Diabetes

Question 1

Describe the prevalence of diabetes in Northern Ireland

Answer 1

• 4% population has diabetes
• Prevalence increased of 33% in last 5 years
• 90% have T2DM and 10% have T1DM

Question 2

Name 4 reasons why diabetes is so important

Answer 2

1. Considerable morbidity associated with disease
2. Retinal disease may result in blindness
3. Dialysis is end stage diabetes
4. Heart disease and stroke common

Question 3

What is a very simplified definition of diabetes?

Answer 3

High blood sugar

Question 4

Describe the HbA1c test

Answer 4

• Average plasma glucose measured over 8-12 weeks
• Can be performed at any time of day and does not require fasting
• Diabetes > 48mmol/mol
• > 42mmol/l is high risk of developing diabetes

Question 5

Name 5 types of primary diabetes

Answer 5

1. T1DM
2. T2DM
3. Gestational
4. Drug induced
5. Genetic

Question 6

Name 5 types of secondary diabetes

Answer 6

1. Pancreatitis
2. Cushing’s syndrome
3. Acromegaly
4. Phaeochromocytoma
5. Hyperthyroidism

Question 7

Describe T1DM

Answer 7

• Autoimmune destruction of pancreatic B-cells
• Typically presents < 40 years with peak at 12 years
• Presents with polyuria, polydipsia, weight loss and ketosis

Question 8

Describe T2DM

Answer 8

• Insulin resistance with or without pancreatic failure
• Typically presents > 40 years with peak at 60 years
• May be asymptomatic
• Presents with hyperglycaemia symptoms and fatigue

Question 9

Describe the 4 types of insulin used in treatment of T1DM

Answer 9

1. Rapid acting
2. Short acting
3. Intermediate acting
4. Long acting

Question 10

Name an example, onset of action (mins) and duration of action (hrs) of rapid acting insulin

Answer 10

Novorapid
15 mins
2-5 hours

Question 11

Name an example, onset of action (mins) and duration of action (hrs) of short acting insulin

Answer 11

Actrapid
30-60 mins
8 hours

Question 12

Name an example, onset of action (mins) and duration of action (hrs) of intermediate acting insulin

Answer 12

Insulatard
1-2 hours
16 hours

Question 13

Name an example, onset of action (mins) and duration of action (hrs) of long acting insulin

Answer 13

Lantus
No peak onset (slow release)
18-24 hours

Question 14

What is the first line treatment of T2DM?

Answer 14

Diet and lifestyle advice

Question 15

Name 4 drugs used in the treatment of T2DM

Answer 15

1. Metformin
2. Gliclazide (sulphonylureas)
3. Acarbose (a-glucosidase inhibitor)
4. Pioglitazone (thiazolidinedione)

Question 16

Describe the mechanism of action and side effects of metformin

Answer 16

• Reduce hepatic gluconeogenesis
• Increase muscle glucose uptake
• Nausea, diarrhoea, lactic acidosis

Question 17

Describe the mechanism of action and side effects of gliclazide

Answer 17

• Stimulate B-cells to produce insulin

- Hypoglycaemia and weight gain

Question 18

Describe the mechanism of action and side effects of acarbose

Answer 18

• Inhibits breakdown of carbohydrates thus delaying glucose uptake
• Bloating, flatulence, diarrhoea

Question 19

Describe the mechanism of action and side effects of pioglitazone

Answer 19

• Improve insulin sensitivity

- Fluid retention, heart failure, weight gain, bladder cancer

Question 20

Describe the Incretin System

Answer 20

• Liver senses glucose has been taken orally
• Stimulates production of GLP1
• GLP1 stimulates pancreas to make insulin in appropriate manner
• Insulin production increases

Question 21

Name 2 drug therapies used to target the incretin system

Answer 21

1. GLP-agonists

2. DPP4 inhibitors

Question 22

Why do DPP4 inhibitors affect the incretin system?

Answer 22

DPP4 is responsible for the breakdown of GLP1 so inhibitors prevents GLP1 breakdown and increases presence in the body

Question 23

With regards to normal glucose handling, describe how SGLT2 inhibitors can be used as a treatment for T2DM

Answer 23

• Glucose is filtrated in the glomerulus
• Majority of glucose is absorbed by SGLT2 receptor in PCT
• Remaining glucose absorbed by SGLT1 receptor in descending limb of Loop of Henle
• SGLT2 inhibitors prevent resorption of glucose from PCT
• This leads to increased urinary glucose extraction
• Reduces the blood-glucose level

Question 24

Name 3 emergencies in diabetes

Answer 24

1. Diabetic ketoacidosis
2. Hyperosmolar hyperglycaemia state
3. Hypoglycaemia

Question 25

Name 3 things which make up diabetic ketoacidosis

Answer 25

1. Hyperglycaemia (glucose > 11.1 mmol/l) 2. Acidosis (ph < 7.3) 3. Ketosis (urinary or capillary)

Question 26

Describe the management of diabetic ketoacidosis

Answer 26

- IV fluids and insulin - Potassium - Treat underlying cause e.g infection - Careful monitoring - Education

Question 27

What is hypoglycaemia?

Answer 27

Low blood glucose (< 4mmol/l)

Question 28

Describe the symptoms of hypoglycaemia

Answer 28

Sweating, Pallor, Anxiety, Tremors Confusion, Fatigue, Headache Slurred speech, Incoordination, Drowsy, Coma

Question 29

Describe the treatment of hypoglycaemia

Answer 29

- Treat with quick acting carbohydrate (glucotabs) | - Follow up with long acting carbohydrate (meal / bread)

Question 30

Name 5 common complications of diabetes

Answer 30

1. Periodontitis 2. Dry mouth 3. Altered taste sensation 4. Oral infection 5. Poor oral wound healing

Question 31

Name 4 things to consider when planning a procedure

Answer 31

1. Medications the patient is on 2. How long the procedure is 3. Time of the procedure 4. Will they be able to eat after the procedure

Question 32

Describe 3 steps to take if a patient is taking insulin or gliclazide

Answer 32

1. Reduce long acting insulin the evening before the procedure 2. Hold short acting insulin and gliclazide on the day of test 3. Put patient first on the morning list