Type 2 Pathophysiology

Question 1

why is the prevalence of T2DM but not the incidence of T2DM increasing

Answer 1

people are living longer

Question 2

what two factors lead to insulin resistance

Answer 2

genetic predisposition

obesity lifestyle factors

Question 3

what is the relationship between BMI and risk of T2DM

Answer 3

as BMI increases so does t2dm risk

Question 4

why are asian people more susceptible to T2DM

Answer 4

they need a smaller BMI to be at increased risk

Question 5

how does T2DM cause microvascular disease

Answer 5

hyperglycaemia leads to damage to microvasculature

Question 6

how to treat microvascular disease which is caused by T2DM

Answer 6

intensive glucose control

Question 7

how to treat MACROvascular disease in T2DM

Answer 7

statins/anti-hypertensives

Question 8

how is T2DM confirmed in people with symptoms

Answer 8

random blood glucose >11.1 only one test needed if they have symptoms

Question 9

best treatment for T2DM

Answer 9

weight loss, diet and exercise

Question 10

treatment for T2DM (dan in slide)

Answer 10

Diet and life style 
Weight target (5-10%) 
Metformin (gradual increase to 100mg) 
Statin 
ACEi (blood pressure control) 
review

Question 11

first line therapy for T2DM

Answer 11

metformin

Question 12

how does metformin work

Answer 12

decreased hepatic gluconeogenesis

increased peripheral glucose uptake

Question 13

What affect does metformin have on diabetes

Answer 13

decreases HBA1c
weight neutral
no hypoglycaemia when used as mono therapy
decreased cardiac risk

Question 14

adverse affects of metformin

Answer 14

GI

lactic acidosis

Question 15

what factors can lead to failure in reaching glycemic targets

Answer 15

younger 
female 
obese 
not at BP or lipid targets 
having 2 or 3 more drugs 
poor adherence to meds and lifestyle

Question 16

second line drug for diabetes

Answer 16

sulphonylurea

Question 17

what should be the major focus of diabetes therapy

Answer 17

cardiovascular risk reduction

Question 18

how do sulphonylurea’s work

Answer 18

block b-cell Katp channel

increases insulin secretion

Question 19

affect of sulphonylureas on diabetes

Answer 19

decrease HbAc1
increase weight gain
increase hypoglycaemia

Question 20

adverse affects of sulphonylureas

Answer 20

abnormal LFTs

increased CHD??

Question 21

what happens to sulphonylurea at higher doses

Answer 21

efficacy is reduced

Question 22

how do glitazones work

Answer 22

PPARy activator

increases peripheral glucose uptake

Question 23

Affect of glitazones on diabetes

Answer 23

decreased HbA1c

increased weight gain

Question 24

adverse affects of glitazones

Answer 24

increased fracture risk
hepatotoxicity
fluid retention