Type 2 DM

Question 1

What is the pathophysiology of T2DM?

Answer 1

↓insulin secretion ± ↑insulin resistance

Question 2

What are the RF?

Answer 2

1. FHx
2. Increasing age
3. Obesity + inactivity
4. Ethnicity - Asian, African and Black
5. Poor diet - low fibre, high glycemic index
6. Drugs - statins, CS
7. PCOS
8. Hx of gestational diabetes

Question 3

How do children and young people with T2DM tend to present?

Answer 3

1. Persistent hyperglycaemia (RPG >11mmol/L)
2. Characteristic features e.g. thirst, polyuria, blurred vision WL, recurrent inf not usually as severe can be absent)
3. RF for T2DM
4. Evidence of insulin resistance

Question 4

How do adults w T2DM tend to present?

Answer 4

1. Persistent hyperglycaemia - HbA1c >48mmol/mol or RPG >11
2. Characteristic features usually less severe or absent
3. RFs for T2DM
4. Evidence of insulin resistance

Question 5

When should HbA1c not be used to diagnose DM?

Answer 5

• <18yrs
• Pregnant women or women 2 months postpartum
• Sx of DM for less than 2m
• Those taking meds that may cause hyperglycaemia
• End stage CKD

Question 6

What dietary advice do you give in the management of T2DM?

Answer 6

Encourage high fibre, low GI sources of carbs
Include low fat dairy products + oily fish
Less sat fats + trans fats
Discourage use of foods marketed specifically at ppl w DM
Target weight loss to 5-10% f overweight

Question 7

What is the HbA1c target with lifestyle management?

Answer 7

48

Question 8

How often should HbA1c be checked

Answer 8

3-6monthly then 6 monthly one stable

Question 9

What is the target HbA1c if levels aren’t adequately controlled by a single drug and rises to 58mmol/mol or more

Answer 9

53

Question 10

What is the first line drug treatment for T2DM not controlled with lifestyle factors? how would u give it?

Answer 10

Metformin - gradually increase the dose over several weeks to minimise the risk of GI effects

Question 11

What is the second line treatment?

Answer 11

Dual therapy: metformin plus either of the following:

• DPP-4i
• Pioglitazone
• SU
• SGLT-21

Question 12

What is the third line treatment?

Answer 12

Triple therapy:

1. Triple therapy:
   - Met + SU+ DPP4i
   - Met + SU + pioglitazone
   - Met + SU/pioglitazone + SGLT-2i
2. Insulin based therapy

Question 13

What type of drug is metformin?

Answer 13

biguanide

Question 14

What are the SE of metformin?

Answer 14

Nausea
Diarrhoea
Abdo pain 
Anorexia
NOT HYPOGLYCAEMIA

Question 15

When is metformin contraindicated?

Answer 15

Acute metabolic acidosis (lactic + DKA)

Avoid if eGFR <30 due to risk of lactic acidosis

Question 16

What are SE of SU?

Answer 16

Hypoglycaemia

Weight gain

Question 17

What are CIs of SU?

Answer 17

Hepatic impairment - metabolised by the liver
Severe renal impairment
not a CI but if overweight as promotes weight gain

Question 18

Give an example of an SU

Answer 18

gliclazide

Question 19

What SU should be used in the elderly?

Answer 19

oral tolbutamide

Question 20

how does metformin work?

Answer 20

increases insulin sensitivity and helps weight

Question 21

How does SU work?

Answer 21

increases insulin secretion

Question 22

When are SUs only effective?

Answer 22

when some residual pancreatic beta cell activity is present