Type 2 diabetes mellitus Flashcards
Which test is used to diagnose diabetes mellitus?
75g glucose tolerance test
What is type 2 diabetes?
A common condition where there’s insulin resistance and abnormal beta cells which cannot produce enough insulin to keep the blood glucose normal
What is the islet characterised by in type 2 diabetes?
amyloid deposits
What are the causes of type 2 diabetes?
Genetic - polygenic. fetal programming (epigenetic) - maternal hyperglycaemia and intrauterine growth retardation. leads to reduced beta cell mass.
Old age, change in gut microbiota, glucotoxicity and lipotoxicity - later effects.
What is the cause of insulin resistance?
visceral fat. epicardial fat is a strong risk factor for vascular disease. excess fat in the diabetic pancreas is specific to T2DM and important in preventing normal insulin production.
Why is ectopic fat a problem?
Production of:
Free fatty acids - insulin resistance and atherogenic lipids.
Cytokines - insulin resistance, inflammation.
Procoagulant factors (PAI1).
Which measurement is taken for insulin resistance?
waist circumference
What are the morbidities of type 2 diabetes related to?
hyperglycaemia, dysregulation of lipid metabolism, high levels of proinflammatory cytokines and free radicals, increased susceptibility to infection.
Which conditions can arise due to type 2 diabetes?
Cataracts (increased generation of polyols from glucose).
Due to blood glucose being too high for too long:
retinopathy e.g. maculopathy,
renal disease - haemodialysis for chronic renal failure,
neuropathic ulcer,
glycosylation of connective tissue e.g. cheiroarthropathy.
How does type 2 diabetes affect bone?
Mechanically weaker, increased fractures x2 despite normal bone density
What can treatment of hyperglycaemia lead to?
reduced microvascular and macrovascular complications e.g. coronary artery disease can lead to MI
How do different lipoprotein classes affect inflammation?
potentially proinflammatory: chylomicrons, VLDL and their catabolic remnants.
potentially anti-inflammatory: HDL.
What can atherosclerotic lesions cause?
peripheral vascular disease
How is type 2 diabetes treated?
Prevent diabetes - diet and exercise
Improve hyperglycaemia
Reduce cardiovascular risk factors: dyslipidaemia (e.g. statins), hypertension, smoking, obesity.
Screen for complication and treat early.
Education programmes (e.g. Desmond).
Goals must be tailored to the individual e.g. less aggressive treatment and avoid hypoglycaemia in elderly, tight control in pregnant women.
Which screenings can be carried out to enable early treatment?
Eyes - retinal photography, laser treatment when required
Kidneys - measure urine albumin, control blood pressure, ACE inhibitors and ARBs.
Feet - screen for neuropathy and vascular disease.
