Type 2 diabetes mellitus Flashcards
define diabetes mellitus
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
normal, impaired and diabetic levels for fasting blood glucose
below 6 = normal
6 - 7 = impaired fasting glucose
above 7 = diabetes
normal, impaired and diabetic levels for 2hr blood glucose
below 7.8 = normal
7.8 - 11.1 = impaired fasting glucose
above 11.1 = diabetes
what is MODY?
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
what is the metabolism and presentation of T2DM?
Heterogeneous Obesity Insulin resistance and insulin secretion deficit Hyperglycaemia and dyslipidaemia Acute and chronic complications
how does insulin secretion change with glucose tolerance?
Insulin Secretion Deteriorates With Progressive Impairment of Glucose
Tolerance
how does gut microbiota contribute to obesity?
Obesity, insulin resistance T2DM
Host signaling
Bacterial lipopolysaccharides fermentation to short chain FA, bacterial modulation bile acids
Inflammation, signaling metabolic pathways
Most studies correlative
what condition is a common side effect of diabetes treatments?
weight gain
microvascular complications of T2BM?
retinopathy
nephropathy
neuropathy
macrovascular complications of T2DM?
Ishcaemic heart disease
Cerebrovascular
Renal artery stenosis
PVD
metabolic complications of T2DM?
Lactic acidosis
Hyperosmolar
what is the basic management of T2DM?
Education
Diet
Pharmacological treatment
Complication screening
what should patients with T2DM eat?
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)
what should you monitor in T2DM?
Weight Glycaemia Blood pressure Dyslidiaemia (Cholesterol Triglyceride HDL-Cholesterol Clear benefits to treatment)
one drug that is weight gain neutral for T2DM?
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
when do you not use metformin?
do not use if severe liver, severe cardiac or mild renal failure
how does acarbose work?
-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
what do thiazolidinediones do?
-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
what does GLP-1 do?
GLP 1 agonist used in diabetic treatment
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
what is gliptins and what do they do?
-example of a GLP1 agonist Increase half life of exogenous GLP-1 Increase [GLP-1] Decrease [glucagon] Decrease [glucose] Neutral on weight
what does empaglifozin do?
Inhibits Na-Glu transporter, increases glycosuria N=7200, 206 weeks HbA1c lower 32% lower all cause mortality 35% lower risk heart failure
what can effect the chances of T2DM?
intra uterine environment
adult life
genetics
