Type 2 Diabetes Flashcards
T2DM
Due to progressive insulin secretory defect on the background of insulin resistance
Polygenic common complex disease
Epidemiology
predominantly present in >40
Greatest prevalence in low and middle income countries
Aetiology
Obesity
Chronic Pancreatitis
Peak age of onset: 50 years
Cushing’s syndrome
Genetics
40% lifetime risk in offspring
Over 400 genetic variants
Twin studies: Monozygotic concordance rate of 90%
Highly heritable
Pathophysiology
Combination of insulin resistance and inadequate production
- beta cell destruction
- Impaired secretion of insulin
Exceeding fat storage threshold
- lipid overspill
- lipotoxicity
- vulnerable beta-cells
The adiposity exceeding fat storage threshold leads to lipotoxicity causing vulnerable beta-cells
Fat storage threshold
Insulin resistance occurs when fat can no longer be safely stored in subcutaneous adipose tissue causing spill over of FFA to. the viscera
People with ‘healthy’ obesity are able to safely store lots of fat; others have low fat storage threshold
insulin resistance associations
hypertension
hyperlipidaemia
hyperglycaemia
Polycystic ovarian syndrome
Signs
increased BMi
Retinopathy
Peripheral Neuropathy
Symptoms
Often with complications of diabetes
- e.g. peripheral vascular disease, CVA, MI
Hyperosmolar Non-Ketotic Coma (HONK)
Recurrent infection
Pruritus
Aims of Management
Treat Symptoms
Prevent microvascular complications
- glucose control
- aim for HbA1c <53mmol/L
Prevent CV complications
- cholesterol control
- BP control
- Antiplatelet therapy
Screen for complications early
- eye disease
- neuropathy
- kidney disease
Management pathway
- Diagnosis
- Therapeutic Lifestyle change
- Monotherapy
- Combination therapy (NOT insulin)
- Combination therapy with insulin
Therapeutic management
Diet and exercise
Aim for realistic targets with weight maintanence/ modest weight loss
- 5 to 10kg in one year
General guidance on healthy eating
- Increase veg and decrease fats
HbA1c Targets
Symptomatic control
Prevent complications
- HbA1c <53 mol/mol
Targets should be set with individuals in order to balance benefits with harm (in particular hypoglycaemia and weight gain)
For patients on triple oral therapy or insulin
- an HbA1c of 58 mol/L may be appropriate
Glycaemic Control
Initially treat with diet
If unsatisfactory control, consider oral hypoglycaemic
Complication Surveillance
Annual Review
- Fundoscopy
- Feet examination (neurological and vascular)
Check Insulin Sites
BP monitoring
Monitor renal function
Urine. protein dipstick
Thyroid function
