Flashcards in T2 DM Deck (15)
Causes- humans have become a lot more calorie excess
- Increase in visceral fat= production of FFA, proinflammatory cytokines, procoagulant factors.
- Age [>40]
- Obesity, especially central obesity
Main Aetiological causes of T2 DM
Decrease in beta-cell mass:
- Identical twins showed high incidence.
Nutrient deficiency in utero--> Intrauterine growth retardation
Other possible aetiological causes of T2 DM
Gut bacterial change
SOX-5 gene mutation-->Beta-cell regression
Decreased incretin action
- Reduced GLP-1, GIP
Abnormal glucagon action
Glucotoxicity and lipotoxicity
Glucose diagnosis of diabetes
- >11mmol/L + symptoms
- >11mmol/ L x 2 without symptoms
HbA1c diagnosis of diabetes
HbA1c= glycated haemoglobin
Diabetes if HbA1c> 48 mmol/ mol or 6.5%
75 g glucose tolerance test
Method of diagnosing T2 DM.
1. Fasted period.
- DM if blood glucose > 7mmol/L
- Impaired fasting if blood glucose is 6-6.9 mmol/L.
2. Injection of 75g, 2 hrs weight
- DM if blood glucose> 11.1 mmol/L
- Impaired glucose tolerance if blood glucose is 7-11 mmol/L
Epidemiology of T2 DM
- 4.6 million
- Further 12.3 M are at risk
Most prevalent in
- Older age, >45
- Overweight [70%]
Pathology of T2 DM
Insulin resistance and inadequate insulin production.
- Increase in B-cell apoptosis
- Amyloid deposits from IAPP disrupts beta-cells.
Dyslipidemia and T2 DM
In those with T2 DM, there can be high levels of LDL, chylomicrons, VLDL+ their catabolic remnants
- Increases atherosclerotic formation
Leads to vascular pathologies
- Coronary heart disease
Major consequences of T2 diabetes
Dysregulation of lipid metabolism
High proinflammatory cytokines + free radicals
Increased susceptibility to infection
T2 DM morbidities
Peripheral vascular disease
Increased fractures/ weaker bones
Coronary heart disease/ MI
Preventative treatment for T2 DM
- Diet/ exercise, smoking cessation.
- Feet: neuropathy and vascular disease.
Taking aspirin to prevent MI/ CV events
Eye screening tests for T2 DM
- Screen for maculopathy/ retinopathy
Using laser eye treatment when required.
Measuring urine albumin [EMU]
Using ACEi/ ARBs