Type 2 Diabetes Mellitus Flashcards
Define:
Characterised by peripheral insulin resistance ,impaired insulin secretion and increased hepatic glucose output
Aetiology:
Associated with obesity - this increases the rate of release of NEFAs = post-receptor defects
Genetics + environmental - genetics may lead to defects in insulin receptors
Drugs - corticosteroids, atypical antipsychotics, protease inhibitors
Pancreatic - chronic pancreatitis
Endocrine - acromegaly and Cushing’s.
Circulating autoantibodies to the extracellular domain of the insulin receptor
Risk factors:
o Metabolic syndrome o Obesity o Asian ethnicity o TB drugs o SSRIs o Pregnancy o Acromegaly o Renal failure o Cystic fibrosis o PCOS o Werner’s syndrome
Epidemiology:
Uk prevalence 5-10%
More common in Asian, African and hispanic.
Incidence is increasing over the last 20 years and this is believed to be associated with increasing obesity
Symptoms:
- May be an incidental finding
- polyuria
- polydipsia
- Tiredness
- hyperosmolar hyperglcaemic state
- Increased CVS risk factors - hypertension
- Infections - foot ulcers + candidaisis
Signs:
- BMI + waist circumference
- Blood pressure
- Diabetic foot
- Skin changes (rare)
What are the signs of diabetic foot:
o Dry skin o Reduced subcutaneous tissue o Ulceration o Gangrene o Charcot's arthropathy o Weak foot pulses
What are possible skin changes:
Necrobiosis lipoidica diabeticorum (well-demarcated plaques on shins or arms with shiny atrophic surface and red-brown edges)
Granuloma annulare (flesh-coloured papules coalescing in rings on the back of hands and fingers)
Diabetic dermopathy (depressed pigmented scars on shins)
Investigations:
Urinanalysis–> random glucose –> fasting glucose –> OGTT –> HbA1C
Diagnosed by:
- Symptoms + random glucose >11.1mmol/L
- Fasting glucose >7mmol/L
- OGTT of 75g >11.1 mmol/L
Monitor:
- U+E’s
- Lipid profile
- HbA1C
- eGFR
- Urine albumin:creatinine ration (microalbunimuria)
Management:
Lifestyle - stop smoking, diet and exercise
Metformin - a biguanide that increases insulin sensitivity + helps with weight
If HbA1c is >53mmol/L add a sulphonylurea
If HbA1c is >57mmol/L:
- INSULIN – first basal, then premeal rapid-acting insulin
- GLITAZONE (thiazolidinedione) e.g. pioglitazone
- SULPHONYLUREA RECEPTOR BINDERS
- GLP ANALOGUES and DPP4 INHIBTORS
- A-GLUCOSIDASE INHIBITORS e.g. acarbose
Monitor for complications
Pregnancy - requires strict glycaemic control and planning of conception
Hyperosmolar Hyperglycaemic State - management is similar DKA
o Except use 0.45% saline if serum Na+ > 170 mmol/L
Complications:
Hyperosmolar hyperglycaemic state
Nephropathy
Neuropathy
Retinopathy
IHD
Stroke/TIA
PVD
Describe what happens in HHS:
o Due to insulin deficiency o Marked dehydration o High Na+ o High glucose o High osmolality o No acidosis
Describe the neuropathy that may occur as a complication:
o Microabuminuria o Proteinuria o Renal failure o Prone to UTI o Renal papillary necrosis
Describe the neuropathy that may occur as a complication:
o Distal symmetrical sensory neuropathy o Painful neuropathy o Carpel tunnel syndrome o Diabetic amyotrophy o Mononeuritis o Autonomic neuropathy o Gastroparesis (abdominal pain, nausea, vomiting) o Impotence o Urinary retention
Describe the retinopathy that may occur as a complication:
Background (hard exudates, micro-aneurysms and blot haemorrhages)
Pre-proliferative(cotton wool spots -pan-retinal photocoagulation)
Proliferative (visible new vessels - pan-retinal photocoagulation)
Maculopathy (hard exudates near the macula - grid photocoagulation)
Prone to glaucoma, cataracts and transient visual loss
