Type 2 Diabetes Mellitus

Question 1

what is type 2 diabetes mellitus?

Answer 1

condition in which the combination of insulin resistance and beta-cell failure result in hyperglycaemia

Question 2

T2DM is associated with?

Answer 2

obesity

Question 3

The resultant chronic hyperglycaemia from T2DM may initially be managed by?

Answer 3

diet

weight loss

Question 4

With time, T2DM will need what treatment?

Answer 4

insulin

Question 5

WHO diabetes classification

Answer 5

T1DM
T2DM
hybrid forms
other
unclassified
during pregnancy

Question 6

What is LADA?

Answer 6

Autoimmune diabetes leading to insulin deficiency can present later in life

Question 7

what can be a feature of T2DM?

Answer 7

diabetic ketoacidosis

Question 8

What is MODY?

Answer 8

maturity onset diabetes of the young

Question 9

Diabetes may present following what diseases?

Answer 9

pancreatic damage

other endocrine disease

Question 10

epidemiology of diabetes

Answer 10

globally varies enormously
increasing prevalence
occurring/being diagnosed younger
greatest in ethnic groups that move from rural to urban lifestyle

Question 11

what are normal fasting glucose levels?

Answer 11

less than 6mmol/L

Question 12

what are normal 2 hr glucose (OGTT) levels?

Answer 12

less than 7.7mmol/L

Question 13

what are normal HbA1c levels?

Answer 13

less than 42 mmol/L

Question 14

describe beta cell function (%) as time progresses with T2DM

Answer 14

beta cell function is decreasing

Question 15

relative insulin deficiency

Answer 15

insulin is produced by pancreatic beta cells but not enough to overcome insulin resistance

Question 16

what are fasting glucose levels for T2DM?

Answer 16

more than 7mmol/L

Question 17

what are 2 hr glucose (OGTT) levels for T2DM?

Answer 17

more than 11mmol/L

Question 18

what are HbA1c levels for T2DM?

Answer 18

more than 48mmol/L

Question 19

the intermediate state for fasting glucose levels is called?

Answer 19

impaired fasting glycaemia

Question 20

the intermediate state for 2hr glucose levels is called?

Answer 20

impaired glucose tolerance

Question 21

the intermediate state for HbA1c is called?

Answer 21

pre diabetes

Question 22

why is their usually no diabetic ketoacidosis in relative insulin deficiency?

Answer 22

usually enough insulin to compensate

Question 23

overview pathophysiology of T2DM

Answer 23

genetic risk, intrauterine environment and adult environment
insulin resistance/secretion
fatty acids important in pathophysiology
T2DM is heterogenous

Question 24

pathophysiology of T2DM

Answer 24

first phase insulin response is lost

still get hepatic glucose production > drives progression

Question 25

draw the relationship between insulin secretion and sensitivity

Answer 25

secretion on y axis sensitivity on x axis curve starts high, sharp decrease then plateaus

Question 26

consequences to insulin resistance in the liver

Answer 26

production of hepatic glucose from glycogen

Question 27

consequences to insulin resistance in the muscle

Answer 27

no glucose uptake | stays in the circulation

Question 28

consequences to insulin resistance in the adipocytes

Answer 28

disrupts lipid metabolism no glucose uptake increased triglycerides because insulin promotes conversion to NEFA

Question 29

list inflammatory adipokines that are involved in T2DM

Answer 29

TNF-alpha, IL-6, glucocorticoids, visfatin, endocannabinoids, adiponectin, leptin, fatty acids, resistin, apelin

Question 30

monogenic diabetes

Answer 30

single gene mutation > MODY

Question 31

polygenic diabetes

Answer 31

polymorphisms that increase risk of development

Question 32

how does the strength of genetic risk affect the chance of developing T2DM?

Answer 32

low genetic risk requires a high environmental trigger | high genetic risk requires a low environmental trigger

Question 33

what is the role of obesity in T2DM?

Answer 33

major risk factor | fatty acids + adipocytokines important in pathophysiology

Question 34

which puts you at a higher risk of development of T2DM: central or visceral obesity?

Answer 34

visceral

Question 35

other than obesity, list other associations with the development of T2DM?

Answer 35

perturbations in gut microbiota | intra-uterine growth retardation

Question 36

list major risk factors for T2DM

Answer 36

``` age increased BMI ethnicity PCOS family Hx inactivity ```

Question 37

typical presentation of T2DM

Answer 37

``` hyperglycaemia overweight dyslipidaemia fewer osmotic symptoms than type 1 w/ complications insulin resistance later insulin deficiency ```

Question 38

what is the first line test for the diagnosis of T2DM?

Answer 38

HbA1c no fasting required quick cheap

Question 39

diagnosis of T2DM w/ HbA1c

Answer 39

1x HbA1c >=48mmol/L + symptoms | 2x HbA1c >=48mmol/L if asymptomatic

Question 40

T2DM usually diagnosed in patients when?

Answer 40

osmotic symptoms infections screening: incidental finding presentation of complication (acute or chronic)

Question 41

hyperosmolar hyperglycaemic state

Answer 41

presents commonly w/ renal failure, profoundly dehydrated insufficient insulin for preventing hyperglycaemia but enough to suppress lipolysis/ketogenesis absence of acidosis often identifiable precipitating event (infection, MI)

Question 42

management of T1DM

Answer 42

exogenous insulin (basal-bolus) regime self-monitoring of glucose structured education technology

Question 43

management of T2DM

Answer 43

``` diet oral meds structured education may need insulin remission/reversal ```

Question 44

list diabetic complications

Answer 44

retinopathy neuropathy nephropathy CVS

Question 45

principles of a T2DM consultation

Answer 45

glycaemia > HbA1c, review meds, glucose monitor weight assessment blood pressure dyslipidaemia > cholesterol profile screening for complications > foot check, retinal screening

Question 46

dietary recommendations

Answer 46

``` total calorie control reduce fats, refined carbs increase complex carbs increase soluble fibre decrease sodium ```

Question 47

list four main facets of pathophysiology of T2DM

Answer 47

excess hepatic glucose production resistance to action of circulating insulin inadequate insulin production for extent of insulin resistance excess glucose in circulation

Question 48

drug treatment to reduce hepatic glucose production

Answer 48

metformin

Question 49

drug treatment to improve insulin sensitivity

Answer 49

metformin | thiozolidinediones

Question 50

drug treatment to boost insulin secretion

Answer 50

sulphonylureas DPP4-inhibitors GLP-1 agonists

Question 51

drug treatment to inhibit carb gut absorption/inhibit renal glucose resorption

Answer 51

alpha glucosidase inhibitor | SGLT-2 inhibitor

Question 52

first line T2DM drug treatment

Answer 52

metformin

Question 53

main side effects of metformin

Answer 53

GI side effects

Question 54

metformin is contraindicated in?

Answer 54

severe liver, sever cardiac or moderate renal failure

Question 55

how do sulphonylureas work?

Answer 55

bind to ATP-sensitive K+ channel and close it, independent of glucose/ATP

Question 56

what is pioglitazone?

Answer 56

peroxisome proliferator-actived receptor agonists (PPAR- gamma)

Question 57

side effects of pioglitazone

Answer 57

older types hepatitis, heart failure, mild weight gain

Question 58

function of pioglitazone

Answer 58

insulin sensitiser

Question 59

what procedures have the potential to induce remission of T2DM?

Answer 59

gastric bypass surgery | low calorie diet for 3-6 months