Type 2 Duabetes Flashcards
what is type II DM?
combination of insulin resistance + beta cell failure → hyperglycaemia
what kind of insulin deficiency is this
relative insulin deficiency
what are some predisposing factors?
genetic susceptibility, obesity
what ages does type II DM typically affect?
usually older/adults but youth and children can also be affected
Normal levels for fasting glucose,2 hour glucose and HbA1C
- fasting glucose?less than 6 mmol/L
- 2-hr glucose (oral glucose tolerance test)?less than 7.7 mmol/L
- HbA1c?less than 42 mmol/L
levels indicative of type II DM for:
- fasting glucose?above 7 mmol/L
- OGTT?above 11 mmol/L
- HbA1c?above 48 mmol/L
what do values in between these benchmarks sugges
intermediate state between normal and type II DM
- intermediate stage
when in the progression towards type II DM is insulin production highest?
Intermediate stage
As it rises to combat increasing insulin resistance
Drops eventually following beta cells can be failure
what test in combination with what else can diagnose type II DM?
random glucose within DM range + symptoms of diabetes = diagnosis
can type II DM cause diabetic ketoacidosis?
yes but not under usual circumstances (due to relative insulin deficiency)
important consideration for long term type II DM?
late in disease course → can progress to complete insulin deficiency bc beta cell failure
important not to stop insulin treatment bc risk of ketoacidosis
what does the insulin response to glucose look like in type II DM?
First phase insulin release is lost
what are the consequences of reduced insulin action?
less uptake of glucose into muscles
more glucagon action
more hepatic production of glucose
consequences of insulin resistance in adipocytes?
less triglyceride formation and storage → more non-esterified fatty acids
An example of mono genic diabetes
MODY
What is polygenic diabetes
not born with certainty of developing diabetes → high risk contributed to by multiple polymorphisms + other factors
type II DM – associated conditions?
obesity (major), perturbations in gut microbiota due to bacterial lipopolysaccharides ferment to short chain FA, intrauterine growth retardation
how might patients with type II DM present?
overweight, hyperglycaemia, dyslipidemia
fewer osmotic symptoms
first line diagnostic tool for type II DM?
HbA1c
how does this work in detail?
1x HbA1c above 48 mmol/L + symptoms
or
2x HbA1c above 48 mmol/L if asymptomatic
Also check for osmotic symptoms,infections. If acute then hyperosmolar hyperglycemia if chronic then ischaemic heart disease and retinopathy present
how does a hyperosmolar hyperglycaemic state commonly present?
Renal failure
Conditions for hyperosmolar hyperglycemia
insufficient insulin (not absent) for hyperglycaemia prevention
sufficient insulin for lipolysis and ketoacidosis suppression
Presents commonly with renal failure
type II DM management?
diet and lifestyle adjustment, oral medication, education, possibly insulin later
what specifically should diet adjustments aim to achieve?
total calorie control, less calories as simple carbs and fat and more as complex carbs
sodium down, soluble fibre up
what can metformin help with
decreasing hepatic glucose production, improving insulin sensitivity,increases peripheral glucose disposal
Is biguanjde insulin sensitiser
what medications can boost insulin secretion?
sulphonylureas, DPP4-inhibitors, GLP-1 agonists
what medications can inhibit glucose reabsorption in kidneys and absorption in gut?
alpha glucosidase inhibitor, SGLT-2 inhibitor
Targets circulating glycogen
metformin contraindications and side effects?
GI side effects
severe liver/cardiac or moderate renal failure = contraindicated
-
how do sulphonylureas help?
bind to and close ATP sensitive K+-channels regardless of glucose and ATP conc → required for insulin release
what is pioglitazone?
peripheral insulin sensitiser
what kind of drug is plioglitazine
PPAR agonist
improvement in glycaemia and lipids, weight gain - peripheral not central
side effect of some glucose lowering therapies?
Weight gain
what is GLP-1?
gut hormone glucagon like peptide 1
When is GLP1 secreted
In response to nutrients in the gut
What cells is GLP1 secreted from and fcuntion
L cells
Stimulates insulin and suppresses glucagon,increases satiety
what is the gastrointestinal incretin effect?
More insulin response to oral glucose than IV
what do GLP-1 agonists do?
Decrease glucagon and glucose causes weight loss
Injectable daily/weekly
Liraglutide and semaglutide
what do DPPG-4 inhibitors do?
Lengthen GLP1 half life
Decrease glucagon and glucose but neutral on weight
SGLT2
empagliflozin, dapagliflozin
Inhibit sodium glucose transporter so more glycosuria
HbA1c lower,lower mortality,lower heart failure risk and improve CKD
What has the potential to induce remission if type 2 diabetes
gastric bypass surgery, potentially low-cal diets
other aspects of DM management?
hypertension, lipids (higher cholesterol (total and HDL), triglycerides raised)
Pathophysiology type 2
Genes and intrauterine environment and adult environment
Insulin resistance and secretion defects
Type 2 consultation
Glycaemia HbA1c,glucose,med review
Weight assessment
Blood pressure
Dylipidaemia-cholesterol profile
Screen fir complications eg foot check and retinal screen
How else do we get glucose
Impaired glucose disposal and increased hepatic glucose increases rhe fasting glucose l else
Thus means that there is decreased storage of glucose thus decreased clearance of glucose which is converted to lactate
Lactate is then converted to glucose via rhe cori cori cycle which increases glucose levels again. The early increase in fasting glucose therefore is a result from the previous nights meal
As well as that impaired glucose levels cause increased glucagon secretion causing production of glucose
SNP affect
Individual SNP have a mild affect
Cumulative have buggee affects
Intra uterine growth retardation
Weight at age 1 less than 8.16kg 22% had type 2 diabetes
If weight was >12.25 then 6% had type 2
