Type 2 diabetes mellitus (T2DM) Flashcards
What is the pathophysiology in T2DM?
Repeated exposure to glucose and insulin makes the cells in the body become resistant to the effects of insulin. It therefore requires more insulin to produce a response from the cells and get them to take up and use glucose. Over time, the beta cells of the pancreas becomes fatigued and damaged by producing so much insulin so they start to produce less
Name 2 modifiable and 2 non-modifiable risk factors for T2DM
Modifiable - diet high in refined carbohydrates, obesity, sedentary lifestyle
Non-modifiable - family history, age, ethnicity
Name 3 ways T2DM may present
- Fatigue
- Polydipsia and polyuria
- Unintentional weight loss
- Opportunistic infections
- Slow healing
- Glucose in urine (on dipstick)
Pre-diabetes can be diagnosed with a HbA1c, impaired fasting glucose test or an impaired glucose tolerance test. What are the values, for these 3 tests, would indicate a diagnosis of prediabetes?
- HbA1c – 42-47 mmol/mol
- Impaired fasting glucose – fasting glucose 6.1 – 6.9 mmol/l
- Impaired glucose tolerance – plasma glucose at 2 hours 7.8 – 11.1 mmol/l on an OGTT (oral glucose tolerance test)
Diabetes can be diagnosed with a HbA1c, random glucose, fasting glucose or OGTT. What are the values for these 4 tests that would indicate a diagnosis of T2DM?
- HbA1c > 48 mmol/mol
- Random Glucose > 11 mmol/l
- Fasting Glucose > 7 mmol/l
- OGTT 2 hour result > 11 mmol/l
1) Name a dietary modification for the management of patients with T2DM
2) Name 2 lifestyle modification for the management of patients with T2DM
3) Name 2 complications that you should monitor as a part of the management of T2DM
1) Vegetables and oily fish, low glycaemic, high fibre diet
2) Smoking cessation, optimisation of co-morbidities treatment, increased activity levels and weight loss
3) Diabetic foot, diabetic nephropathy, diabetic retinopathy
1) What is the 1st line medication for T2DM?
2) Name 2 drugs/classes of drugs that are 2nd line
3) Name a third line treatment for T2DM
4) Which 2 groups of drugs are preferentially given for patients with cardiovascular disease?
1) Metformin
2) Pioglitazone, SGLT2 inhibitors, sulphonylurea, DPP-4 inhibitors
3) Insulin + metformin, metformin and 2 second line drugs
4) GLP-1 mimetics and SGLT-2 inhibitors
Hyperosmolar hyperglycaemic state (HHS) (1)
1) What are the 3 major problems caused by HHS?
2) Name 2 precipitating factors
3) Aswell as the fact that HHS is more associated with T2DM, and DKA is more associated with T1DM, what is a key difference between the 2, and how is this relevant?
1) Osmotic diuresis, electrolyte imbalances and severe dehydration
2) Dementia, infection, sedative drugs
3) DKA presents much faster (hrs), whereas HHS develops over days - this means that the dehydration and metabolic disturbances may be more severe
Hyperosmolar hyperglycaemic state (HHS) (2)
1) Name 4 clinical features of HHS
2) Even though there isn’t a definitive way to diagnose HHS, name 2 things typically seen that would point towards a diagnosis of HHS
3) What is the main management of HHS?
1) polyuria, polydipsia, lethargy, nausea and vomiting, altered consciousness, focal neural deficits, hyperviscosity of blood (stroke, MI risk)
2) hypovolaemia, marked hyperglycemia (>30 mmol/L), significantly raised serum osmolarity (> 320 mosmol/kg), no significant hyperketonemia (<3 mmol/L), no significant acidosis (bicarbonate > 15 mmol/l or pH > 7.3)
3) Fluid replacement
At what HBA1c should you add a 2nd drug in the management of T2DM?
58mmol/mol
Which antibodies are useful for differentiating between type 1 and type 2 diabetes?
- C peptides (low in T1)
- Anti GAD, ICA and IAA (high in T1)
If metformin isn’t tolerated initially, what should be done?
Trial modified release formulation
