DIABETES TYPE 2

Question 1

What is T2DM?

Answer 1

Progressive disorder defined by deficit in insulin secretion and action

Question 2

What causes T2DM?

Answer 2

Cells do not respond well to Insulin

Beta Cells undergo hyperplasia and hypertrophy to produce more

Increase in release of Amylin which causes hypoplasie and hypotrophy

Hyperglycaemia

Question 3

What are the common symptoms of T2DM?

Answer 3

Usually Asymptomic

Commonly seen: polyuria, polydipsia, fatigue, weight loss, opportunistic infections, slow healing

Question 4

What are the signs of T2DM?

Answer 4

Blurred vision

UTI (cystitis or pyelonephritis)

Skin infections (Cellulitis or 
Abscesses)

Question 5

What are Risk Factors of T2DM?

Answer 5

> 30yo

Obesity

Inactivity

Black/Hispanic/native American

FHx

Pre-Diabetes

Question 6

What is Pre-Diabetes?

Answer 6

Higher than normal blood glucose levels (yet not high enough to be T2DM but can lead to it)

Question 7

What is Diabetes Insipidus?

Answer 7

Uncommon metabolic disorder that causes imbalance of fluids in the body due to lack of ADH - leading to thirty and polyuria

Treated with Desmopressin (synthetic ADH)

Question 8

What is the first line drug treatment for T2DM?

Answer 8

Metformin or Pioglitazone (reduce insulin resistance)

SE: weight loss, GI symptoms (diarrhoea, nausea, abdominal discomfort, lactic acidosis)

Question 9

What do you do if hbA1c rises to 58mmol/mol while on metformin?

Answer 9

+ sitagliptin (DPP4 inhibitor - reducing blood sugar level)

+ Pioglitazone

+ sulphonylurea (helps the body secret insulin by increasing B cells activity)

+ glifazon (SGLT-2i increase glucose secretion)

Question 10

What if the hbA1c rises after dual therapy?

Answer 10

+ su

+ glifazon

Move to insulin based therapy

Question 11

Name a long Acting and short acting Insulin supplement?

Answer 11

SA: lispro or Novolog

LA: Lantus or Levemir

Question 12

What can be used to manage hypertension in diabetes?

Answer 12

Amlodipine

Bendrofluazide

Lisinopril

Question 13

What is Hyperosmolar Hyperglycemic State (HHS)?

Answer 13

Increased plasma similarity from dehydration and increased concentration of glucose causing water to enter blood vessels increasing urination and dehydration

Question 14

What are the signs and symptoms of HHS?

Answer 14

Mental status changes
Ketonemia
Acidosis
Poor skin turgor 
Hypotension
Seizures

Question 15

How is HHS treated?

Answer 15

IV fluid

IV insulin

IV electrolytes replacement (potassium)

Vasopressor (noradrenaline/dopamine)

Question 16

What is DKA?

Answer 16

An acute metabolic complication of diabetes that is potentially fatal

Characterised by absolute insulin deficiency

Question 17

What causes DKA?

Name some common triggers

Answer 17

Reduced insulin in diabetes causes increased lipolysis which increases ketone bodies produced by the liver and results in acidity of the blood

Common triggers:
Infections 
High levels of cortisol or adrenaline
Trauma
Pancreatitis
Alcohol 
Pregnancy
Cocaine 
Corticosteroids

Question 18

What are the symptoms of DKA?

Answer 18

Polydipsia

Polyuria

Nausea and vomiting

Fatigue

Hyperkalaemia

Hyperglycaemia

Ketone in urine

Question 19

What are the signs of DKA?

Answer 19

Acetone smell on breath

Hyperventilation

Cerebral oedema

Acute abdominal pain

Confusion

Question 20

What are common risk factors of DKA?

Answer 20

T1DM

Poor Insulin therapy

Infection

MI

Question 21

What blood test it performed for DKA diagnosis?

Answer 21

VBG: Metabolic acidosis

Blood ketone: ketonaemia

Blood glucose: hyperglycaemia

U&E: hyponatreamia and hyperkalaemia (hypokalaemia in severe DKA)

FBC: leukocytosis

Question 22

How do you treat DKA?

Answer 22

Fluids (500ml saline)

Insulin

Glucose

Potassium

Infection (antibiotic)

Chart fluid balance

Ketones (monitor)