1. Type 2 Diabetes
What I think you need to Know
Nick Thomas

2. • Is an epidemic
• Prevalence in UK set to double in next twenty
years
• Diabetes currently costs 10% Of entire NHS
budget
• You do the maths…………

3. • Type 2 diabetes is a mixture
and
Insulin resistance
Beta cell dysfunction
Diabetes occurs when beta cells can noDiabetes occurs when beta cells can no
longer produce enough insulin tolonger produce enough insulin to
compensate for insulin resistancecompensate for insulin resistance

4. • Insulin resistance directly linked to Obesity
• By the time Diabetes diagnoses Beta cell
function has started to deteriorate

5. • Need to diagnose diabetes early (ideally
pick up those with high insulin resistance)
• Weight loss, decreases insulin resistance,
decreases risk of developing diabetes…
Simples

6. • Beta cell function started to deteriorate and will
deteriorate with time.
• Thus management in a stepwise fashion, will
require additional management with decreasing
endogenous insulin production.
• 50% of patients with Type 2 diabetes will require
insulin therapy 6 years after diagnosis.

7. Step 1 = Life style (weight loss + diet)
Step 2 = Oral hypoglycaemic agents
Step 3 = Insulin (start as combination with OGA)

8. ORALORAL
HYPOGLYCAEMICHYPOGLYCAEMIC
AGENTSAGENTS
METFORMIN (1st
line)
Insulin resistance
Hepatic glucose
production
Insulin release
from pancreas
Pros:- Weight loss
Cons:- Can worsen
renal function
SULFONYLUREAS (2nd
line)
Pros:- fast onset of action
Cons:-
•Weight gain,
•risk of hypoglycaemia
THIAZOLIDENEDIONES
(glitazones) (3rd line)
Cons:- weight gain,
contraindicated in heart failure
Rosiglitazone no longer
available due to cardiovascular
risk
Insulin resistance
insulin release
glucagon release
Gastric digestion
Appetite
INCRETINS (3rd line)
Pros:- No weight gain, Low risk of
hypoglycaemia
Cons:-
• Expensive
• Exenatide has to be given SC

9. • Macrovascular complications
Increased:-
– Cardiac Risk
– Stroke risk
– Peripheral vascular disease risk
• Microvascular complications
– Renal disease
– Diabetic Retinopathy
– Neuropathy

10. • Short term hyperglycaemia is not ideal
• But better than hypoglycaemia
• Slowly adjust doses, especially insulin.
• except
– HONK (Hyperosmolar non-ketotic state)
• Hyper glycaemia typically >30 mmol/l
• NO ACIDOSIS
• Iv Insulin therapy
• Fluids