Type 2 DM

Question 1

Compare and contrast T1DM and T2DM.

Answer 1

• T1DM - Absolute insulin deficiency. T2DM - Relative insulin deficiency with insulin resistance
• More rapid onset for T1DM and also earlier age of onset
• BMI non influencing in T1DM - while obesity is principal driver in T2DM

Question 2

What are the goals in T2DM care?

Answer 2

• Prevention
• Early diagnosis
• Lifestyle intervention
• Controlling BP/ Glucose / cholesterol (Principal CV risk factors)
• Annual screening for complications

Question 3

Describe the benefit of early diagnosis of T2DM.

Answer 3

• 1/3 people with diabetes don’t know they have diabetes
• 20-30% of people with diabetes sustain complications by time of diagnosis
• Early interventions help improve long term outcomes

Question 4

What happens when HbA1c
- <42 mmol/l
- 43-47 mmol/l
- >48 mmol/l

Answer 4

• Diabetes unlikely
• Diabetes/IGT - intesive lifestyle advice and reassess following six months
• Diabetes

Question 5

Describe the twin cycle hypothesis (i.e the two cycles centering around T2DM aetiology)

Answer 5

• A chronic positive calorie balance causes fat to accumulate in the liver.
• Fat in the liver leads to insulin resistance - liver cells don’t respond as well to insulin.
• Hyperinsulinemia - increases the amount of excess calories that are converted to fat in the liver.
• Fat that accumulates in the liver eventually spills over into the pancreas and can inhibit the secretion of insulin after eating.
• Hyperglycemia can occur as a result of the twin cycle