L31 Type 2 DM

Diabetes Mellitus is a metabolic disorder resulting from high concentrations of blood glucose. Glucose remains in the blood, therefore: • [blank_start]Increased[blank_end] urination • Thirsty • Weight [blank_start]loss[blank_end] • Tired • [blank_start]Poor[blank_end] circulation

T2DM is due to insulin deficiency (Beta islet cell dysfunction & cell loss up to 50% at diagnosis), and insulin resistance.

Metabolic syndrome is associated with excess nutrition, insufficient [blank_start]exercise[blank_end] and a genetic predisposition. It is characterised by chronic [blank_start]inflammation[blank_end] in the adipose tissue, liver, pancreas, and vasculature. • Doubles the risk of [blank_start]atherosclerotic[blank_end] heart disease • Doubles risk of stroke • Five times the risk of [blank_start]diabetes[blank_end] • Increased risk of venous thrombosis

HbA1c is glycosylated haemoglobin. It can be used to determine plasma [blank_start]glucose[blank_end] over the previous 8-12 [blank_start]weeks[blank_end] and so [blank_start]monitor[blank_end] diabetic control or [blank_start]diagnose[blank_end] diabetes. The more glucose in the blood, the more haemoglobin is [blank_start]glycosylated[blank_end].

The lifetime risk of a child with 1 parent with T2D is 40%, and increases to 70% if both parents have/had T2D.

Type 2 Diabetes - Pathogenesis: • Insulin resistance begins many [blank_start]years[blank_end] before onset of T2D • When insulin [blank_start]secretion[blank_end] can not overcome [blank_start]resistance[blank_end]: hyperglycaemia and T2D • Typically [blank_start]half[blank_end] of B islet cells left at diagnosis • Abnormalities in other hormones (increased [blank_start]glucagon[blank_end]) & impaired responses to others (egg GLP-1) • Changes in gut [blank_start]microbiota[blank_end] • Inflammation

Pathophysiology of T2DM: - Macrovascular (50% of patients): [blank_start]cardiovascular disease[blank_end], develops earlier and is more severe - Microvascular (~27% patients): [blank_start]kidney, retina and the nervous system[blank_end] - Co-morbidities: non-alcoholic [blank_start]fatty liver[blank_end] disease, obstructive sleep [blank_start]apnoea[blank_end] and depression