Diabetes

Question 1

what is the normal body reaction to glucose

Answer 1

insulin produced, binds to receptor, glucose enters the cell

Question 2

what is the body reaction with insulin resistance

Answer 2

receptor is less responsive to insulin, less glucose enters the cell = build up of glucose in the blood

Question 3

what are the beta cells initial response to insulin resistance

Answer 3

initial compensation

Question 4

step 1 of type 2 diabetes treatment

Answer 4

diet and exercise

Question 5

step 2 of type 2 diabetes treatment

Answer 5

oral therapy

Question 6

step 3 of type 2 diabetes treatment

Answer 6

oral combination therapy

Question 7

step 4 of type 2 diabetes treatment

Answer 7

injectable and oral therapies

Question 8

first line oral therapy

Answer 8

Biguanide - Metformin

Question 9

how does metformin help hyperglycaemia management?

Answer 9

reduces HbA1c by 15-20mmol/mol

Question 10

what effect does metformin have on cholesterol?

Answer 10

reduces triglycerides and LDL

Question 11

side effects of metformin

Answer 11

GI side effects, interferes with B12 and folate absorption, lactic acidosis, liver failure and rash

Question 12

name the first generation sulphonylureas, are these still used?

Answer 12

chlorpropramide and tolbutamine, rarely used now

Question 13

what makes first generation sulphonylureas different from 2nd generation

Answer 13

first generation are shorting acting

Question 14

first sulphonylurea of choice and dose

Answer 14

Glicazide 40mg OD or 160mg BD

Question 15

do SUs prevent macrovascular complications?

Answer 15

no

Question 16

what is the only thiazolidinedione (TZD) still used on the market?

Answer 16

Pioglitazone

Question 17

what pathway do SGLT2 inhibitors work on? and give an example

Answer 17

The incretin pathway, Dapagliflozin

Question 18

what is incretin?

Answer 18

intestinal secretion of insulin

Question 19

what is GIP and where is it secreted from?

Answer 19

Gastric inhibitory polypeptide, secreted from K cells

Question 20

what is GLP-1 and where is it secreted from?

Answer 20

Glucagon like peptide, secreted from L cells

Question 21

give an example of an GLP-1 receptor agonist

Answer 21

Exenatide

Question 22

where do GLP-1 receptor agonists work?

Answer 22

act on hypothalamus

Question 23

what are the benefits of GLP-1 receptor agonists

Answer 23

promote insulin secretion without hypoglycaemia, suppress glucagon, decrease gastric emptying

Question 24

DPP-4 inhibitors are given by what route? and how do they work

Answer 24

orally active, less effect that GLP-1 mimetics, they can only work on what hormone is already in the body

Question 25

benefits of DPP4s

Answer 25

promote insulin secretion with hypo, suppress glucagon, neutral effect on weight

Question 26

SGLT2 inhibitors end in what?

Answer 26

-LIFLOZIN

Question 27

How do SGLT inhibitors work?

Answer 27

they decrease the uptake of sugar by 1/4

Question 28

disadvantages of using SGLT inhibitors?

Answer 28

more sugar in urine = more thrust and more urine infections

Question 29

where do SUs bind? and what is the effect of this?

Answer 29

to SUR1, close the Katp channel causing depolarisation and insulin release.