Type 2 diabetes mellitus Flashcards
Recall the defining values of T2DM
1. Fasting glucose: Impaired = 6-7 Diabetes = >7 2. GTT Impaired = 7.8-11.1 Diabetes = >11.1
Recall 4 risk factors for T2DM
- Genetics (greater genetic component than T1DM)
- Low birth weight
- South asian ethnicity
- Gut microbiota
Describe how the gut microbiota can affect diabetes risk
GM responsible for lipopolysaccharide fermentation to FAs
FAs modulate bile acids in circulation –> modulate host metabolism
Recall the inheritance of MODY
autosomal dominant (rare)
What molecules modulate insulin resistance
adipocytokines
What are the 2 main effects of elevated adipocytokine levels
dyslipidaemia and mitogenic pathway stimulation
Recall the 2 main effects of the mitogenic pathway
SMC hypertrophy
Increased BP
What is the first functional loss experienced in T2DM
Loss of phase 1 insulin
Why is atheroma more prevalent in T2DM patients
FAs that enter liver cannot be used as substrates for GNG and so are used in vLDL production –> atherogenic
What % of T2DM patients are obese?
80%
What are the 4 main principals of T2DM treatment?
Education
Diet
Complication screening
Pharmacological treatment
Recall the 5 main pharmacological treatments for tackling T2DM
- Metformin
- Sulphonylureas
- GLP-1 analogues/ gliptins
- Alpha-glucosidase inhibitors
- PPAR agonists
Recall the mechanism of action of metformin
Biguanide
Insulin-sensitiser
Recall 3 contra-indications for metformin
Liver, cardiac, RENAL failure
Recall the mechanism of action of sulphonylureas
Block ATP-sensitive K+ channel in beta cells - makes pancreas secrete more insulin
Give an example of a sulphonylurea drug and one side effect
Glibenclamide - weight gain
Recall the mechanism of action of alpha-glucosidase inhibitors and one side effect
Delay glucose absorption - side effect = flatus
Recall the mechanism of action of PPAG agonists
Act on adipocytes to address insulin resistance in fat and muscle
What does PPAR agonist stand for?
Peroxisome proliferator-activated receptor agonist
Recall the mechanism of action of GLP-1 receptor agonists
Incretin effect to increase satiety - modified to increase half-life compared to GLP-1
By what enzyme is GLP1 broken down?
DPPG4
What are gliptins? Recall their mechanism of action
DPP4 inhibitors - prolong half life of existing GLP1
