Type 2 diabetes mellitus

Question 1

define diabetes mellitus

Answer 1

Diabetes mellitus can be defined as a state of chronic hyperglycaemia sufficient to cause long-term damage to specific tissues, notably the retina, kidney, nerves, and arteries
T2D is not ketosis prone

Question 2

normal, impaired and diabetic levels for fasting blood glucose

Answer 2

below 6 = normal
6 - 7 = impaired fasting glucose
above 7 = diabetes

Question 3

normal, impaired and diabetic levels for 2hr blood glucose

Answer 3

below 7.8 = normal
7.8 - 11.1 = impaired fasting glucose
above 11.1 = diabetes

Question 4

what is MODY?

Answer 4

Several hereditary forms (1-8)
Autosomal dominant
Ineffective pancreatic B cell insulin production
Mutations of transcription factor genes, glucokinase gene
Positive FH, no obesity
Specific treatment for type

Question 5

what is the metabolism and presentation of T2DM?

Answer 5

Heterogeneous
Obesity
Insulin resistance and insulin secretion deficit
Hyperglycaemia and dyslipidaemia
Acute and chronic complications

Question 6

how does insulin secretion change with glucose tolerance?

Answer 6

Insulin Secretion Deteriorates With Progressive Impairment of Glucose
Tolerance

Question 7

how does gut microbiota contribute to obesity?

Answer 7

Obesity, insulin resistance T2DM
Host signaling
Bacterial lipopolysaccharides fermentation to short chain FA, bacterial modulation bile acids
Inflammation, signaling metabolic pathways
Most studies correlative

Question 8

what condition is a common side effect of diabetes treatments?

Answer 8

weight gain

Question 9

microvascular complications of T2BM?

Answer 9

retinopathy
nephropathy
neuropathy

Question 10

macrovascular complications of T2DM?

Answer 10

Ishcaemic heart disease
Cerebrovascular
Renal artery stenosis
PVD

Question 11

metabolic complications of T2DM?

Answer 11

Lactic acidosis

Hyperosmolar

Question 12

what is the basic management of T2DM?

Answer 12

Education
Diet
Pharmacological treatment
Complication screening

Question 13

what should patients with T2DM eat?

Answer 13

Control total calories/increase exercise (weight)
reduce refined carbohydrate (less sugar)
increase complex carbohydrate (more rice etc)
reduce fat as proportion of calories (less IR)
increase unsaturated fat as proportion of fat (IHD)
increase soluble fibre (longer to absorb CHO)
Address salt (BP risk)

Question 14

what should you monitor in T2DM?

Answer 14

Weight
Glycaemia
Blood pressure
Dyslidiaemia (Cholesterol 
Triglyceride 
HDL-Cholesterol 
Clear benefits to treatment)

Question 15

one drug that is weight gain neutral for T2DM?

Answer 15

Biguanide, insulin sensitiser
overweight patient with T2DM where diet alone has not succeeded
Reduces insulin resistance
Reduced hepatic glucose output
Increases peripheral glucose disposal
GI side effects

Question 16

when do you not use metformin?

Answer 16

do not use if severe liver, severe cardiac or mild renal failure

Question 17

how does acarbose work?

Answer 17

-slows glucose absorption 
Alpha glucosidase inhibitor
Prolongs absorption of oligosaccharides
Allows insulin secretion to cope, following defective first phase insulin
As effective as metformin
Side effects flatus

Question 18

what do thiazolidinediones do?

Answer 18

-decrease insulin resistance
Peroxisome proliferator-actived receptor agonists PPAR-γ
Pioglitazone
Insulin sensitizer, mainly peripheral
Adipocyte differentiation modified, weight gain but peripheral not central
Improvement in glycaemia and lipids
Evidence base on vascular outcomes
Side effects of older types hepatitis, heart failure

Question 19

what does GLP-1 do?

GLP 1 agonist used in diabetic treatment

Answer 19

Secreted in response to nutrients in gut
Transcription product of proglucagon gene, mostly from L cell.
Stimulates insulin, suppresses glucagon
Increases satiety
Restores B cell glucose sensitivity
Short half life, rapid degredation from enzyme dipeptidyl peptidase-4 (DPPG-4 inhibitor)
Key in the incretin effect

Question 20

what is gliptins and what do they do?

Answer 20

-example of a GLP1 agonist 
Increase half life of exogenous GLP-1
Increase [GLP-1]
Decrease [glucagon]
Decrease [glucose]
Neutral on weight

Question 21

what does empaglifozin do?

Answer 21

Inhibits Na-Glu transporter, increases glycosuria
N=7200, 206 weeks
HbA1c lower
32% lower all cause mortality
35% lower risk heart failure

Question 22

what can effect the chances of T2DM?

Answer 22

intra uterine environment

adult life

genetics