Type 2 Diabetes

Question 1

What is the definition of type 2 diabetes?

Answer 1

Peripheral insulin resistance with partial insulin deficiency (CHO/lipid/b amyloid deposits in pancreas)

Question 2

Who are at risk of T2DM?

Answer 2

40+, males (south Asian)

Question 3

What causes T2DM?

Answer 3

Reduced insulin secretion +/- increased insulin resistance
Gestational diabetes, steroids, Cushings, chronic pancreatitis

Question 4

What are some risk factors of T2DM?

Answer 4

Lifestyle: obesity, lack of exercise, smoking, alcohol excess, hypertension
Late onset

Question 5

What is the pathology of T2DM?

Answer 5

Peripheral insulin resistance (eg. Malfunctional insulin extracellular activation pathway)

Therefore decreased GLUT4 expression + minor destruction to pancreatic islets (amyloid + CHO/lipid)

Result= hyperglycemia with increased insulin demand from a depleted B cell population

Question 6

What are some signs and symptoms of T2DM?

Answer 6

Central obesity
Hypertensive
Older patient with polydipsia, polyuria (+ nocturia), glycosuria
Slower onset, blurred vision

Ancanthosis nigricans = dark pigmented skin folds - severe insulin deficiency

Question 7

What tests would you do to diagnose someone with T2DM?

Answer 7

Same as T1DM
FPG, RPG, HbA1C

Question 8

What are the pre diabetic states? And tests?

Answer 8

Impaired glucose tolerance (IGT)
normal FPG <6 mmol/L + 2 hour OGTT (75g): 7.8 - 11.1

Impaired fasting glycaemia (IFG)
FPG: 6.1 - 6.9 mmol/L
2h OGTT (75g) <7.8

Question 9

What are the normal, pre diabetic and diabetic ranges for OGTT and FPG?

Answer 9

OGTT:
Normal = <7.8
Prediabetic = 7.8 - 11
Diabetic = 11<

FPG:
Normal = <6
Prediabetes = 6.1 - 6.9
Diabetes = >7

Question 10

What is the treatment for prediabetes?

Answer 10

1st line management: Lifestyle changes
Diet, exercise, decreased alcohol and smoking, regular HbA1C monitoring

Question 11

What is the treatment for diabetes?

Answer 11

2nd line management- medications
1. Metformin (biguanide - increase insulin sensitivity)
2. Dual therapy - SGLT-2 inhibitor, GLP1 analogues or DPP4-i
3. Triple therapy -sulphonylureas (glicazide) - increase insulin secretion
4. Last resort - insulin

Question 12

What do SGLT-2 inhibitors do?
Side effects?

Answer 12

Inhibit reabsorption of glucose in kidneys therefore increased excreted

Side effects: euglycaemia, ketoacidosis, thrush

Question 13

Why are Thiazolidinediones rarely used?

Answer 13

Increased weight, risk of heart failure and risk of fracture

Question 14

What is MODY?
Who does it effect?

Answer 14

Maturity onset diabetes of youths
Rate auto dominant T2DM presentation in young patient
Treatment= Sulfonylureas