T2 diabetes Flashcards
(33 cards)
What is type II diabetes? What is it associated with? What can it be managed with initially and at later stages?
- Type II diabetes is a combination of insulin resistance and defect in insulin production by β cells.
- Associated with obesity but not always.
- Initially resultant hyperglycaemia can be managed by lifestyle changes/medications but later on may need insulin.
What is the initiating factor of T2D?
insulin resistance
What happens during the intermediate phase before T2D and at T2D stage?
During the intermediate phase there is an increase in insulin production by β cells in order to compensate for the insulin resistance but by T2D insulin production has wained/decreased.
What is needed for T2D diagnosis?
Can be made on random blood glucose above 11.1 if associated with symptoms. Can be made with fasting glucose or 2-hour glucose test.
Why doesn’t the hyperglycaemia here usually not cause ketosis?
Because ketosis usually happens when there is no insulin production at all, here there is just enough to prevent ketosis. They can still get ketoacidosis if unwell.
What is long duration type II diabetes?
When β cell failure can progress to complete insulin deficiency
What is the pathophysiology behind insulin resistance?
Increase in adipocytokines (pro-inflammatory cytokines) increase insulin resistance. Fatty acids play a major role
What are the responses normally and in type II diabetes when exposed to glucose?
Normally when exposed to glucose they should have a very fast peak of insulin production (first phase insulin production). In intermediate state this is blunted. In T2D this is absent. Loss of 1st phase insulin production
What does the reduced action of insulin do to the liver?
Increases hepatic glucose output. Impaired insulin mediated glucose disposal.
What do GWAS show in T2D?
GWAS show that SNPs alone have mild effect on T2D but cumulative effect of all SNPs is significant
What is the role of obesity in T2D?
Big association. Fatty acids and adipocytokines important and drive insulin resistance. Central obesity.
What are other things that contribute to T2D?
Intrauterine environment and gut microbiota
What is the presentation of T2D?
Less osmotic symptoms, hyperglycaemia, obesity, dyslipidaemia, hypertension
What are risk factors for T2D?
Age, high BMI, ethnicity, PCOS, inactivity, family history
What is needed for diagnosis in terms of HbA1C?
1 x HbA1C > 48 mmol/l if symptomatic. 2x if asymptomatic
What is a hyperosmolar hyperglycaemic state?
Hyperosmolar hyperglycaemic state is when they usually present with renal failure. They are both hyperglycaemic and very hyperosmolar (dehydrated) - get osmotic diuresis to get rid of the glucose
What is management for T2D?
Lifestyle changes/diet modification, medications, insulin later on, education
What does a consultation of T2D usually include?
Check glucose levels, HbA1C, weight, medication review, blood pressure, dyslipidaemia, complication asessemnt
What are dietary reccomendations for T2D?
Total calorie control, reduce calories as simple carbs increase as complex carbs, reduce sodium intake
What drugs are used to reduce hepatic glucose production?
metformin
What drugs are used to improve insulin sensitivity?
Metformin, thiazolidinenones
What drugs are used to boost insulin secretion?
Sulphonylureas, DPP4 inhibitors, GLP -1 agonists
What drugs are used to inhibit carb gut absorption & renal glucose reabsorption?
Alpha gluconidase inhibitors, SGLT2 inhibitors
What does metformin do? What are side effects? When is it contraindicated?
Metformin reduces insulin resistance and decreases hepatic glucose output and increases glucose disposal. GI side effects. Contraindicated in liver disease, moderate renal failure, heart failure
