1: T2 DM pathophysiology and management Flashcards Preview

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1

What is the prevalence of Type 2 diabetes in Scotland?

Around 5%

2

The prevalence of Type 2 diabetes is increasing but its incidence is remaining the same.

Why?

Aging population

3

Which disease has a stronger genetic component - Type 1 or Type 2 diabetes?

Type 2 diabetes

4

What do beta cells do to compensate for insulin resistance in Type 2 diabetes?

Increase in number

hyperplasia

5

What pre-diabetic state of hyperglycaemia occurs before the onset of Type 2 diabetes?

Impaired glucose tolerance

6

Which cells fail to cause impaired glucose tolerance?

Beta cells

7

Type 2 diabetes has a massive genetic component - what do these genes usually affect the function of?

Beta cells

8

In Type 2 diabetes, cells have a reduced ___ to insulin.

sensitivity

9

What sort of relationship exists between BMI and Type 2 diabetes risk?

Higher BMI = Higher risk of diabetes

10

Why does obesity accelerate the onset of Type 2 diabetes?

Obesity causes insulin resistance

11

Beta cell dysfunction in Type 2 diabetes leads to the state of ___, which over time causes ___ complications.

hyperglycaemia

microvascular complications

12

How is the risk of microvascular complications reduced in Type 2 diabetes?

Glycaemic control

diet, exercise, drugs

13

(Impaired glucose sensitivity / Insulin resistance) is strongly linked to the onset of macrovascular disease.

Insulin resistance

14

Independent of diabetes drugs, how is cardiovascular disease risk reduced in those diagnosed with Type 2 diabetes?

According to Tayside guidelines:

If age > 40, add atorvastatin

If BP > 130/80 mmHg, add anti-hypertensive (usually an ACE inhibitor)

15

What is the first line drug for all patients diagnosed with Type 2 diabetes?

Metformin

16

What dose is metformin prescribed at initially?

What is this dose then increased to?

Over how long?

500mg (BD)

Increased to 1g (BD)

Over 4-6 weeks

17

How does metformin reduce blood glucose concentration?

Decreases hepatic gluconeogenesis

Increases peripheral glucose uptake

18

What is metformin's effect on weight?

Weight neutral

19

When should the use of metformin be avoided?

In patients with renal impairment

20

In terms of HbA1c targets:

The ideal level is < ___ mmol/mol, but if levels drift upwards, you should aim to have the patient below ___ and never above ___.

Unless the patient is elderly, in which case you'd relax the target up to __.

Ideally < 48 mmol/mol, if upward drift then aim for < 53 and don't allow it to exceed 58

Elderly target is between 53 - 75 mmol/mol

21

Metformin (increases / reduces) your risk of coronary heart disease.

reduces risk of CHD

22

What are two important side effects of metformin?

GI upset - nausea; vomiting; diarrhoea

Lactic acidosis

23

If a patient was already showing osmotic symptoms or they couldn't tolerate metformin, what would you give them along with 3 months of lifestyle modification?

Sulphonylurea

24

Generally, if a patient's glycaemic control was poor, would you

a) increase the dose of drugs they are taking

b) add more drugs?

Different for specific cases but generally you want to add more drugs