Diabetes

Question 1

what are the types of diabetes?

Answer 1

type 1 - develops as young child/adult, autoimmune destruction of beta cells, sudden onset associated with rapid weight loss

type 2 - >45 years old, insulin resistance and deficiency, slow onset associated with people who are overweight

LADA/type 1.5 - gradual autoimmune destruction of beta cells, slower onset

MODY - hereditary condition, insulin deficient production

type 3c - damage to exocrine function of pancreas,

Question 2

metformin

Answer 2

1st line
increases sensitivity to glucose
- increases peripheral utilisation of glucose
- decreases hepatic glucose production

side effects - GI effects (nausea, vomiting, diarrhoea), lactic acidosis, metallic taste

+ves - no weight gain, no hypoglycemia

Question 3

SGLT2 inhibitors

Answer 3

block SGLT2 transporters - responsible for 90% of glucose reabsorption in kidneys

• inhibit reabsorption
• promote urinary glucose excretion

side effects - glycosuria, UTI, dehydration

+ves - cardiovascular benefit - decreases BP, decreases weight

DAPAGLIFLOZIN

Question 4

sulphonylureas

Answer 4

directly increase insulin secretion from beta cells
- block ATPase K+ channels
- depolarises beta cell
- opens voltage gated Ca channels
- increase Ca2+ conc
- stimulates migration of insulin containing secretory vesicles to cell membrane
- fusion + exocytosis of insulin

side effects - hypoglycemia, weight gain, GI effects

+ves - HbA1c effectiveness - high , 2nd line with metformin or without if metformin C/I

GLICAZIDE

Question 5

thiozolidinediones

Answer 5

reduced gluconeogenesis

increased peripheral utilisation of glucose

decreased free fatty acids

reduced insulin resistance

ROSAGLITAZONE
PIOGLITAZONE

+ves - no hypoglycemia, hba1c effectiveness - high

adverse effects - CVD, bladder cancer, weight gain

Question 6

GLP1 agonists and DPP4 inhibitors

Answer 6

GLP1 agonists - increase insulin secretion, reduce glucagon secretion and slow gastric emptying and reduce appetite
- XENATIDE
+ves - weight loss, hba1c effectiveness - high, used in obese patients - 3rd line

side effects - GI disturbances, decreased appetite

dpp4 inhibitors - inhibit DPP - increases levels of GLP-1
- 2nd line with metformin, sulphonylurea and thiazolidinedione
- LINAGLIPTIN, SITAGLIPTIN

+ves - no hypoglycemia, weight neutral, hba1c effectiveness high

S.E. - GI effects, nasopharyngitis, upper respiratory tract infection, oedema