T2DM

Question 1

What are examples of microvascular complications?

Answer 1

Retinopathy
Nephropathy
Neuropathy

Question 2

What are examples of macrovascular complications?

Answer 2

IHD
CVD
PVD

Question 3

Which countries have the highest incidence of T2DM?

Answer 3

China
India
USA

Question 4

What % of inpatients have T2DM?

Answer 4

20-30%

Question 5

What is the diagnostic criteria for T2DM?

Answer 5

Random glucose =/> 11.1 + symptoms
Random glucose =/> 11.1 x2
HbA1c =/> 48mmol/L

Question 6

Which oral test can be done for T2DM?

Answer 6

Oral glucose tolerance test

Question 7

What would glucose levels be during a oral glucose tolerance test for someone with T2DM?

Answer 7

Fasting >7
2 hour >11.1

Question 8

What happens to the pancreas in T2DM?

Answer 8

Decreased insulin secretion
Increased beta cell apoptosis
Decreased beta cell mass
Hyperglucagonemia (excess glugacon secretion)

Question 9

What happens to adipocytes in T2DM?

Answer 9

Increase in circulation fatty acids –> hyperlipidemia

Question 10

What happens to the gut in T2DM?

Answer 10

Impaired incretin effect (hormones that stimulate a decrease in blood glucose after eating)

Question 11

What happens to the liver in T2DM?

Answer 11

Insulin resistance
Increased hepatic glucose output

Question 12

What happens to muscles in T2DM?

Answer 12

Insulin resistance

Question 13

What modifiable risk factors are there for T2DM?

Answer 13

Obesity
HTN
Hyperlipidaemia

Question 14

Which ethnicity has a higher risk of developing T2DM?

Answer 14

South asian

Question 15

What are the three stages to T2DM?

Answer 15

Normal glucose tolerance
Pre-diabetes = impaired glucose tolerance
T2DM

Question 16

Which medications can increase the risk of developing T2DM?

Answer 16

Glucocorticoids
Beta blockers
Statins
Thiazides
Anti-psychotics

Question 17

What happens to beta cells as T2DM progresses?

Answer 17

Beta cell dysfunction + insulin resistance leads to beta cell destruction = beta cell mass loss = less able to produce enough insulin.

Question 18

What is released from adipose tissue that increases insulin resistance?

Answer 18

Free fatty acids
Adipokines - causes inflammation

Question 19

How does insulin resistance occur?

Answer 19

Increase in free fatty acids + aggravating factors (age, chronic disease, inactivity, excess lipid intake) –> impaired oxidative capacities –> accumulation of lipid derivatives –> Lipotoxicity –> Insulin resistance

Question 20

What is ectopic fat?

Answer 20

Deposition of triglycerides within non-adipose cells that usually would have very little

Question 21

What can ectopic fat lead to in cells?

Answer 21

Adipocyte hypertrophy
Reduction in adipogenic and lipogenic genes
Increased inflammation through macrophage activation.

Question 22

What are the consequences of ectopic fat?

Answer 22

Inflammation
Atherosclerosis
HTN
Atherogenic dyslipidemia
T2DM
Thrombosis

Question 23

What is metabolic syndrome?

Answer 23

Metabolic syndrome is the medical term for a combination of diabetes, high blood pressure (hypertension) and obesity. It puts you at greater risk of getting coronary heart disease, stroke and other conditions that affect the blood vessels.

Question 24

What is the diagnosis criteria for metabolic syndrome?

Answer 24

Central obesity
Plus two of the following four;
- Raised triglycerides
- Reduced HDL
- HTN
- Raised fasting plasma glucose

Question 25

How doe exercise affect the pancreas?

Answer 25

Increased glucagon Reduces insulin

Question 26

How does exercise affect the liver?

Answer 26

Increases gluconeogenesis Increases fat oxidation Increases glucogenesis

Question 27

How does exercise increase vasodilation?

Answer 27

Increased fat oxidation, glycolysis and glucose uptake = increased muscle permeability. This + increased O2 delivery = vasodilation.

Question 28

Can T2DM be reversed?

Answer 28

Yes but incidence only 1.47%. Defined as remission if <48mmol/L for at least 3 months without glucose lowering medications.

Question 29

What is the most common cause of death in diabetic patients?

Answer 29

IHD

Question 30

How does diabetes cause atherogenesis?

Answer 30

Diabetes causes hyperglycaemia, fatty acid excess + insulin resistance. These lead to oxidative stress, PKC activation + production of advanced glycation end products. These leads to changes in the endothelium.

Question 31

What happens to the endothelium in atherogenesis?

Answer 31

Decreased NO + Prostacyclin Increased Endothelin 1, NF-KB, AT II + Tissue factor.

Question 32

Which type of diet should those with T2DM have?

Answer 32

High fibre, low GI sources of carbs Reduced saturated and trans fatty acids

Question 33

Which medications can help with weight management in T2DM?

Answer 33

GLP1

Question 34

When would someone with T2DM be eligible for bariatric surgery?

Answer 34

BMI >35, has T2DM + undergoing tier 3 weight management BMI 30-34.9 if Asian ethnicity

Question 35

In which type of diabetes would DKA occur?

Answer 35

Type 1

Question 36

In which type of diabetes would HHS occur?

Answer 36

Type 2