Type 2 Diabetes Mellitus

Question 1

What are the symptoms of diabetes?

Answer 1

Chronic condition characterised by high blood glucose Symptoms (more common in T1DM): - Polyphagia - Polydipsia - Polyuria - Recurrent infections

Question 2

When to suspect T2DM?

Answer 2

1. Persistent hyperglycaemia (HbA1c > 48mmol/mol) OR random plasma glucose > 11mmol/L 2. Risk factors for T2DM (Family history, obesity, ethnicity i.e Asian, black) 3. Evidence of insulin resistance (acanthosis nigricans)

Question 3

How to diagnose T2DM?

Answer 3

Asymptomatic: 2 abnormal HbA1c or plasma glucose level Symptomatic: single HbA1c or fasting plasma glucose level Cutoffs: HbA1c > 48mmol/mol If HbA1c is inappropriate (i.e ESRF), use fasting plasma glucose level > 7.0mmol/L

Question 4

When should HbA1c not be used to diagnose diabetes?

Answer 4

Age < 18 years Pregnant women or women 2 months post-partum Patients with diabetic symptoms < 2 months Patients with diabetes who are acutely ill People who take meds which result in hyperglycaemia (i.e steroids) People with acute pancreatic injury People with ESRF People with HIV infection

Question 5

Lifestyle management for T2DM?

Answer 5

Structured group education programme i.e DESMOND Diet and exercise Stop smoking

Question 6

What is the target HbA1c for patients?

Answer 6

Diet/Exercise only - 6.5% (48mmol/mol) Meds which do not cause hypos - 6.5% (48mmol/mol) Meds which cause hypos - 7.0% (53mmol/mol)

Question 7

What is the step-wise management strategy for T2DM?

Answer 7

Always check medication adherence and review diet/exercise

If symptomatically T2DM –> give insulin/sulfonylurea

Question 8

What are the side effects of the different diabetes drugs?

Answer 8

Metformin (biguanide)

Weight loss

No hypoglycaemia

Nause and vomiting

eGFR < 30: risk of lactic acidosis

Sitagliptin (DPP4 inhibitor)

Pancreatitis

Pioglitazone (Thiazolidinediones)

Weight gain

Heart Failure

Osteoporosis

Risk of bladder cancer

Question 9

What are the autonomic and neuroglycopenic features of hypoglycaemia?

Answer 9

Autonomic

• Palpitations
• Jitteriness
• Tremor
• Anxiety
• Hunger

Neuroglycopenic

• Confusion
• Slurred
• Loss of consciousness
• Seizures

Question 10

Management strategy for patients having a hypoglycaemic episode?

Answer 10

Give liquid form of fast-acting carbohydrate i.e

• Lucozade

If unconscious/unable to swallow (severe hypoglycaemia):

• IM glucagon

Question 11

What do you do for annual review of diabetes?

Answer 11

1. Retinopathy - NHS retinopathy screening programme
2. Diabetic foot - Examine feet
3. Nephropathy - albumin:creatinine ratio / eGFR
4. Cardiovascular risk + QRisk

–> Give ACE-i if hypertensive for all adults!