Type 2 diabetes mellitus

Question 1

What is a hyperglycaemic clamp?

Answer 1

When you keep a patient in a steady state with infusions of glucose and insulin

Question 2

What is the problem with HGO (Hepatic glucose output) in T2DM?

Answer 2

• Reduced insulin action causes less uptake of glucose into skeletal muscle
• HGO is also increased due to both a reduction in insulin action and increase in glucagon action

Question 3

What is HGO production and glucose clearance like in T2DM people?

Answer 3

• Impaired insulin-mediated glucose disposal
• Excessive glucagon-mediated glucose output

Question 4

What are the consequences of insulin resistance in:
-Liver
-Adipocytes
-Muscle

Answer 4

Liver: Increased HGO
Adipocytes: Increased fatty acid uptake from gut
Muscle: Less glucose uptake

Question 5

What is monogenic diabetes?

Answer 5

-Single gene mutation that means you’re born with diabetes

Question 6

What is the first line test for T2DM diagnosis?

Answer 6

HbA1c:

• 1x HbA1c above or equal 48 mmol/L with symptoms
• 2x HbA1c above or equal 48 mmol/L without symptoms

Question 7

What drug can you use to decrease hepatic glucose output?

Answer 7

Metformin

Question 8

What drugs can help increase insulin sensitivity?

Answer 8

• Metformin
• Thiazolidinediones

Question 9

What do sulphonylureas e.g. gliclazide do?

Answer 9

• Boost insulin production of beta cells
• They bind to ATP-sensitive potassium channel and close it, independent of glucose/ATP, which needs to be done for insulin production
• They therefore bypass normal physiology to produce a lot of insulin