Diabetes Mellitus - Type 2 Flashcards
Define Type 2 Diabetes Mellitus
Chronic syndrome of impaired metabolism characterised by peripheral target-tissue resistance to insulin action, impaired insulin secretion and raised hepatic glucose output
Aetiology of Type 2 Diabetes Mellitus
Insulin resistance + impaired secretion -> hyperglycaemia
Background genetic predisposition + ageing, physical inactivity, obesity
Insulin resistance usually affects the liver, muscle and adipocytes
Secondary to: chronic pancreatitis, haemochromatosis, pancreatic cancer, Cushing’s, acromegaly, phaeos, steroid use
Symptoms of Type 2 Diabetes Mellitus
Asymptomatic
Tiredness/fatigue Blurred vision Infections (foot ulcers, candidiasis, balantitis, pruritus vulvae, cellulitis, UTI) Polyuria, polydipsia, nocturia Paraesthesia Polyphagia Unintentional weight loss
Signs of Type 2 Diabetes Mellitus on examination
Acanthosis nigricans
Obesity
Diabetic foot: dry skin | reduced SC tissue | corns + calluses | ulceration | gangrene | Charcot’s foot | Pedal pulses weak/absent
Rare skin changes: Necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic dermopathy
Investigations for Type 2 Diabetes Mellitus
Fasting plasma flucose >6.9
Random plasma glucose > 11.1 (+symptoms)
Oral glucose tolerance test >11.1
HbA1c >48
Urinary/Plasma ketones: negative (differentiate from T1)
ABPI: Suggests PAD
Urinary albumin excretion: may be increased (end-organ damage)
ECG: ?ischaemia
Fundoscopy: detect retinopathy
Albumin:creatinine ratio: detect microalbuminuria (nephropathy)
Fasting C peptide: >1 (differentiate from T1)
Fasting lipid profile: dyslipidaemia (More common T2)
Serum Cr and eGFR: Detect renal insufficiency
CXR: ?Charcot’s foot
Conservative management for Type 2 Diabetes Mellitus
First line before medication Personalised self-management - Limit caloric intake - Moderate physical activity (3-4 aerobic a week) - Weight loss - Reduce alcohol intake - Smoking cessation
Medical management for Type 2 Diabetes Mellitus
- Glycaemic control
Start with Metformin - BP management
Start with ACEi/ARB - Lipid management
Atorvastatin (dose depends on underlying disease) - Antiplatelets (bg cardiovascular disease)
Aspirin
What are the types of glycaemic control drugs for Type 2 Diabetes Mellitus and which cause weight gain/loss
=> Insulin sensitisers
- Metformin (biguanide): Reduces insulin resistance (Wt loss)
- Thiazolidinedione (Pioglitazone): insulin sensitiser (PPAR-y receptor) (Wt gain)
=> Insulin provider
- Insulin
- Sulphonylureas (glibenclamide): insulin secretagogue (K+ channel blocker) (Wt gain)
- Metaglinide (repaglinide) (Wt gain)
=> Incretin enhancers
- GLP-1 (liraglutide, exenatide): stimulate insulin, suppress glucagon secretion (Wt loss)
- Gliptins: DPP4 inhibitors to reduce breakdown of GLP-1 (weight neutral)
=> Glucose excretors:
- SLGT-2 inhibitos (anagliflozin): inhibitis sodium glucose transporter -> renal glucose reabsorption inhibited (Wt loss, risk of necrotising fasciitis)
- Alpha-glucosidase inhibitors (acarbose): delays + prolongs absorption of carbs
Complications of Type 2 Diabetes Mellitus
End stage renal disease Blindness Amputation Cardiovascular disease Congestive heart failure Stroke Infection Periodontal disease Neuropathy Depression Obstructive sleep apnoea DKA Non-ketotic hyperosmolar state/HHS
What is HHS
Hyperosmolar hyperglycaemic state
Due to insulin deficiency
Longer history (1 week) of:
Collpase/confusion
Dehydration
Nause + vomiting
Features: Marked dehydration Hypernatraemia Hyperglycaemia (>35) Hyperosmolar >240) NO acidosis
Prognosis for Type 2 Diabetes Mellitus
UKDSP showed intensive therapy for glycaemic control reduces risk of development and progression of diabetic microvascular complications
Early control reduces risk for MI and all-cause mortality
