Please enable JavaScript.
Coggle requires JavaScript to display documents.
Type 2 Diabetes Mellitus (Treatment Plan (MDT approach, Educate patient on…
Type 2 Diabetes Mellitus
Treatment Plan
-
-
-
Good glycemic control with good diet -
- Low in sugar
- High in starchy carbohydrates
- High in fibre
- Low in fat
Treatment of hypertension with ACE inhibitors and hyperlipidaemia control
- Orlistat may be given in obesity to reduce the absorption of fat from the diet
- As a second line mechanism, oral metformin may be given
- Reduces rate of gluconeogenesis in the liver
- Increases cells sensitivity to insulin
- Helps with weight issue and reduces CVS risk in diabetes
- Side effects of anorexia, diarrhoea, nausea, abdominal pain, NOT HYPOGLYCAEMIA
- Contraindicated in heart failure, liver disease or renal disease, since can induce lactic acidosis
If HbA1c > 53mmol/l 16 weeks later then add a sulfonylurea (e.g. oral gliclazide)
- Promotes insulin secretion
- These are ineffective in patients without functional cell mass
- Avoided in pregnancy
- Effect wears off as beta-cell mass declines
- Side effects of hypoglycaemia, promote weight gain (avoid in overweight)
- Used in care in those with liver disease and renal impairment
- Safest drug in the elderly
If at 6 months the HbA1c > 57mmol/l consider adding insulin or a glitazone (to replace metformin or sulfonylurea)
Investigations
Diagnostic tests 1
- Random plasma glucose > 11.1mmol/l
- Fasting plasma glucose > 7mmol/l
- For both tests one abnormal value is diagnostic in symptomatic individuals
- Two abnormal values are required in asymptomatic values
Diagnostic tests (for borderline cases)
- Oral glucose tolerance tests (OGTT)
- Fasting >7mmol/l = diabetes diagnosis
- 2hrs after glucose >11.1mmol/l = diabetes diagnosis
Can also detect impaired glucose tolerance (IGT) - a risk factor for future diabetes and cardiovascular disease
- Fasting <7mmol/l
- 2hrs after glucose 7.8 - 11 mmol/l
Haemoglobin A1c
- Measures amount of glycated haemoglobin - thus tells us blood glucose concentrated
- HbA1c> 6.5% normal (48mmol/mol) = diabetes diagnosis
-
FBC, U&E, liver biochemistry, fasting blood sample for cholesterol and triglycerides
-
Pathophysiology
-
-
- Associated with central obesity, hypertension, hypertriglyceraemia, decreased HDL, modest increase in pro-inflammatory markers
- Insulin binds normally to its receptor on the surface of cells, as normal, thus insulin resistance occurs post receptor
- Most patients show amyloid deposition in Islets in pancreas (co-secreted with insulin)
Epidemiology
-
More prevalent in South Asian, African and Caribbean ancestry
-
-
-
Causes
Diabetes is usually primary but may be secondary to other conditions such as:
- Pancreatic pathology
- Endocrine disease e.g. Acromegaly
- Drug induced e.g. corticosteroids
-
Complications
-
Microvascular
Danger in the retina, glomerulus and nerve sheath
Diabetic retinopathy, nephropathy and neuropathy
-
-
-