Type two diabetes (R1)

Question 1

Aetiology
- Adiposity/obesity can contribute to diabetes through which three mechanisms?
- Are genetics important?

Answer 1

Yes

Question 2

Pathophysiology
- Describe the body’s initial compensation for insulin resistance

Answer 2

Initially, the body produces more insulin via beta cell hypertrophy + hyperplasia.
Keeps BGLs at normal levels despite insulin resistance.

Question 3

Pathophysiology
- What happens to the beta cells over time?
- Why is DKA more rare in T2DM compared to T1DM?

Answer 3

Beta cells become exhausted –> undergo hypotrophy + hypoplasia –> hyperglycaemia

There is some circulating insulin left from remaining beta cells. This is enough to suppress lipolysis and thus ketogenesis

Question 4

What are the short term complications of T2DM

Answer 4

• Hyperosmolar hyperglycaemic state
• DKA (less common)

Question 5

What are the long term complications of T2DM?

Answer 5

Macrovascular + microvascular complications, as per T1DM
Infections: skin (cellulitis/abscesses), UTIs, yeast infections
NAFLD

Question 6

Risk factors for T2DM?

Answer 6

Question 7

Prevention of T2DM

Answer 7

Question 8

History?

Answer 8

As per T1DM (not DKA)
- Polyphagia + weight loss + fatigue
- Polyuria + polydipsia
- Blurred vision

Question 9

Investigations
- For diagnosis: is it as per T1DM?

Answer 9

Yes

Question 10

3 principles of management?

Answer 10

• Glycaemic monitoring
• Glycaemic control
• Monitoring for complications

Question 11

Glycaemic control
- 2 ways of monitoring?

Answer 11

BGLs + HbA1c

Question 12

Glycaemic control
- 2 ways

Answer 12

Lifestyle
Medications

Question 13

Glycaemic control
- Lifestyle approaches?
- Should lifestyle changes be trialled before starting medications?

Answer 13

Weight loss
- Diet (low GI + low sat fat) and exercise
- Medications + bariatric surgery

YesG

Question 14

Glycaemic control: medications
- What is the first line medication?
- If Hb1Ac target (usually 7%) is not met, what can you do?

Answer 14

Metformin

Add other therapies, but consider:
- Patient factors: patient understanding of management plan, adherence to treatment
- Medication factors: appropriateness, side effects

Question 15

Glycaemic control: medications
- Diabetes Australia recommendations?

Answer 15

Question 16

Patient explanation:
- Normal physiology?

Answer 16

• Your cells use glucose for fuel.
• Your pancreas makes a chemical from insulin, which gets glucose from your bloodstream into your cells –> where it can be used for energy

Question 17

Patient explanation
- What is type 2 diabetes?
- What causes it?

Answer 17

• Type 2 diabetes is when your cells don’t respond to insulin effectively (insulin resistance).
• Makes it more difficult for glucose to get from your bloodstream into your cells. Glucose stays in the blood, leading to high blood sugar.

Question 18

Patient explanation
- Treatment?

Answer 18