoglycaemia
  • Pregnant women
    • Tight conttrol
55
Q

Treating Type 2 Diabetes - Goals must be tailored to the individual - what particular groups of individuals (2)

A
  • Elderly
  • Pregnant women

Year 2 Medicine (162 decks)

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