Chapter 5-diabetes

Question 1

Does glycemic control worsen over time?

Answer 1

YES

Question 2

Name a biguanide

Answer 2

Metformin

Question 3

How does metformin work

Answer 3

Decreases gluconeogensis

Increases peripheral utilisation of glucose

Question 4

Does metformin work in the presence of insulin?

Answer 4

Yes acts only in the presence of insulin

Question 5

What’s the rate but potentially fatal side effect of metformin

Answer 5

Lactic acidosis

Question 6

Why can lactic acidosis occur with metformin

Answer 6

Because metformin reduces hepatic uptake of lactate

Question 7

What are the symptoms of lactic acidosis

Answer 7

Insidious onset with vague and non specific symptoms: 
Anorexia 
Lethargy 
Nausea 
Respiratory distress

Question 8

How do sulfonylureas work

Answer 8

Stimulate insulin release by the beta cells of the pancreas

Question 9

What do sulfonylureas need in order to work

Answer 9

Require functioning beta cells

Question 10

Why do you need to take sulfonylureas with food?

Answer 10

To prevent hypoglycaemia

Question 11

How do meglitinides work?

Answer 11

Stimulate insulin secretion but only in the presence of food

Question 12

Do meglitinides work quickly and how long for?

Answer 12

Rapid onset and short duration of action

Question 13

Which has a lower risk of hypoglycaemia:
Sulfonylureas
Meglitinides

Answer 13

Meglitinides

Question 14

What class of drugs prevent intestinal absorption of starch and sucrose

Answer 14

Alpha-glucosidase inhibitors

Question 15

When a patient is on alpha-glucosidase inhibitors should they use sucrose to treat hypos?

Answer 15

NO USE GLUCOSE

Question 16

How do thiazolidinediones work?

Answer 16

Enhance tissue sensitivity to insulin

Question 17

What does GLP-1 stand for?

Answer 17

Glucagon-like peptide

Question 18

What is GLP-1 glucagon like peptide?

Answer 18

It’s a neuropeptide it increases insulin excretion from the pancreas in a glucose dependant manner

Question 19

define incretin

Answer 19

Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels

Question 20

Name two incretin based therapies

Answer 20

DPP-4 inhibitors

GLP-1 receptor agonists

Question 21

When is GLP-1 secreted

Answer 21

Upon the ingestion of food

Question 22

Two benefits of DPP-4 inhibitors

Answer 22

Weight neutral

Low risk for causing hypos

Question 23

How do you administer GLP-inhibitors?

Answer 23

Subcutaneous injection

Question 24

Key benefit of GLP-1?

Answer 24

Weight loss woo

Question 25

what does SGLT2 stand for?

Answer 25

Sodium-glucose co-transporter-2

Question 26

How do SGLT-2 inhibitors work?

Answer 26

Work by helping the kidneys to lower blood glucose levels- they inhibit reabsorption at the proximal tubule

Question 27

List 4 ways in which insulin works

Answer 27

Removes glucose from circulation Helps tissues (muscles) to uptake glucose Promotes glucose to be stored as glycogen Helps body make fat and protein

Question 28

How do WHO diagnose diabetes?

Answer 28

Random venous glucose >11.1mmol/l or Fasting venous >7mmol/l or 2hour venous conc>11.1mmol/l 2hrs after 75g anhydrous glucose in an oral glucose tolerance test

Question 29

Name the types of insulin

Answer 29

Short/rapid acting Intermediate Long acting Biphasic

Question 30

First line insulin should be what?

Answer 30

OD or BD human insulin e.g humulin insulatard

Question 31

What is phentermine

Answer 31

The first anti obesity drug acts my stimulating catecholamine release thus fight or flight reducing appetite, now a controlled drug

Question 32

What is fenfluramine

Answer 32

Weight loss drug withdrawn from market after reports of hypertension, it acted by increasing serotonin levels and caused a sensation of fullness

Question 33

What is rimonabant?

Answer 33

Is a cannabinoid CB1 receptor antagonist that after centrally on the brain, decreasing appetite

Question 34

Why was rimonabant withdrawn?

Answer 34

Links to serious psychiatric disease and suicidal behaviour

Question 35

What's sibutramine

Answer 35

Centrally acting serotonin-NA reuptake inhibitor structurally related to amphetamines

Question 36

Why was sibutramine withdrawn?

Answer 36

Cardiovascular events and strokes

Question 37

How does orlistat work?

Answer 37

Acts peripherally where it inhibits an enzyme involved in the breakdown of fat causing it to be excreted rather than digested

Question 38

List 5 obesity drugs

Answer 38

``` Phentermine Fenfluramine Rimonabant Sibutramine Orlistat ```

Question 39

What's leptin

Answer 39

A signalling molecule secreted from the adipocyte cell found from the ob gene

Question 40

Mouse with the Db/db gene had what?

Answer 40

Obesity and diabetic

Question 41

What BMI is a healthy weight

Answer 41

18.5-24.9

Question 42

What BMI is overweight

Answer 42

25-29.9

Question 43

What BMI is obese class 1

Answer 43

30-34.9

Question 44

What BMI is obese class 3

Answer 44

40+

Question 45

What BMI is obese class 4

Answer 45

50+

Question 46

What waist circumference in women is associated with an increased risk of for type 2 diabetes?

Answer 46

>35inches

Question 47

Above what waist circumference is associated with an increased risk of diabetes in men?

Answer 47

>40

Question 48

Name the 9 types of drug in T2DM

Answer 48

``` Biguanides Sulfonylureas Meglitinides Alpha-glucosidase inhibitors Thiazolidinediones DPP4 inhibitors GLP-1 agonists SGLT2 inhibitors Insulin ```