T1 L13 Type 2 DM

Question 1

What is diabetes mellitus?

Answer 1

Condition where blood glucose is above an internationally accepted level

Question 2

What is the clinical diagnosis of diabetes mellitus in terms of blood results?

Answer 2

Glucose ≥11.1mmol/l + symptoms
Glucose ≥ 11.1mmol/l x 2
GbA1c ≥48mmol/mol (6.5%)

Question 3

Describe the results of the 75g glucose tolerance test and what they indicate

Answer 3

Diabetes mellitus:
Fasting plasma glucose ≥7mmol/l
2 hour plasma glucose ≥11.1mmol/l

Impaired glucose tolerance:
2 hour glucose between 7-11mmol/L

Impaired fasting glucose:
fasting glucose between 6-6.9 mmol/l

Question 4

What is type 2 diabetes?

Answer 4

Insulin resistance and beta cells which can’t produce enough insulin to keep blood glucose normal

Question 5

What are the epigenetics of type 2 diabetes?

Answer 5

Fetal programming:

• maternal hyperglycaemia
• intrauterine growth retardation

Question 6

What are some possible aetiological factors for type 2 diabetes?

Answer 6

Beta cell regression
Old age
Other pancreatic pathology
Change in gut microbiota
Glucotoxicity and lipotoxicity

Question 7

What things are produced by endocrine organs that lead to ectopic fat?

Answer 7

Free fatty acids:

• insulin resistance
• atherogenic lipids

Cytokines:

• insulin resistance
• inflammation

Procoagulant factors

Question 8

What age group is most likely to be overweight or obese?

Answer 8

55 to 64

Question 9

What does the nurses health study attribute diabetes to?

Answer 9

BMI >23
Lack of exercise
Unhealthy diet

Question 10

What are the side effects of type 2 diabetes that lead to morbidity?

Answer 10

Hyperglycaemia
Dysregulation of lipid metabolism
High levels of pro inflammatory cytokines
High levels of free radicals
Increased susceptibility to infection

Question 11

How does diabetes lead to retinopathy?

Answer 11

Blood glucose too high for too long

Question 12

How does diabetes lead to cataracts?

Answer 12

Increased generation of polyols from glucose

Question 13

Describe bone in type 2 diabetes

Answer 13

Mechanically weaker

Risk of fractures is double despite having normal bone density

Question 14

What should be done in type 2 diabetes?

Answer 14

Prevent the diabetes
Improve the hyperglycaemia
Reduce cardiovascular risk factors
Screen for complications so they can be treated early

Question 15

How can you treat dyslipidaemia?

Answer 15

Statins

Question 16

What screening should be done for eye health?

Answer 16

Retinal photography

Laser treatment when required

Question 17

What screening should be done for kidney health?

Answer 17

Measure urine albumin (EMU)
Control BP
ACE inhibitors and ARBs

Question 18

What screening should be done for foot health?

Answer 18

Screen for neuropathy

Screen for vascular disease

Question 19

What are the goals in T2DM?

Answer 19

Lifestyle modification
Screen for complications
Special clinics for complications (foot, renal, eye)
HbA1c 6.5-7.5%
BP 120-140/89
LDL <2.0mmol/l
Non-HDL cholesterol <2.78

Question 20

What are the pharmacological goals when treating T2DM?

Answer 20

Reduce insulin resistance
Increase insulin production / secretion
Provide insulin replacement

Question 21

What metabolic surgery can be done to treat T2DM?

Answer 21

Sleeve gastrectomy

Roux en Y bypass