Type 2 Duabetes Flashcards
(46 cards)
what is type II DM?
combination of insulin resistance + beta cell failure → hyperglycaemia
what kind of insulin deficiency is this
relative insulin deficiency
what are some predisposing factors?
genetic susceptibility, obesity
what ages does type II DM typically affect?
usually older/adults but youth and children can also be affected
Normal levels for fasting glucose,2 hour glucose and HbA1C
- fasting glucose?less than 6 mmol/L
- 2-hr glucose (oral glucose tolerance test)?less than 7.7 mmol/L
- HbA1c?less than 42 mmol/L
levels indicative of type II DM for:
- fasting glucose?above 7 mmol/L
- OGTT?above 11 mmol/L
- HbA1c?above 48 mmol/L
what do values in between these benchmarks sugges
intermediate state between normal and type II DM
- intermediate stage
when in the progression towards type II DM is insulin production highest?
Intermediate stage
As it rises to combat increasing insulin resistance
Drops eventually following beta cells can be failure
what test in combination with what else can diagnose type II DM?
random glucose within DM range + symptoms of diabetes = diagnosis
can type II DM cause diabetic ketoacidosis?
yes but not under usual circumstances (due to relative insulin deficiency)
important consideration for long term type II DM?
late in disease course → can progress to complete insulin deficiency bc beta cell failure
important not to stop insulin treatment bc risk of ketoacidosis
what does the insulin response to glucose look like in type II DM?
First phase insulin release is lost
what are the consequences of reduced insulin action?
less uptake of glucose into muscles
more glucagon action
more hepatic production of glucose
consequences of insulin resistance in adipocytes?
less triglyceride formation and storage → more non-esterified fatty acids
An example of mono genic diabetes
MODY
What is polygenic diabetes
not born with certainty of developing diabetes → high risk contributed to by multiple polymorphisms + other factors
type II DM – associated conditions?
obesity (major), perturbations in gut microbiota due to bacterial lipopolysaccharides ferment to short chain FA, intrauterine growth retardation
how might patients with type II DM present?
overweight, hyperglycaemia, dyslipidemia
fewer osmotic symptoms
first line diagnostic tool for type II DM?
HbA1c
how does this work in detail?
1x HbA1c above 48 mmol/L + symptoms
or
2x HbA1c above 48 mmol/L if asymptomatic
Also check for osmotic symptoms,infections. If acute then hyperosmolar hyperglycemia if chronic then ischaemic heart disease and retinopathy present
how does a hyperosmolar hyperglycaemic state commonly present?
Renal failure
Conditions for hyperosmolar hyperglycemia
insufficient insulin (not absent) for hyperglycaemia prevention
sufficient insulin for lipolysis and ketoacidosis suppression
Presents commonly with renal failure
type II DM management?
diet and lifestyle adjustment, oral medication, education, possibly insulin later
what specifically should diet adjustments aim to achieve?
total calorie control, less calories as simple carbs and fat and more as complex carbs
sodium down, soluble fibre up
