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Endocrinology Y2 > Type II Diabetes Mellitus > Flashcards

Type II Diabetes Mellitus Flashcards

1
Q

Definition

A

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

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2
Q

Is T2DM ketosis prone? Why

A

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

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3
Q

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

A

6

7

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4
Q

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

A

7.8

11

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5
Q

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

A

Impaired glucose tolerance

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6
Q

Using random glucose is unreliable as ….

A

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

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7
Q

Diabetes is most prevalent in which race

A

The White™

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8
Q

Biggest environmental factor for T2DM?

A

Greatest in ethnic groups that move from rural to urban lifestyle

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9
Q

What factors influence TIIDM? (5)

A

Genes
Obesity
Genes and Intrauterine Environment
Adult environment

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10
Q

What needs to happen for T2DM? (4)

A

Beta cell failure
Inflammation
Metabolic dyslipidaemia
Hyperglycaemia

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11
Q

What is MODY?

A
  • Autosomal dominant – single gene defect

- Leads to Ineffective pancreatic Beta cell insulin production

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12
Q

What gene is commonly affected in MODY

A

Glucokinase

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13
Q

TIIDM is largely influenced by what?

A

Genetic

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14
Q

What is T2DM fundamentally

A

There is insulin resistance

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15
Q

What modulates insulin resistance

A

modulated by adipocytokines

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16
Q

How does birth weight come in with T2DM

A

Being born light IUGR is associated with genetic mechanisms of T2DM

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17
Q

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

A

Beta islet cells

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18
Q

ONLY diabetes can cause microvascular ….

A

complications

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19
Q

The β-cell failure will eventually lead to …

A

insulin requirement as the pancreas fails.

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20
Q

with age, insulin resistance [increases/decreases]

A

Increases

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21
Q

with age, potential insulin secretion [increases/decreases]

A

decreases

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22
Q

What does the potential Isec/insulin resistance graph suggest

A

That everyone will get diabetes at some point

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23
Q

Presentation of T2DM

A
  • 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
24
Q

Insulin effects?

A

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

25
Q

Adipocytokines are produced by…..

A

Adipocytes

26
Q

Adipocytokines role is to …

A

tell the brain of the level of fat in your body

27
Q

Most simple way to test risk of ischaemic heart disease?

A

Measure waist circumference

28
Q

gut microbiota and T2DM / obesity?

A

There is an association but no causation thus far

29
Q

Common side effect of diabetes treatments?

A

Weight gain

30
Q

Which diabetes drug doesn’t cause weight gain?

A

Metformin

31
Q

What factors affect Isec potential?

A

Genes

32
Q

What factors affect IR? (6)

A 
Intrauterine environment
Microbiota
Adipocytokines
Exercise
Diet
Medication
33
Q

Early Presentation of T2DM:

A
  • Osmotic symptoms- glycosuria which leads to polyuria, polydipsia
  • Infections
  • Late presentation is in the form of complications
34
Q

Microvascular complications of T2DM? (3)

A

Retinopathy
Nephropathy
Neuropathy

35
Q

Metabolic complications of T2DM? (2)

A

Lactic acidosis

Hyperosmolar

36
Q

Macrovascular complications of T2DM? (4)

A

Ischaemic heart disease
Cerebrovascular problems
Renal artery stenosis
PVD

37
Q

Treatment complications of T2DM?

A

Hypoglycaemia

38
Q

Basics of managing T2DM (4)

A
  • Education
  • Diet
  • Pharmacological treatment
  • Complication screening
39
Q

how to manage diet in diabetes:

A
  • 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)
40
Q

4 targets for treating T2DM?

A
  1. Weight
  2. Glycaemia
  3. BP
  4. Dyslipidaemia
41
Q

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

A

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

42
Q

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

A 
METFORMIN
insulin 
sulphonylureas 
metaglinides
alpha glucosidase inhibitors
thiazolidinediones
GLP DPP4 inhibitors 
SGLT2 inhibitor
43
Q

What does metformin do

A

Reduces HGO

Increases peripheral glucose disposal

44
Q

When is metformin contraindicated

A

if severe liver, severe cardiac, or mild renal failure

45
Q

Huge pro of metformin?

A

Doesn’t cause weight gain

46
Q

MoA of metformin?

A
  • 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
47
Q

What is acarbose

A
  • Alpha glucosidase inhibitor - enzyme that digests carbohydrates
48
Q

What does acarbose do

A
  • Prolongs absorption of oligosaccharides

- Allows insulin secretion to cope, following defective first phase insulin

49
Q

Side effect of acarbose?

A

Flatus

50
Q

What is thiazolidinedione

A
  • Peroxisome proliferator-activated receptor agonists- PPAR-GAMMA
51
Q

effect of thiazolidinedione

A
  • Insulin sensitizer, mainly peripherally effective
52
Q

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

A
  • Secreted in response to nutrients in the gut by L cells
53
Q

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

A
  • Stimulates insulin, suppresses glucagon
54
Q

WHY DO WE COADMINISTOR DPPG4 INHIBITORS INSTEAD OF JUST GLP1?

A
  • Short half-life, rapid degradation
55
Q

EMPAGLIFOZIN IS A …

A

SGLT2 inhibitor

56
Q

WHAT DOES AN SGLT2 INHIBITOR SUCH AS EMPALIFOZEN DO

A
  • Inhibits Na-Glu transporter, increases glycosuria (and so polyuria unfortunately)
57
Q

Best way to precent diabetes/

A

Diet and exercise

Endocrinology Y2 (18 decks)

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