Type II DM

Question 1

How common is it?

Answer 1

• 2.7 million people in the UK. 90% of diabetes cases.

Question 2

What causes it?

Answer 2

• Reduced insulin secretion and/or increased insulin resistance, leading to increased blood glucose.

Question 3

What risk factors are there (and how can they be reduced)?

Answer 3

• Associated with obesity, lack of exercise. calorie and alcohol excess. Higher prevalence in asian men and the elderly. >80% concordance in identical twins.

Question 4

How does it present?

Answer 4

• Polydipsia, polyuria, lethargy, boils, pruritus vulvulae, increased hunger, increased thirst.

Question 5

Which other conditions may present similarly?

Answer 5

• Type II DM, monogenic DM, secondary hyperglycaemia, disorders of target tissues, other endocrine hypersecretion disorders, drugs, chronic pancreatitis, CF, prader-willi syndrome, non-diabetic glycosuria, renal glycosuria, peripheral neuropathy from alcohol abuse of B12 deficiency.

Question 6

How would you investigate the patient?

Answer 6

Diagnosis

• Symptoms of hyperglycaemia AND raised venous glucose detected once – fasting >7mmol/L or random >11.1mmol/L OR
• Raised venous glucose on 2 separate occasions – fasting >7mmol/L, random >11.1mmol/L or oral glucose tolerance test (OGTT) – 2h value >11.1mmol/L
• HbA1c >48mmol/L but below doesn’t exclude DM. Avoid in pregnancy, children and type 1 DM.

Question 7

What treatment/s would you consider? What risks and benefits of treatment are there?

Answer 7

Drugs

• Metformin - (a biguanide) - increased insulin sensitivity and helps weight. (SE = nausea, diarrhoea, abdo pain, not hypoglycaemia.) Avoid if eGFR 53mmol/L 16 weeks later, add:
• Sulfonylurea - Increase insulin secretion. (Eg gliclazide). (SE = hypoglycaemia, increases weight.) If HbA1c >57mmol/L at 6mths, consider:
• Insulin - may be needed.
• Glitazone - Increased insulin sensitivity.
• Sulfonylurea receptor binders - Increased beta-cell insulin release.
• Glucagon-like-peptide (GLP) analogues - Incretins are gut peptides that work by augmenting insulin release.
• Alpha-glucosidase inhibitors - (acarbose) - reduced breakdown of starch to sugar.