What is the prevalence of Type 2 diabetes in Scotland?
The prevalence of Type 2 diabetes is increasing but its incidence is remaining the same.
Which disease has a stronger genetic component - Type 1 or Type 2 diabetes?
Type 2 diabetes
What do beta cells do to compensate for insulin resistance in Type 2 diabetes?
Increase in number
What pre-diabetic state of hyperglycaemia occurs before the onset of Type 2 diabetes?
Impaired glucose tolerance
Which cells fail to cause impaired glucose tolerance?
Type 2 diabetes has a massive genetic component - what do these genes usually affect the function of?
In Type 2 diabetes, cells have a reduced ___ to insulin.
What sort of relationship exists between BMI and Type 2 diabetes risk?
Higher BMI = Higher risk of diabetes
Why does obesity accelerate the onset of Type 2 diabetes?
Obesity causes insulin resistance
Beta cell dysfunction in Type 2 diabetes leads to the state of ___, which over time causes ___ complications.
How is the risk of microvascular complications reduced in Type 2 diabetes?
diet, exercise, drugs
(Impaired glucose sensitivity / Insulin resistance) is strongly linked to the onset of macrovascular disease.
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)
What is the first line drug for all patients diagnosed with Type 2 diabetes?
What dose is metformin prescribed at initially?
What is this dose then increased to?
Over how long?
Increased to 1g (BD)
Over 4-6 weeks
How does metformin reduce blood glucose concentration?
Decreases hepatic gluconeogenesis
Increases peripheral glucose uptake
What is metformin's effect on weight?
When should the use of metformin be avoided?
In patients with renal impairment
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
Metformin (increases / reduces) your risk of coronary heart disease.
reduces risk of CHD
What are two important side effects of metformin?
GI upset - nausea; vomiting; diarrhoea
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?
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