type 2 diabetes mellitus Flashcards

1
Q

define T2DM

A
  • state of chronic hyperglycaemia sufficient to cause long-term damage to specific tissues
  • not ketosis prone
  • involves weight, lipids, BP
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2
Q

describe fasting glucose in diabetes

A

fasting glucose above 7mmol/L

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3
Q

what is MODY?

A
  • autosomal dominant
  • mutations in TF glucokinase gene = produces ineffective beta cell insulin secretion
  • no obesity
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4
Q

what can the pathophysiology of T2DM be influenced by?

A
  • genetics
  • intrauterine environment
  • adult environment
  • epigenetic changes in intrauterine environment can affect functioning of developing genes
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5
Q

what is T2DM caused by?

A
  • insulin resistance

- insulin secretion deficits

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6
Q

what specifically about the intrauterine environment can greatly inc. chance of developing T2DM?

A

intrauterine growth restriction

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7
Q

how does insulin resistance lead to macrovascular disease?

A
  • insulin resistance
  • dyslipidaemia
  • inc. mitogenic pathway
  • hypertrophy and inc. in BP
  • macrovascular disease
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8
Q

if dyslipidaemia leads to macrovascular disease, what does hyperglycaemia lead to?

A

microvascular

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9
Q

why would everyone get T2DM at some point?

A
  • insulin production dec. with age
  • we become more resistant with age
  • at some point, insulin resistance and secretion lines bisect
  • cannot make enough insulin for our resistance
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10
Q

what is hyperglycaemia clamp?

A
  • in people that are developing T2DM, they will have some insulin production
  • but lose their first phase response to glucose
  • make insulin but takes longer
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11
Q

what are the 1st and 2nd phase responses in insulin secretion?

A

1st phase: stored insulin that is ready to be released when stimulated
2nd phase: produced and secreted insulin over time

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12
Q

describe the inc. blood glucose in T2DM

A
  • deficient insulin means HGO continues after eating food

- deficient insulin also meands glucose cannot move into muscles and fat

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13
Q

what happens to fatty acids in insulin resistance?

A
  • fatty acids cannot be used to make glcose
  • instead are made into VLDLs which are atherogenic
  • liver not inhibited to make new glucose in gluconeogenesis or breakdown glycerol into glucose
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14
Q

how is the gut microbiota involved?

A
  • associated with obesity, insulin resistance, T2DM, inflammation, adipocytokine pathwayys
  • via host signalliing
  • various lipopolysaccharides are fermented by gut bacteria to short chain FFAs, enter host circulation, modulate bile acids
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15
Q

how do people with T2DM found?

A
  • osmotic symptoms
  • infections (hyperglycaemia)
  • screnning tests
  • often found at presentation of complications
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16
Q

what can these complications be?

A
  • microvascular
  • macrovascular
  • metabolic
  • from treatment (hypo attack)
17
Q

how do you manage T2DM?

A
  • education
  • diet
  • pharmacological treatment
  • complication screening
18
Q

in what ways, should the diet be changed?

A
  • control total calorie intake/ inc. exercise
  • reduce fat as proportion of calories
  • reduce refined carbs
  • inc. complex carbs, unsat fat
19
Q

how do you monitor T2DM?

A
  • weight
  • glycaemia
  • BP and dyslipidaemia
20
Q

name the 5 different drug treatments for T2DM

A
  • orlistat: pancreatic lipase inhibitor
  • metformin: biguanide, insulin sensitiser
  • sulphonylureas: makes existing pancreas secrete more insulin
  • alpha glucosidase inhibitors: delays glucose absorption
  • thiazolidinediones: acts on adipocytes and insulin sensitizer peripherally in fat and muscles
21
Q

describe metformin

A
  • biguanide class (oral anti-hyperglycaemic drugs)
  • insulin sensitiser
  • used in overweight pt when diet has succeeded
  • reudces HGO and inc. peripheral glucose disposal
22
Q

what are the side effects of metformin?

A

GI effects
don’t use if severe liver/cardiac failure
or mild renal failure

23
Q

describe sulphonylurea

A

e. g. Glibenclamide
- acts on beta cell and act to inc. insulin secretion
- blocks ATP-sensitive K channel
- cause influx of Ca
- used in lean patients with T2DM

24
Q

which patients are sulphonylureas used in?

A

lean patients

with T2DM

25
Q

what are the side effects of these?

A

hypoglycaemia

weight gain

26
Q

what are alpha glucosidase inhibitors?

A

e. g. Acarbose
- prolongs absorption of oligosaccharides
- allows insulin secretion to cope following defective 1st phase insulin
- effective as metformin

27
Q

what are the side effects of these?

A

flactulence

28
Q

what are thiazolidinediones?

A

e. g. Pioglitazone
- peroxisome proliferator-activated receptor agonist
- insulin sensitiser peripherally
- adipocytes are rearranged so weight gain is peripheral not central

29
Q

what are the side effects of these?

A

hepatitis

HF

30
Q

what are GLP-1 and Gliptins?

A

e. g. Exenatide, liraglutide, gliptins
- GLP-1 secreted in response to nutrients in gut (incretin effect)
- stimulates insulin, suppresses glucagon and inc. satiety
- GLP-1 short half life, broken down by DPPG-4

31
Q

describe the GLP-1 drug

A
  • injectable
  • long acting GLP-1 agonist
  • dec. glucagon and glucose
  • leads to weight loss
32
Q

describe the gliptins drug

A
  • DPPG-4 inhibitor
  • inc. hald life of exogenous GLP-1
  • neutral effect on weight
33
Q

what does empaglifozin do?

A

Na-glucose transporter inhibitor

inc. glycosuria

34
Q

what are other aspects of control with drugs?

A
  • BP (90% of T2DM have BP problems)

- Dyslipidaemia (high cholesterol, TG and less HDLs lead to microvascular problems)