Type 2 Diabetes Mellitus

These flashcards cover key vocabulary related to Type 2 Diabetes Mellitus, its management, pathophysiology, and associated complications.

Type 2 Diabetes Mellitus

A chronic condition that affects the way the body metabolizes sugar (glucose), leading to high blood sugar levels.

Pathophysiology

The study of the functional changes that occur in the body as a result of a disease.

Impaired glucose tolerance

A state in which blood glucose levels are higher than normal but not high enough to be classified as diabetes.

Hyperglycemia

An excess of glucose in the bloodstream, commonly associated with diabetes.

Insulin resistance

A condition in which cells in the body become less responsive to insulin, leading to elevated blood sugar levels.

Diabetic nephropathy

A complication of diabetes characterized by damage to the kidneys due to high blood sugar levels.

Cardiovascular disease

A general term for conditions affecting the heart and blood vessels, often associated with diabetes.

Blood glucose control

Management of blood sugar levels to maintain them within a target range.

HbA1c

A blood test that measures the average blood glucose levels over the past 2 to 3 months, used to diagnose diabetes.

Diabetes prevention programme

An intervention aimed at preventing the onset of diabetes through lifestyle changes like diet and exercise.

Metformin

An oral medication that helps control blood sugar levels in people with type 2 diabetes.

SGLT2 inhibitors

A class of diabetes medications that help lower blood sugar by preventing glucose reabsorption in the kidneys.

GLP-1 receptor agonists

A class of medications that stimulate insulin secretion and suppress glucagon release, used for managing type 2 diabetes.

Hypertension

High blood pressure, often seen in individuals with diabetes.

Polyuria

Excessive urination, a common symptom of diabetes.

Polydipsia

Excessive thirst, often experienced by those with uncontrolled diabetes.

Ketogenesis

The process of converting fatty acids into ketone bodies, which can occur during periods of low insulin.

Diabetic ketoacidosis

A serious diabetes complication that occurs when the body produces high levels of blood acids called ketones.

Hypertensive crisis

A severe elevation in blood pressure that can lead to organ damage.

Chronic kidney disease

A long-term condition characterized by a gradual loss of kidney function, often associated with diabetes.

Efficacy

The ability of a drug to produce the desired therapeutic effect.

Diabetes-related complications

Health issues that can arise as a result of uncontrolled diabetes, including cardiovascular disease, neuropathy, nephropathy, and retinopathy.

Hyperosmolar Hyperglycemic State (HHS)

A serious condition characterized by very high blood sugar without significant ketosis, often associated with type 2 diabetes.

Patient-centered care

An approach to healthcare that focuses on the needs and preferences of the patient.

Chronic complications of diabetes

Long-term health problems that can result from diabetes, such as heart disease, nerve damage, and foot ulcers.

What percentage of diabetes cases are Type 2?

Most diabetes cases are Type 2 diabetes.

Name key risk factors for Type 2 diabetes.

Increasing age; family history; obesity (especially central obesity); hypertension; certain ethnic groups; male sex.

What skin sign is associated with insulin resistance in Type 2 diabetes?

Acanthosis nigricans.

How does Type 2 diabetes usually present compared to Type 1?

Gradual onset; usually no weight loss; usually no ketones initially; develops over months.

Name common symptoms suggesting diabetes.

Polydipsia; polyuria; blurred vision; recurrent infections; tiredness.

What HbA1c level indicates diabetes?

HbA1c ≥48 mmol/mol.

What HbA1c range suggests increased risk of diabetes?

HbA1c between 42–47 mmol/mol.

What fasting plasma glucose level suggests diabetes?

Fasting plasma glucose ≥7 mmol/L.

What random plasma glucose level with symptoms suggests diabetes?

Random plasma glucose ≥11.1 mmol/L.

When should HbA1c not be used to diagnose diabetes?

Pregnancy; recent onset of symptoms; steroid-induced hyperglycaemia; end-stage renal disease; certain blood disorders.

Why is HbA1c unreliable in anaemia or blood disorders?

Altered red blood cell turnover affects glycation measurement.

Why may HbA1c be unreliable in pregnancy?

Changes in glucose metabolism make HbA1c less reliable for diagnosis.

What are the three main treatment targets in Type 2 diabetes?

Blood glucose; blood pressure; lipid control.

Why are lipid levels managed in diabetes?

To reduce cardiovascular disease risk.

Why is blood pressure control important in diabetes?

To prevent complications such as kidney disease; stroke and cardiovascular disease.

What complications can occur from poorly controlled diabetes?

Retinopathy; nephropathy; neuropathy; cardiovascular disease; peripheral vascular disease; periodontal disease.

Why does Type 2 diabetes often worsen over time?

Progressive decline in beta-cell function and persistent insulin resistance.

Why might treatment be reduced in very elderly patients with diabetes?

To prioritise quality of life over strict glucose control.

Why should clinicians explain disease progression to patients?

To avoid patients feeling they have failed when treatment intensifies.

What lifestyle factors should be assessed during diabetes review?

Diet; physical activity; access to healthy food; patient motivation.

Why should socioeconomic factors be considered when managing diabetes?

They influence the patient’s ability to follow treatment and lifestyle advice.

Why is shared decision-making important in diabetes care?

Patients are more likely to follow treatments they helped choose.

Why should educational resources be offered to patients with diabetes?

Patients cannot absorb all information during short consultations.

What is the purpose of the Diabetes Prevention Programme?

To identify high-risk individuals and support lifestyle changes to prevent diabetes.

What lifestyle changes help prevent Type 2 diabetes?

Improved diet; increased physical activity; weight management.

What happens to glucose uptake in muscle in Type 2 diabetes?

Glucose uptake decreases.

What happens to hepatic glucose production in Type 2 diabetes?

Hepatic glucose production increases.

What happens to glucagon secretion in Type 2 diabetes?

Glucagon secretion increases.

What happens to insulin secretion in Type 2 diabetes?

Insulin secretion decreases over time.

What metabolic process increases in adipose tissue in Type 2 diabetes?

Lipolysis.

What hormone system is impaired in Type 2 diabetes related to gut signalling?

The incretin system.

What drug class does metformin belong to?

Biguanide.

What is the main mechanism of metformin?

Reduces hepatic glucose production.

Why is metformin usually first-line therapy?

Effective; safe; inexpensive and low risk of hypoglycaemia.

What are common side effects of metformin?

Gastrointestinal upset such as nausea and diarrhoea.

What serious rare adverse effect is associated with metformin?

Lactic acidosis.

When is metformin contraindicated?

Severe renal impairment.

What nutrient deficiency can occur with long-term metformin use?

Vitamin B12 deficiency.

How should metformin be taken?

With or just after food.

What is the mechanism of sulfonylureas?

Stimulate insulin secretion from pancreatic beta cells.

Name an example of a sulfonylurea.

Gliclazide.

What is the main risk of sulfonylureas?

Hypoglycaemia.

What other common effect occurs with sulfonylureas?

Weight gain.

Why should sulfonylureas be used cautiously in elderly patients?

Higher risk of hypoglycaemia and falls.

What is the mechanism of pioglitazone?

Increases insulin sensitivity.

Name disadvantages of pioglitazone.

Weight gain; fluid retention; fracture risk.

Why is pioglitazone avoided in heart failure?

It can cause fluid retention and worsen heart failure.

What rare cancer risk has been associated with pioglitazone?

Bladder cancer.

Where do SGLT2 inhibitors act?

Kidneys.

What is the mechanism of SGLT2 inhibitors?

Block renal glucose reabsorption causing glucose excretion in urine.

Name examples of SGLT2 inhibitors.

Dapagliflozin; empagliflozin; canagliflozin; ertugliflozin.

What physiological effects result from glucose excretion in urine?

Reduced blood glucose; reduced blood pressure; weight reduction.

What infections are associated with SGLT2 inhibitors?

Genital infections and urinary tract infections.

What rare metabolic complication can SGLT2 inhibitors cause?

Euglycaemic diabetic ketoacidosis.

What rare severe infection is linked to SGLT2 inhibitors?

Fournier’s gangrene.

When should SGLT2 inhibitors be temporarily stopped?

During illness, dehydration or surgery.

What is the mechanism of DPP-4 inhibitors?

Prevent breakdown of incretins leading to increased insulin and reduced glucagon.

Name examples of DPP-4 inhibitors.

Sitagliptin; linagliptin; saxagliptin; alogliptin.

What is the weight effect of DPP-4 inhibitors?

Weight neutral.

What rare adverse effect has been associated with DPP-4 inhibitors?

Pancreatitis.

Where is GLP-1 produced?

Intestinal L cells.

When is GLP-1 released?

After eating.

What happens to GLP-1 secretion in Type 2 diabetes?

It is reduced or impaired.

What is the mechanism of GLP-1 receptor agonists?

Increase insulin secretion, decrease glucagon, slow gastric emptying and reduce appetite.

Name examples of GLP-1 receptor agonists.

Semaglutide; liraglutide; dulaglutide; exenatide.

What major benefit do GLP-1 receptor agonists provide?

Weight loss.

What common side effects occur with GLP-1 receptor agonists?

Nausea; vomiting; diarrhoea.

What serious complication has been associated with GLP-1 receptor agonists?

Pancreatitis.

Why must patients with diabetic retinopathy be monitored when starting GLP-1 therapy?

Rapid glucose reduction can worsen retinopathy.

What eating advice helps reduce GLP-1 gastrointestinal side effects?

Eat smaller meals; eat slowly; stop when full.

What foods may worsen GLP-1 side effects?

Fried; fatty; very sweet or spicy foods.

What lifestyle habits can worsen GLP-1 side effects?

Alcohol use and smoking.

How should oral semaglutide be taken?

On an empty stomach with a small sip of water before other food or medication.

Why must oral semaglutide tablets not be crushed or split?

It may affect drug absorption.

When might insulin be introduced in Type 2 diabetes?

Poor control with other therapies or during illness or surgery.