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203: The endocrine system > T2 DM > Flashcards

Flashcards in T2 DM Deck (15)
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1

Insulin resistance
- Cause
- Associations

Causes- humans have become a lot more calorie excess
- Increase in visceral fat= production of FFA, proinflammatory cytokines, procoagulant factors.

Associations
- Age [>40]
- Obesity, especially central obesity
- Hypertension
- Hyperglycaemia
- Dyslipidaemia

2

Main Aetiological causes of T2 DM

Decrease in beta-cell mass:

Polygenic factors
- Identical twins showed high incidence.

Maternal hyperglycaemia

Nutrient deficiency in utero--> Intrauterine growth retardation

3

Other possible aetiological causes of T2 DM

Gut bacterial change

SOX-5 gene mutation-->Beta-cell regression

Autoimmune

Old age

Decreased incretin action
- Reduced GLP-1, GIP

Abnormal glucagon action

Glucotoxicity and lipotoxicity

4

Glucose diagnosis of diabetes

Blood glucose
- >11mmol/L + symptoms
- >11mmol/ L x 2 without symptoms

5

HbA1c diagnosis of diabetes

HbA1c= glycated haemoglobin

Diabetes if HbA1c> 48 mmol/ mol or 6.5%

6

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

7

Epidemiology of T2 DM

Prevalence
- 4.6 million
- Further 12.3 M are at risk

Most prevalent in
- Older age, >45
- Overweight [70%]

8

Pathology of T2 DM

Insulin resistance and inadequate insulin production.

Progression
- Increase in B-cell apoptosis
- Amyloid deposits from IAPP disrupts beta-cells.

9

Dyslipidemia and T2 DM

In those with T2 DM, there can be high levels of LDL, chylomicrons, VLDL+ their catabolic remnants
- Proinflammatory
- Increases atherosclerotic formation

Leads to vascular pathologies
- Coronary heart disease

10

Major consequences of T2 diabetes

Hyperglycaemia

Dysregulation of lipid metabolism

High proinflammatory cytokines + free radicals

Increased susceptibility to infection

11

T2 DM morbidities

Maculopathy/ Retinopathy

Neuropathy

Foot ulcers

Peripheral vascular disease

Cataracts

Cheiroarthropathy

Increased fractures/ weaker bones

Nephropathy

Coronary heart disease/ MI

12

Preventative treatment for T2 DM

Lifestyle modification
- Diet/ exercise, smoking cessation.

Screening
- Eyes
- Kidneys
- Feet: neuropathy and vascular disease.

Taking aspirin to prevent MI/ CV events

13

Eye screening tests for T2 DM

Retinal photography
- Screen for maculopathy/ retinopathy

Using laser eye treatment when required.

14

Kidney screening

Measuring urine albumin [EMU]

Blood pressure

Using ACEi/ ARBs

15

T2 DM treatment goals

Modifying lifestyle and screening for complications

HbA1c+ 48-59 mmol/mol OR 6.5-7.5%

BP controlled= 12-140/180

LDL< 2.0 mmol/L