Week 1/2 - C - Type II diabetes and treatment Flashcards
What percentage of patients with diabetes does type II diabetes account for?
approx 85%
How does obesity lead to type II diabetes? 90% of people with type 2 diabetes are overweight or obese
Leads to a decreased number and decreased sensitivity of insulin receptors causing hyperinsulinaemia and hyperglycaemia
Is being a pear or apple shape a risk factor for diabetes? What two conditions in women can cause type II diabetes? (one can affect getting pregnant, one occurs during pregnancy)
Obesity – central/apple shape
Gestational diabetes and polycystic ovarian syndrome (PCOS)
What are the two main pathophysiological defects associated with type II diabetes? How do they occur?
Insulin resistance and beta cell dysfunction
Insulin resistance can occur due to obesity - insulin resistance causes an initial attempt of compensation by the beta cells leading to the initial hyperinsulinaemia
followed by beta cell exhaustion (beta cell dysfunction) causing hypoinsulinaemia
Apart from obesity, what are other risk factors for type II diabetes?
Smoking
Genetics
Inactivity
Hypertension
What are symptoms of type II diabetes?
Thrush
Fatigue
Infections
Blurred vision
Signs of complication eg retinopathy or neuropathy
Symptoms of hyperglycaemia, appears rapid although takes place over a long time and weight loss What are the symptoms of hyperglycaemia in type II diabetes and how T2DM diagnosed?
Polyuria and polydipsia
Diagnosed by measuring blood glucose levels
What is usually seen on histological appearance of the islet cell in T2DM?
Amyloid deposition within the islet cell
How is the prognosis of T2DM greatly improved?
Greatly improved with weight loss and exercise
What type of diabetes develops in pregnancy and resolves post-natally?
Gestation diabetes - greatly increases risk of T2DM
If weight loss and exercise fail to maintain blood sugar with these methods alone, what can be given as first line for Type 2 diabetes mellitus? Start low and go slow How does this drug work?
Give metformin
Metformin is an insulin sensitizer
Also decreases hepatic gluconeogenesis and decreases carbohydrate absorption in the GI tract
What positive effects does metofrmin have? (name 4)
Reduces HbA1c by 15-20mmol/mol by lowering insulin resistance
Does not cause hypoglycaemia
Prevents micro and macrovascular complications
Reduces BP and weight loss
What are the adverse effect of metofrmin and what patients should be avoided in? Also what type of drug is metformin?
Can cause GI upset - mostly anorexia, diarrhoea and nausea
Avoid in patients with liver, cardiac or renal failure as can cause lactic acidosis
Metformin is a biguanide
What HbA1c level is targeted for a person with T2DM on metformin? What is the recommended HbA1c level before adding a second drug to metformin to manage the diabetes?
In a patient taking maximum dose metformin who has a HbA1c of 58 or greater current guidelines recommend the addition of a second agent.
The average patient who is taking metformin for T2DM, you can titrate up metformin and encourage lifestyle changes to aim for a HbA1c of 48 mmol/mol (6.5%),
but should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)
What is the second line treatment of type 2 diabetes? How does this drug work?
Sulphonylureas -
they work by binding to the sulphonylurea subunit receptors (SUR1) on the ATP sensitive potassium channels and therefore closing them increasing the release of endogenous insulin -
* increase endogenous insulin secretion