Type 2 diabetes mellitus Flashcards
What is a hyperglycaemic clamp?
When you keep a patient in a steady state with infusions of glucose and insulin
What is the problem with HGO (Hepatic glucose output) in T2DM?
- Reduced insulin action causes less uptake of glucose into skeletal muscle
- HGO is also increased due to both a reduction in insulin action and increase in glucagon action
What is HGO production and glucose clearance like in T2DM people?
- Impaired insulin-mediated glucose disposal
- Excessive glucagon-mediated glucose output
What are the consequences of insulin resistance in:
-Liver
-Adipocytes
-Muscle
Liver: Increased HGO
Adipocytes: Increased fatty acid uptake from gut
Muscle: Less glucose uptake
What is monogenic diabetes?
-Single gene mutation that means you’re born with diabetes
What is the first line test for T2DM diagnosis?
HbA1c:
- 1x HbA1c above or equal 48 mmol/L with symptoms
- 2x HbA1c above or equal 48 mmol/L without symptoms
What drug can you use to decrease hepatic glucose output?
Metformin
What drugs can help increase insulin sensitivity?
- Metformin
- Thiazolidinediones
What do sulphonylureas e.g. gliclazide do?
- Boost insulin production of beta cells
- They bind to ATP-sensitive potassium channel and close it, independent of glucose/ATP, which needs to be done for insulin production
- They therefore bypass normal physiology to produce a lot of insulin