Endocrinology

Question 1

Describe how carbohydrates are metabolised

Answer 1

Carbohydrates ingested
Carbohydrates digested by enzymes in stomach and intestine to release glucose
Glucose absorbed into blood stream stimulates pancreas to release insulin
Glucose is then stored in fat, muscle and in the liver

Question 2

What is insulin?

Answer 2

Hormone which acts like a key to unlock the body’s cells and let glucose in which is then converted to energy

Question 3

What is diabetes mellitus?

Answer 3

A syndrome of chronic hyperglycaemia due to reactive insulin deficiency, resistance or both

Question 4

What is the optimum blood glucose level before a meal?

Answer 4

4-7 mmol/L

Question 5

What is the optimum blood glucose level 2 hours after a meal?

Answer 5

<10mmol/L

Question 6

What advice can you give someone with T2DM?

Answer 6

Lifestyle interventions

CV risk reduction

Question 7

When is HBA1C not an appropriate way of measuring diabetic control?

Answer 7

Young
Pregnant
T1DM
Diabetes symptoms <2 months
Medication causing a rapid rise in glucose such as steroids and antipsychotics
Acute pancreatic damage including surgery
Genetic and haematological factors

Question 8

Describe treatment intensification for the management of T2DM

Answer 8

Initial drug therapy - Monotherapy - Non insulin blood glucose therapy
First intensification - Dual therapy - Non insulin blood glucose therapy
Second intensification - Triple therapy - Non insulin blood glucose therapy + any combination with insulin

Question 9

Describe how muscle and fat affect the glucose level in T2DM

Answer 9

Insulin resistance

Question 10

Describe how the pancreas affects the glucose level in T2DM

Answer 10

Beta cell dysfunction

Question 11

Describe how the gut affects the glucose level in T2DM

Answer 11

Glucose absorption

Question 12

Describe how the liver affects the glucose level in T2DM

Answer 12

Hepatic glucose overproduction

Question 13

What T2DM drugs target the pancreas?

Answer 13

Sulfonylureas
Meglitinides
DPP4 inhibitors
GLP1 analogs

Question 14

Which T2DM drugs target the liver?

Answer 14

Metformin
Thiazolidinediones
DPP4 inhibitors
GLP1 analogs

Question 15

Which T2DM drugs target the gut

Answer 15

Alpha glucosidase inhibitors
GLP 1 analogs
Pramlintide

Question 16

Which T2DM drugs target muscle and fat?

Answer 16

Thiazolidinediones

Metformin

Question 17

Which is the most common first line treatment for T2DM?

Answer 17

Metformin

Question 18

List the side effects of metformin

Answer 18

Anorexia, GI disturbance, metallic taste, metabolic acidosis, decreased vitamin B12 absorption

Question 19

What happens to peoples weight as a result of metformin?

Answer 19

Remains neutral

Question 20

Where does metformin target?

Answer 20

Liver and muscle

Question 21

Where do sulfonylureas target?

Answer 21

Pancreas

Question 22

Name some sulfonylureas

Answer 22

Glipizide 
Gliclazide 
Tolbutamide
Glimepiride 
Glibenclamide

Question 23

List the side effects of sulfonylureas

Answer 23

Hypos - inform DVLA
GI disturbance
Weight gain
Deranged LFTS

Question 24

Where do thiazolidinediones act?

Answer 24

Liver
Pancreas
Fat cells
Muscle cells

Question 25

Name a thiazolidinedione

Answer 25

Pioglitazone

Question 26

What are thiazolidinediones associated with?

Answer 26

Increased risk of HF, bladder cancer and fractures

Question 27

How long does it take thiazolidinediones to take full effect?

Answer 27

8 weeks

Question 28

List the side effects of thiazolidinediones

Answer 28

``` GI disturbance Weight gain Oedema Hypoglycemia Altered lipids ```

Question 29

When should you continue thiazolidinediones?

Answer 29

If there is a reduction of at least 0.5% HbA1c in 6 months

Question 30

Name some glucagon like peptide 1 receptor agonists

Answer 30

Exenatide Liraglutide Lixisenatide

Question 31

When do you continue GLP1 agonists?

Answer 31

If beneficial metabolic response in 6 months

Question 32

How are GLP 1 agonists administered?

Answer 32

SC injection

Question 33

Who should you be cautious of giving GLP1 agonists to?

Answer 33

Elderly and those with renal problems

Question 34

What interactions should patients be aware of when taking GLP1 agonists

Answer 34

Take other medications 1 hour before or 2 hours after injections

Question 35

List the side effects of GLP 1 agonists

Answer 35

``` GI disturbance Weight loss Hypoglycemia Pancreatitis AKI ```

Question 36

Name some dipeptidyl peptidase 4 inhibitors

Answer 36

``` Alogliptin Linagliptin Saxagliptin Sitagliptin Vildagliptin ```

Question 37

When should sitagliptin and vildagliptin be continued?

Answer 37

If reduction is at least 0.5% HbA1c in 6 months

Question 38

What must you do when prescribing DPP4 inhibitors in liver and renal impairment?

Answer 38

Reduce the dose

Question 39

List the side effects of DPP4 inhibitors?

Answer 39

GI disturbance Peripheral oedema Pancreatitis

Question 40

Where are sodium glucose co transporter 2s located?

Answer 40

Proximal tubule

Question 41

What percentage of filtrate is reabsorbed by SGLT2s

Answer 41

90%

Question 42

Name some sodium glucose co transporter 2 inhibitors

Answer 42

Canagliflozin Dapagliflozin Empagliflozin

Question 43

Describe the mechanism of action of SGLT2 inhibitors

Answer 43

Blocks lucose reabsortption in the proximal renal tubule

Question 44

When should you be cautious of prescribing SGLT2 inhibitors

Answer 44

Volume depletion CVD Liver and renal impairment

Question 45

List the side effects of SGLT2 inhibitors

Answer 45

GI disturbance Dyslipidaemia Urinary symptoms Dehydration

Question 46

Which SGLT2 inhibitor is not indicated with pioglitazone?

Answer 46

Dapagliflozin

Question 47

Name an alpha glucosidase inhibitor

Answer 47

Acarbose

Question 48

Describe the mechanism of action of alpha glucosidase inhibitors

Answer 48

Delays glucose absorption from the gut after a carbohydrate meal by blocking glucosidase in the small intestine

Question 49

When should you avoid alpha glucosidase inhibitors

Answer 49

Renal and liver impairment

Question 50

List the side effects of alpha glucosidase inhibitors

Answer 50

Nausea and vomiting Diarrhoea Flatulence Hypos

Question 51

What must you monitor when prescribing alpha glucosidase inhibitors

Answer 51

Liver

Question 52

Name some meglitinides

Answer 52

Nateglinide | Repaglinide

Question 53

Describe the mechanism of action of meglitinides

Answer 53

Stimulate insulin secretion in the presence of glucose

Question 54

What is the main side effect of meglitinides

Answer 54

Hypoglycaemia (less so than SU) | GI disturbance

Question 55

Name a biguanide

Answer 55

Metformin

Question 56

Which drug is the only one that can be used to treat gestational diabetes?

Answer 56

Metformin

Question 57

Describe the DVLA regulation on diabetes and driving

Answer 57

Must inform the DVLA Insulin, Sulfonylureas, meglitinides Test blood glucose a maximum of 2 hours before driving and every 2 hours during driving