Type II Diabetes Mellitus

Question 1

Definition

Answer 1

A STATE OF CHRONIC HYPERGLYCAEMIA SUFFICIENT TO CAUSE LONG-TERM DAMAGE TO SPECIFIC TISSUES, NOTABLY THE RETINA, KIDNEYS, NERVES AND ARTERIES

Question 2

Is T2DM ketosis prone? Why

Answer 2

No, we still have insulin and that will stop ketone production

Question 3

Fasting sugar should be X or below, but Y or above means diabetes

Answer 3

6

7

Question 4

2-hour sugar should be X or below, but above Y means diabetes

Answer 4

7.8

11

Question 5

What is someone described as being if their fasting/2 hour sugar is in-between normal and diabetic

Answer 5

Impaired glucose tolerance

Question 6

Using random glucose is unreliable as ….

Answer 6

you don’t know where the reference range should be.

Question 7

Diabetes is most prevalent in which race

Answer 7

The White™

Question 8

Biggest environmental factor for T2DM?

Answer 8

Greatest in ethnic groups that move from rural to urban lifestyle

Question 9

What factors influence TIIDM? (5)

Answer 9

Genes
Obesity
Genes and Intrauterine Environment
Adult environment

Question 10

What needs to happen for T2DM? (4)

Answer 10

Beta cell failure
Inflammation
Metabolic dyslipidaemia
Hyperglycaemia

Question 11

What is MODY?

Answer 11

• Autosomal dominant – single gene defect

- Leads to Ineffective pancreatic Beta cell insulin production

Question 12

What gene is commonly affected in MODY

Answer 12

Glucokinase

Question 13

TIIDM is largely influenced by what?

Answer 13

Genetic

Question 14

What is T2DM fundamentally

Answer 14

There is insulin resistance

Question 15

What modulates insulin resistance

Answer 15

modulated by adipocytokines

Question 16

How does birth weight come in with T2DM

Answer 16

Being born light IUGR is associated with genetic mechanisms of T2DM

Question 17

Insulin resistance and high glucose can also contributes to failure of what cells?

Answer 17

Beta islet cells

Question 18

ONLY diabetes can cause microvascular ….

Answer 18

complications

Question 19

The β-cell failure will eventually lead to …

Answer 19

insulin requirement as the pancreas fails.

Question 20

with age, insulin resistance [increases/decreases]

Answer 20

Increases

Question 21

with age, potential insulin secretion [increases/decreases]

Answer 21

decreases

Question 22

What does the potential Isec/insulin resistance graph suggest

Answer 22

That everyone will get diabetes at some point

Question 23

Presentation of T2DM

Answer 23

• Heterogeneous – TIIDM is a range of conditions with a final common pathway of high sugar.
• Obesity
• Insulin resistance and insulin secretion deficit
• Hyperglycaemia and dyslipidaemia
• Acute and chronic complications

Question 24

Insulin effects?

Answer 24

Encourages glucose uptake into muscle
Decreases hepatic glucose output
Decreases adipocyte FA output
Decreases adipocyte glycerol output

Question 25

Adipocytokines are produced by.....

Answer 25

Adipocytes

Question 26

Adipocytokines role is to ...

Answer 26

tell the brain of the level of fat in your body

Question 27

Most simple way to test risk of ischaemic heart disease?

Answer 27

Measure waist circumference

Question 28

gut microbiota and T2DM / obesity?

Answer 28

There is an association but no causation thus far

Question 29

Common side effect of diabetes treatments?

Answer 29

Weight gain

Question 30

Which diabetes drug doesn't cause weight gain?

Answer 30

Metformin

Question 31

What factors affect Isec potential?

Answer 31

Genes

Question 32

What factors affect IR? (6)

Answer 32

``` Intrauterine environment Microbiota Adipocytokines Exercise Diet Medication ```

Question 33

Early Presentation of T2DM:

Answer 33

- Osmotic symptoms- glycosuria which leads to polyuria, polydipsia - Infections - Late presentation is in the form of complications

Question 34

Microvascular complications of T2DM? (3)

Answer 34

Retinopathy Nephropathy Neuropathy

Question 35

Metabolic complications of T2DM? (2)

Answer 35

Lactic acidosis | Hyperosmolar

Question 36

Macrovascular complications of T2DM? (4)

Answer 36

Ischaemic heart disease Cerebrovascular problems Renal artery stenosis PVD

Question 37

Treatment complications of T2DM?

Answer 37

Hypoglycaemia

Question 38

Basics of managing T2DM (4)

Answer 38

- Education - Diet - Pharmacological treatment - Complication screening

Question 39

how to manage diet in diabetes:

Answer 39

- Control total calories/increase exercise (weight) - Reduce refined carbohydrate (less sugar) - Increase complex carbohydrate (more rice etc.) - Reduce fat as a proportion of calories (lowers IR) - Increase unsaturated fat as a proportion of fat (IHD) - Increase soluble fibre (longer to absorb carbs) - Address salt (BP risk)

Question 40

4 targets for treating T2DM?

Answer 40

1. Weight 2. Glycaemia 3. BP 4. Dyslipidaemia

Question 41

What is used to treat weight in T2DM? (2)

Answer 41

Orlistat- a GI lipase inhibitor, surgery (gastric bypass)

Question 42

What is used to treat glycaemia in T2DM? (2)

Answer 42

``` METFORMIN insulin sulphonylureas metaglinides alpha glucosidase inhibitors thiazolidinediones GLP DPP4 inhibitors SGLT2 inhibitor ```

Question 43

What does metformin do

Answer 43

Reduces HGO | Increases peripheral glucose disposal

Question 44

When is metformin contraindicated

Answer 44

if severe liver, severe cardiac, or mild renal failure

Question 45

Huge pro of metformin?

Answer 45

Doesn't cause weight gain

Question 46

MoA of metformin?

Answer 46

- Bypasses the need for entry of glucose in order to block the ATP sensitive K+ channel - Causes blockage of this channel when it binds to receptors, irrespective of glucose entry - Calcium ions rush in, causing insulin secretion

Question 47

What is acarbose

Answer 47

- Alpha glucosidase inhibitor - enzyme that digests carbohydrates

Question 48

What does acarbose do

Answer 48

- Prolongs absorption of oligosaccharides | - Allows insulin secretion to cope, following defective first phase insulin

Question 49

Side effect of acarbose?

Answer 49

Flatus

Question 50

What is thiazolidinedione

Answer 50

- Peroxisome proliferator-activated receptor agonists- PPAR-GAMMA

Question 51

effect of thiazolidinedione

Answer 51

- Insulin sensitizer, mainly peripherally effective

Question 52

What is GLUCAGON LIKE PEPTIDE-1 (GLP-1):

Answer 52

- Secreted in response to nutrients in the gut by L cells

Question 53

Effect of GLUCAGON LIKE PEPTIDE-1 (GLP-1): (2)

Answer 53

- Stimulates insulin, suppresses glucagon

Question 54

WHY DO WE COADMINISTOR DPPG4 INHIBITORS INSTEAD OF JUST GLP1?

Answer 54

- Short half-life, rapid degradation

Question 55

EMPAGLIFOZIN IS A ...

Answer 55

SGLT2 inhibitor

Question 56

WHAT DOES AN SGLT2 INHIBITOR SUCH AS EMPALIFOZEN DO

Answer 56

- Inhibits Na-Glu transporter, increases glycosuria (and so polyuria unfortunately)

Question 57

Best way to precent diabetes/

Answer 57

Diet and exercise