Diabetes

Question 1

What is the diagnostic criteria for diabetes

Answer 1

• Fasting glucose: >7mmol/L
• Oral glucose tolerance test: >11.1mmol
• HbA1c: >6.5% (>48mmol) (level below doesn’t exclude)

Question 2

What is the diagnostic criteria for impaired glucose tolerance

Answer 2

• Fasting glucose: 6-7mmol/L

- Oral glucose tolerance test: 7.8-11mmol

Question 3

What is the pathophysiology of T1DM

Answer 3

• Autoimmune destruction of beta-cells

- Leads to total insulin deficiency

Question 4

What are the HLA’s associated with T1DM

Answer 4

• HLA DR3

- HLA DR4 (more so)

Question 5

What are the clinical features of T1DM

Answer 5

• Onset usually < 30yrs
• Polyuria + Polydipsia
• Weight loss + fatigue
• Recurrent infections
• May present with DKA

Question 6

What is the management of T1DM

Answer 6

• Patient Education
• Insulin replacement
• In some cases transplantation

Question 7

What is the Pathophysiology of T2DM

Answer 7

• Peripheral resistance to insulin
• There is not a total deficiency of insulin
• Strong genetic component

Question 8

What are the clinical features of T2DM

Answer 8

• 80% are overweight
• 20% present with a complication (IHD, Stroke etc)
• Insidious polyuria + polydipsia

Question 9

What is the management of T2DM

Answer 9

• Patient education
• Lifestyle changes: diet + exercise + weight loss
• Anti-diabetic medication

Question 10

What are the medication options for T2DM

Answer 10

• Metformin
• Sulphonylureas (e.g. gliclazide)
• Prandial glucose regulators
• Thiazolidinediones (e.g. pioglitazone)
• Alpha-glucosidase inhibitors
• GLP-1 receptor analogues (exenetide)
• Insulin

Question 11

What is the mechanism of action of Metformin

Answer 11

• Increases insulin sensitivity

- Inhibits hepatic gluconeogenesis

Question 12

What is the mechanism of action of Sulphonylureas (and give an example)

Answer 12

E.g. Gliclazide

• Stimulates pancreatic beta cells to secrete insulin
• Can cause weight gain

Question 13

What is the mechanism of action of Thiazolidinediones (and give an example)

Answer 13

E.g. Pioglitazone

• Activates adipocyte cells to stimulate adipogenesis + uptake of fatty acids
• Can cause weight gain

Question 14

What is the mechanism of action of GLP-1 receptor analogues (and give an example)

Answer 14

E.g. Exenetide

• Increase insulin secretion
• Decrease glucagon secretion
• Often result in weight loss

Question 15

When would you add a second anti-diabetic drug (in addition to metformin)

Answer 15

When HbA1c rises above 58mmol (7.5%)