Type 2 Diabetes

Question 1

What is type 2 diabetes?

Answer 1

A condition in which the combination of insulin resistance and beta-cell failure result in hyperglycaemia

Question 2

What condition is associated with type 2 diabetes a lot?

Answer 2

Obesity

Question 3

How is type 2 diabetes initially managed?

Answer 3

Lifestyle measures: diet changes and weight loss

Question 4

Who typically presents with T2DM?

Answer 4

Usually late adulthood but can present in youth

Question 5

What is a typical feature of T2DM?

Answer 5

Diabetic ketoacidosis

Question 6

How much does T2DM reduce life expectancy?

Answer 6

A lot when you are younger but less as you get older

Question 7

Where is T2DM most prevalent?

Answer 7

Ethnic groups that move from rural to urban lifestyle

Question 8

What is the biggest contributory factor to developing T2DM?

Answer 8

Can be insulin resistance mainly, but beta cell failure contributes

Question 9

What is fasting glucose for a diagnosis of diabetes?

Answer 9

> 7 mmol/L

Question 10

What is HbA1c for a diagnosis of diabetes?

Answer 10

> 48 mmol/L

Question 11

What is OGTT for a diagnosis of diabetes?

Answer 11

> 11 mmol/L

Question 12

What is fasting glucose in the intermediate stage of diabetes development?

Answer 12

Greater than 6 but less than 7 mmol/L

Question 13

What is OGTT in the intermediate stage of diabetes development?

Answer 13

Greater than 7.7 but less than 11 mmol/L

Question 14

What is HbA1c in the intermediate stage of diabetes development?

Answer 14

Greater than 42 but less than 48 mmol/L

Question 15

How does insulin resistance change as someone is developing diabetes?

Answer 15

It curves up and plateaus before diabetes has even been diagnosed

Question 16

What are the 3 ways of diagnosing diabetes?

Answer 16

Fasting glucose
OGTT
Random glucose

Question 17

What level do beta cells function at diagnosis of T2DM?

Answer 17

Around 50%

Question 18

Does diabetic ketoacidosis occur in T2DM? Explain your answer

Answer 18

Not usually, there is a small amount of circulating insulin (not enough to overcome resistance), which is enough to suppress the synthesis of ketone bodies from the breakdown of fat

Question 19

What is long duration type 2 diabetes? What feature of diabetes becomes more prominent once this develops?

Answer 19

Beta cell failure may progress to complete insulin deficiency (this is where diabetic ketoacidosis may occur)

Question 20

Does T2DM have a genetic risk?

Answer 20

Yes

Question 21

How can risk of T2DM be increased in utero?

Answer 21

Foetal growth retardation

Question 22

How is beta cell function assessed?

Answer 22

Hyperglycaemic clamp

Question 23

What is hyperglycaemic clamp?

Answer 23

Glucose levels are elevated, in normal people insulin will shoot up, fall and then steadily rise, with T2 diabetics there will be hardly any rise in insulin

Question 24

When is hyperglycaemic clamp used?

Answer 24

To assess beta cell function

Question 25

What happens to glucose uptake in skeletal muscles in T2DM?

Answer 25

Reduced uptake of glucose due to reduced insulin

Question 26

What happens to hepatic glucose output in T2DM? How?

Answer 26

Increased due to reduced insulin action and increased glucagon action

Question 27

What happens to insulin sensitivity when we put on weight (in normal people)?

Answer 27

Insulin becomes less sensitive so more is secreted

Question 28

What happens in the liver, adipocytes and muscle when theres insulin resistance?

Answer 28

Liver: less glycogen synthesis and greater hepatic glucose output Adipocytes: less glucose uptake, less triglyceride synthesis Muscle: less glucose uptake

Question 29

What happens to inflammatory adipokines in T2DM?

Answer 29

Levels are high

Question 30

Is T2DM monogenic or polygenic?

Answer 30

Polygenic- you have a higher risk depending on your genetic makeup

Question 31

Is MODY monogenic or polygenic?

Answer 31

Monogenic

Question 32

What type of adiposity increases T2DM risk most?

Answer 32

Visceral adiposity increases risk a lot more than central

Question 33

How does T2DM present?

Answer 33

``` Hyperglycaemia Overweight Dyslipidaemia Fewer osmotic symptoms With complications Insulin resistance Later insulin deficiency ```

Question 34

What are risk factors for T2DM?

Answer 34

``` Age High BMI Ethnicity PCOS Family history ```

Question 35

What is the first line test for the diagnosis of type 2 diabetes?

Answer 35

HbA1c

Question 36

When will random glucose work as a diagnostic test?

Answer 36

If there are symptoms

Question 37

How is HbA1c used as a diagnostic test?

Answer 37

If symptomatic 1 test can confirm diagnosis | If asymptomatic, 2 positive tests confirm diagnosis

Question 38

What is hyperosmolar hyperglycaemic state? What does it commonly present with?

Answer 38

``` Presents commonly with renal failure. Insufficient insulin (NOT ABSENT) for prevention of hyperglycemia but sufficient insulin for suppression of lipolysis and ketogenesis. Absence of significant acidosis. ```

Question 39

How is type 2 managed?

Answer 39

``` Diet Oral medication Structured education May need insulin later Remission / reversal ```

Question 40

How does a T2DM consultation go?

Answer 40

Glycaemia: HbA1c, glucose monitoring if on insulin, medication review Weight assessment Blood pressure Dyslipidaemia: cholesterol profile Screening for complications: foot check, retinal screening

Question 41

What dietary changes are recommended in T2DM?

Answer 41

``` Total calories control Reduce calories as fat Reduce calories as refined carbohydrate Increase calories as complex carbohydrate Increase soluble fibre Decrease sodium ```

Question 42

What drug is given to reduce hepatic glucose production?

Answer 42

Metformin

Question 43

What drug is given to improve insulin sensitivity?

Answer 43

Metformin | Thiozolidinediones

Question 44

What drug is given to boost insulin secretion?

Answer 44

Sulphonylureas DPP4-inhibitors GLP-1 Agonists

Question 45

What drug is given to inhibit carb absorption in gut and inhibit renal glucose absorption?

Answer 45

Alpha glucosidase inhibitor | SGLT-2 inhibitor (renal)

Question 46

What is the first line drug is lifestayle changes have no effect?

Answer 46

Metformin

Question 47

How do sulphonyureas work?

Answer 47

Bing to ATP sensitive K+ channel and close it independant to glucose so insulin production is boosted

Question 48

How does pioglitazone wrk? What is a side effect?

Answer 48

Modifies insulin sensitivity but can cause weight gain

Question 49

How does metformin effect weight?

Answer 49

Lowers it

Question 50

How does GLP-1 work?

Answer 50

Stimulates insulin and supresses glucagon

Question 51

What is the incretin effect?

Answer 51

Oral glucose increases insulin almost double as much as intravenous glucose

Question 52

How do DPP-4 inhibitors work?

Answer 52

Inhibits DPP-4 enzyme which metabolises GLP-1

Question 53

How do SGLT-2 inhibitors work?

Answer 53

Encourages urinary glucose excretion

Question 54

Do drugs work for diabetes?

Answer 54

Yes but eventually insulin will be needed and beta cell function will always decline

Question 55

What surgery can remit diabetes?

Answer 55

Gastric bypass surgery

Question 56

What lifestyle change can remit diabetes?

Answer 56

Very low calorie diet (800-900 cals a day) for 3-6 months