Type 2 Diabetes

Question 1

What is T2DM?

Answer 1

A chronic metabolic condition characterised by insulin resistance resulting in high blood glucose levels

Question 2

What are the features of T2DM?

Answer 2

1. Obesity, physical inactivity, raised blood pressure, disturbed blood lipid levels
2. Tendency to develop thrombosis inc CV risk
3. Long term micro and macrovascular changes
4. Reduced life expectancy

Question 3

What are the characteristics of T1DM?

Answer 3

1. Onset after 40 years old
2. 58% concordance in iden twins
3. No islet cell antibodies
4. Insulin resistance
5. Glucagon secretion increased
6. Patient not prone to ketoacidosis
7. No association with autoimmune disease
8. Common in African, Afro-caribbean, Asian

Question 4

What are the environmental factors that affect T2DM?

Answer 4

1. Western diet, lack of exercise, obesity hypertension
2. Migrant pops exposed to western diet
3. Correlation between BMI and incidence

Question 5

What is the pathogenesis of T2DM?

Answer 5

1. Decreased insulin secretion
2. Increased insulin resistance
3. Beta cell mass is reduced by half
4. Presence of amyloid polypeptide in proportion of patients

Question 6

What are the features of HONK: hyperglycaemic hypperosmolar nonketotic coma?

Answer 6

Patients will have (and may be old):

1. hyperglycemia
2. Dehydration with thirst
3. Marked drowsiness
4. Convulsions
5. Coma
6. Focal CNS signs

Question 7

If lifestyle changes aren’t enough what are the treatment options?

Answer 7

Meformin:

1. Patients who are overweight
2. 1st line or in combination with patients who are not overweight
3. If serum creatinine xceeds 130 and eGFR below 45 dose should be reviewed
4. Stop metformin if creatinine exceeds 150 and eGFR is below 30

Question 8

What is the mode of action of Metformin?

Answer 8

1. Increases insulin sensitivity

2. Decreases hepatic gluconeogenesis

Question 9

How is metformin taken?

Answer 9

Orally

Question 10

What are the main side effects of Metformin?

Answer 10

1. GI upset

2. Lactic acidosis

Question 11

What is the first line medication in T2DM?

Answer 11

1. Metformin

2. Cannot be used in patients with eGFR <30ml/min

Question 12

What is the mode of action Sulfonylureas?

Answer 12

Stimulate pancreatic beta cells to secrete insulin

Question 13

How is sulphonylureas taken?

Answer 13

Orally

Question 14

What are the side effects of sulphonylureas

Answer 14

1. Hypoglycemia
2. Weight gain
3. Hyponatraemia

Question 15

What are examples of sulphonylureas

Answer 15

1. Glicazide

2. Glimaperide

Question 16

How do the Thiaziolidinediones work?

Answer 16

Activate PPAR-gamma receptor in adipocytes to promote adipogenesis and fatty acid uptake

Question 17

How are thiazolidinediones taken?

Answer 17

Orally

Question 18

What are the side effects of thiazolidinediones?

Answer 18

1. Weight gain

2. Fluid retention

Question 19

What is the only example of a thiazolidinedione?

Answer 19

Pioglitazone

Question 20

How do DPP-4(gliptins) inhibitors work?

Answer 20

Increase incretin levels which inhibit glucagon secretion

Question 21

How are DPP-4 inhibitors taken?

Answer 21

Orally

Question 22

What are the side effects of DPP-4 inhibitors?

Answer 22

1. Well tolerated but increase the risk of pancreatitis

Question 23

What is the mode of action of SGLT-2 inhibitors (gliflozins)?

Answer 23

Inhibit reabsorption of glucose in the kidney in the kidney

Question 24

How are SGLT-2 inhibitors taken?

Answer 24

Orally

Question 25

What are the side effects of SGLT-2 inhibitors (gliflozins)?

Answer 25

1. Urinary tract infection | 2. Weight loss

Question 26

What is the mode of action of GLP-1 agonists (tides)

Answer 26

Incretin mimetic which inhibits glucagon secretion

Question 27

How are GLP-1 agonists (tides) given?

Answer 27

Subcutaneous

Question 28

What are the side effects of GLP-1 agonists?

Answer 28

Nausea, vomiting and pancreatitis. Also weight loss.