Type 2 Diabetes Mellitus Flashcards
define T2DM
A chronic metabolic disorder characterised by the impaired secretion and resistance of insulin, resulting in elevated blood glucose levels.
what happens to the cells in T2DM?
Cells, especially in muscle, liver, and adipose tissue, become less responsive to insulin, reducing glucose uptake.
what does the pancreas do in response to the cells not responding to insulin in T2DM?
Initially, the pancreas compensates by producing more insulin. Over time, beta cells may become impaired, leading to inadequate insulin response.
What is the livers role in producing T2DM?
The liver may contribute to hyperglycaemia by producing excessive glucose due to disrupted insulin regulation.
what are three other factors that could effect insulin sensitivity?
Hormonal Imbalances: Adipose tissue releases substances affecting insulin sensitivity, especially in obesity.
Genetic Factors: Certain genetic variations contribute to insulin sensitivity and beta cell function.
Lifestyle Factors: Sedentary behaviour, poor diet, and excess body weight, particularly abdominal obesity, significantly contribute to insulin resistance and type 2 diabetes.
what are the symptoms of T2DM?
-Excessive Tiredness
-Excessive Urination
-Weight Loss
-Slow Wound Healing
-Excessive Thirst
-Repeated Infections
what are the signs of T2DM?
-Polyuria*
-Polydipsia*
-Glycosuria
-Acanthosis nigricans (thickening and -darkening of skin)
-Glove and stocking sensory loss
-Diabetic retinopathy
-Diabetic foot disease
what is the FBG range for prediabetes?
6.1-6.9 mmol/l
what is the post prandial (food) range for prediabetes?
7.8-11.0 mmol/l
what is thE Hb1Ac range for prediabetes?
42-47 mmol/l
what is the epidemiology for T2DM?
-Presents later in life (30+ years)
-Males > females
- People of Asian, African and Afro-Caribbean ethnicity are 2-4x more likely to develop T2DM than white people
what is the random blood/plasma glucose levels needed for a diagnosis of T2DM?
> 11.1mmol/l
what is the fasting blood/plasma glucose levels needed for a diagnosis of T2DM?
> 7mmol/l
what is the Hb1Ac level needed for a diagnosis of T2DM?
> 48mmol/mol
how many abnormal readings do you need for a diagnosis of T2DM?
In symptomatic patients, one abnormal result will do.
In asymptomatic patients, you need two abnormal readings on two different days.
what is the treatment for pre diabetes?
Lifestyle change; diet, exercise, etc.
what is the first line of treatment for T2DM?
metformin
what is the second line of treatment for T2DM?
Continue metformin and add one of:
- DPP-4 inhibitor
-Pioglitazone
-Sulfonylurea
-GLT-2 inhibitor
what is the third line of treatment for T2DM?
Add another medication from the above list.
what is the last resort of treatment for T2DM?
Insulin Therapy (see T1DM)
how is T2DM managed?
-Structured education programme
-Low-glycaemic index, high-fibre diet
-Exercise
-Weight loss (if overweight)
-Monitoring and managing complications
-Becoming more active (eliminating sedentary habits)
what are the non modifiable risk factors for T2DM?
-Age
-Ethnicity
-Family History (more so compared to T1DM)
What are the modifiable risk factors for T2DM?
-Obesity
-Sedentary Lifestyle
-High-carb diet (particularly sugar
what are the complications that may arise from T2DM?
-Diabetic Retinopathy
-Peripheral Neuropathy
-Diabetic Nephropathy
-Gastroparesis
-Hyperosmolar Hyperglycaemic State
-Chronic Kidney Disease
what are the possible complications of Biguanides (Metformin)?
Lactic Acidosis and Diarrhoea
what are the possible complications of DPP-4 Inhibitors (Sitagliptin)?
Should be used cautiously in patients with a history of pancreatitis.
what are the possible complications of Thiazolidinediones (Pioglitazone)?
Heart failure, Weight Gain, Hepatic Impairment, and increased risk of fractures
what are the possible complications of SGLT-2 Inhibitor (Dapagliflozin)?
Genital mycotic infections, UTI’s
what are the possible complications of Sulfonylureas (Gliclazide)?
Severe hypoglycaemia and Weight Gain.
what are the possible complications of GLP1 Analogues (Exenatide) ?
Weight Loss and should be used cautiously in patients with a history of pancreatitis and severe renal impairment.
