Type 2 Diabetes

T2D: What is the pathophysiology?

Inadequate insulin production from beta cells→ insulin resistance.

T2D: What are the symptoms?

• Polyuria

• Polydipsia

• Unexplained weight loss

• Blurry vision

• Fatigue

T2D: What is the diagnostic criteria?

If symptomatic, one of the following results is sufficient for diagnosis:

• Random blood glucose > 11.1mmol/l

• Fasting plasma glucose > 7mmol/l

• 2-hour glucose tolerance > 11.1mmol/l

• HbA1C > 48mmol/mol (6.5%)

If the patient is asymptomatic, two results are required from different days

T2D: What is the management?

1. Metformin

2. If HbA1c over 58→ combine metformine with pioglitazone or sulphonylurea

3. If dual therapy ineffective, start triple therapy → metformin + pioglitazone/sulphonylurea + empagliflozin

4. Triple therapy ineffective?→ GLP-1 agonist

5. Last resort?→ start insulin

T2D: What is the MOA of metformin?

Inhibits hepatic gluconeogenesis

T2D: What are the microvascular complications?

• Diabetic retinopathy - Leading cause of visual loss in adults.

• Diabetic nephropathy - Leading cause of chronic kidney disease, characterised by proteinuria.

• Diabetic neuropathy - Chronic hyperglycaemia leads to various neuropathies.

• Gastrointestinal Complications - Gastroparesis due to nerve damage.

• Foot Complications - High risk for ulceration and infection.

• Sexual Dysfunction - Related to multiple factors including neuropathy and microvascular complications

T2D: How can Muslims manage their diabetes during Ramadan?

Continue on 500mg, take the morning dose before Suhoor (pre-sunrise meal), combine afternoon dose with dose taken at Iftar (after sunset meal)

T1D/T2D: What is the DVLA’s guidance on driving?

• Insulin-treated diabetes:

  • Group 1 (car/motorcycle): Drive if well-controlled, monitor blood glucose before and during driving.

  • Group 2 (lorry/bus): Stricter rules, annual medical review required.

T1D/T2D: What is the target blood pressure?

<140/90

T1D/T2D: What is the pathophysiology of diabetic neuropathy?

Advanced glycation end products induced by hyperglycaemia damage nerve fibres through their effects on matrix metalloproteinases

T1D/T2D: What is the management of diabetic neuropathy?

Amitriptyline (tricyclic antidepressant)

T1D/T2D: Which drugs should diabetics avoid?

Thiazides→ increases blood sugars!!

T1D/T2D: What is the management of HTN in diabetics?

In diabetes, age or ethnicity doesn’t really matter like it’s usually does so give:

• White→ ACEi

• Black→ ARB (then CCB)