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Rakeem's Endocrinology > Type 2 Diabetes Mellitus > Flashcards

Type 2 Diabetes Mellitus Flashcards

1
Q

define T2DM

A

A chronic metabolic disorder characterised by the impaired secretion and resistance of insulin, resulting in elevated blood glucose levels.

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2
Q

what happens to the cells in T2DM?

A

Cells, especially in muscle, liver, and adipose tissue, become less responsive to insulin, reducing glucose uptake.

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3
Q

what does the pancreas do in response to the cells not responding to insulin in T2DM?

A

Initially, the pancreas compensates by producing more insulin. Over time, beta cells may become impaired, leading to inadequate insulin response.

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4
Q

What is the livers role in producing T2DM?

A

The liver may contribute to hyperglycaemia by producing excessive glucose due to disrupted insulin regulation.

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5
Q

what are three other factors that could effect insulin sensitivity?

A

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.

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6
Q

what are the symptoms of T2DM?

A

-Excessive Tiredness
-Excessive Urination
-Weight Loss
-Slow Wound Healing
-Excessive Thirst
-Repeated Infections

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7
Q

what are the signs of T2DM?

A

-Polyuria*
-Polydipsia*
-Glycosuria
-Acanthosis nigricans (thickening and -darkening of skin)
-Glove and stocking sensory loss
-Diabetic retinopathy
-Diabetic foot disease

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8
Q

what is the FBG range for prediabetes?

A

6.1-6.9 mmol/l

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9
Q

what is the post prandial (food) range for prediabetes?

A

7.8-11.0 mmol/l

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10
Q

what is thE Hb1Ac range for prediabetes?

A

42-47 mmol/l

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11
Q

what is the epidemiology for T2DM?

A

-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

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12
Q

what is the random blood/plasma glucose levels needed for a diagnosis of T2DM?

A

> 11.1mmol/l

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13
Q

what is the fasting blood/plasma glucose levels needed for a diagnosis of T2DM?

A

> 7mmol/l

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14
Q

what is the Hb1Ac level needed for a diagnosis of T2DM?

A

> 48mmol/mol

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15
Q

how many abnormal readings do you need for a diagnosis of T2DM?

A

In symptomatic patients, one abnormal result will do.

In asymptomatic patients, you need two abnormal readings on two different days.

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16
Q

what is the treatment for pre diabetes?

A

Lifestyle change; diet, exercise, etc.

17
Q

what is the first line of treatment for T2DM?

A

metformin

18
Q

what is the second line of treatment for T2DM?

A

Continue metformin and add one of:
- DPP-4 inhibitor
-Pioglitazone
-Sulfonylurea
-GLT-2 inhibitor

19
Q

what is the third line of treatment for T2DM?

A

Add another medication from the above list.

20
Q

what is the last resort of treatment for T2DM?

A

Insulin Therapy (see T1DM)

21
Q

how is T2DM managed?

A

-Structured education programme
-Low-glycaemic index, high-fibre diet
-Exercise
-Weight loss (if overweight)
-Monitoring and managing complications
-Becoming more active (eliminating sedentary habits)

22
Q

what are the non modifiable risk factors for T2DM?

A

-Age
-Ethnicity
-Family History (more so compared to T1DM)

23
Q

What are the modifiable risk factors for T2DM?

A

-Obesity
-Sedentary Lifestyle
-High-carb diet (particularly sugar

24
Q

what are the complications that may arise from T2DM?

A

-Diabetic Retinopathy
-Peripheral Neuropathy
-Diabetic Nephropathy
-Gastroparesis
-Hyperosmolar Hyperglycaemic State
-Chronic Kidney Disease

25
Q

what are the possible complications of Biguanides (Metformin)?

A

Lactic Acidosis and Diarrhoea

26
Q

what are the possible complications of DPP-4 Inhibitors (Sitagliptin)?

A

Should be used cautiously in patients with a history of pancreatitis.

27
Q

what are the possible complications of Thiazolidinediones (Pioglitazone)?

A

Heart failure, Weight Gain, Hepatic Impairment, and increased risk of fractures

28
Q

what are the possible complications of SGLT-2 Inhibitor (Dapagliflozin)?

A

Genital mycotic infections, UTI’s

29
Q

what are the possible complications of Sulfonylureas (Gliclazide)?

A

Severe hypoglycaemia and Weight Gain.

30
Q

what are the possible complications of GLP1 Analogues (Exenatide) ?

A

Weight Loss and should be used cautiously in patients with a history of pancreatitis and severe renal impairment.

Rakeem's Endocrinology (23 decks)

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