Type 2 diabetes

Question 1

What is type 2 diabetes?

Answer 1

A condition in which a combination of insulin resistance and reduced insulin production cause persistently high blood sugar levels

Question 2

What does a high carbohydrate diet combined with insulin resistance and reduced pancreatic function lead to?

Answer 2

Chronic hyperglycaemia

Question 3

Give some non-modifiable risk factors of type 2 diabetes?

Answer 3

Older age

Family history

Ethnicity - Black African / Caribbean / South Asian

Question 4

Give some modifiable risk factors of type 2 diabetes?

Answer 4

Obesity
Sedentary lifestyle
High carbohydrate diet - sugar

Question 5

What is acanthosis nigricans?

Answer 5

Thickening and darkening of the skin giving a ‘velvety’ appearance often at the neck, axilla and groin

Question 6

What is acanthosis nigricans associated with in type 2 diabetes?

Answer 6

Insulin resistance

Question 7

What HbA1c range indicates
pre-diabetes?

Answer 7

42-47 mmol/mol

Question 8

What HbA1c indicates type 2 diabetes?

Answer 8

48 mmol/mol or above

Question 9

Give some non-medical management options for type 2 diabetes?

Answer 9

Patient education
High fibre + low carb diet
Exercise
Weight loss

Question 10

What is the HbA1c target for new type 2 diabetes patients?

Answer 10

48 mmol/mol

Question 11

What is the HbA1c target for patients requiring more than one antidiabetic medication?

Answer 11

53 mmol/mol

Question 12

How often should HbA1c be measured in patients with type 2 diabetes inititally?

Answer 12

Every 3 to 6 months

Question 13

What is the first line treatment of type 2 diabetes?

Answer 13

Metformin

Question 14

What antidiabetic should be given additionally to metformin in a patient with cardiovascular disease or heart failure?

Answer 14

SGLT-2 inhibitor

Question 15

What is the second line treatment of type 2 diabetes?

Answer 15

Add a sulfonylurea, pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor

Question 16

What are the two third-line treatments for type 2 diabetes?

Answer 16

Triple therapy - metformin and two second-line drugs

Insulin therapy

Question 17

What can be done if triple therapy fails in type 2 diabetes?

Answer 17

Switching one of the drugs to a GLP-1 mimetic

Question 18

How does metformin work?

Answer 18

Increases insulin sensitivity

Decreases glucose production

Question 19

What are the notable side effects of metformin?

Answer 19

Gastrointestinal upset - aches, nausea + diarrhoea

Question 20

How do SGLT-2 inhibitors work?

Answer 20

It blocks the reabsorption of glucose from urine into blood causing more glucose to be excreted in the urine

Question 21

What are the notable side effects of SGLT-2 inhibitors?

Answer 21

Glycosuria - glucose in urine
Genital infections / UTIs
Weight loss
Diabetic ketoacidosis

Fournier’s gangrene - rare

Question 22

What does pioglitazone (a thiazolidinedione) do?

Answer 22

Increases insulin sensitivity

Decreases liver production of glucose

Question 23

What are the notable side effects of pioglitazone?

Answer 23

Weight gain
Heart failure
Increased fracture risk

Question 24

What do sulfonylureas do?

Answer 24

Stimulate insulin release from the pancreas

Question 25

What are the notable side effects of sulfonylureas?

Answer 25

Weight gain Hypoglycaemia

Question 26

What do DPP-4 inhibitors do?

Answer 26

Block the action of DPP-4 which allows increased incretin activity

Question 27

What are the notable side effects of DPP-4 inhibitors?

Answer 27

Headaches Low risk of acute pancreatitis

Question 28

What do GLP-1 mimetics do?

Answer 28

Mimic the action of GLP-1 to increase insulin secretion and inhibit glucagon production

Question 29

What are the notable side effects of GLP-1 mimetics?

Answer 29

Reduced appetite Weight loss Gastrointestinal symptoms

Question 30

What are the main complications of type 2 diabetes?

Answer 30

Infections - thrush, infected ulcers Diabetic retinopathy Peripheral neuropathy Autonomic neuropathy Chronic kidney disease

Question 31

What drugs are used to manage hypertension in patients with type 2 diabetes?

Answer 31

ACE inhibitors

Question 32

Name 3 drugs that can be used for neuropathic pain?

Answer 32

Amitriptyline Gabapentin Pregabalin

Question 33

What does HHS stand for?

Answer 33

Hyperosmolar hyperglycaemic state

Question 34

What is hyperosmolar hyperglycaemic state?

Answer 34

A rare but potentially fatal complication of type 2 diabetes It is characterised by hyperosmolality, hyperglycaemia and an absence of ketones

Question 35

What is the clinical presentation of hyperosmolar hyperglycaemic state?

Answer 35

Polyuria, polydipsia Weight loss Dehydration Tachycardia Hypotension Confusion

Question 36

How is hyperosmolar hyperglycaemic state managed?

Answer 36

Medical emergency managed with IV fluids and careful monitoring