Type 2 Diabetes

Question 1

What is the HbA1c for pre diabetes

Answer 1

42-47mmol/mol

Question 2

what are the two diagnostic results for confirmed diabetes

Answer 2

HbA1c of 48 or more
fasting plasma BG of 7 or more

Question 3

What is 2nd line when there is low CVD risk?

and if these dont work?

Answer 3

pioglitazone
sulphonylurea

SGLT2-i
DPP-4i

Question 4

What is 2nd line when there is high CVD risk

Answer 4

SGLT2-i

Question 5

What is the treatment plan for high cvd risk and the patient does not tolerate metformin

Answer 5

SGLT2-i alone

Question 6

What is HbA1c target if pt is not taking any drugs associated with hypoglycaemia and being managed on lifestyle with/without single drug

Answer 6

48mmol/mol
6.5%

Question 7

What is HbA1c target if pt is taking a drug associated with hypoglycaemia and being managed on lifestyle with/without single drug

Answer 7

53mmol/mol
7%

Question 8

What is the HbA1c target for a patient on a single drug

Answer 8

53mmol/mol
7%

Question 9

What is classed as uncontrolled HbA1c for a patient on a single drug

Answer 9

more than 58mmol/mol
7.5%

Question 10

Metformin is what type of drug

what is its action

Answer 10

biguanide

Decreases gluconeogenesis and increases peripheral utilisation of glucose

Question 11

MHRA for metformin

Answer 11

reduced vitamin B12 levels

Question 12

What are the side effects of metformin

Answer 12

lactic acidosis
GI - N&V, diarrhoea

Question 13

what increases the risk of lactic acidosis

Answer 13

reduced kidney function
increased alcohol intake

Question 14

What are examples of DPP-4i

Answer 14

alogliptin
linagliptin
sitagliptin
saxagliptin
vildagliptin

Question 15

What is the action of DPP-4i

Answer 15

inhibits DPP-4 to increase insulin secretion and reduce glucagon secretion

Question 16

what is avoided and cautioned in DPP-4i

Answer 16

avoid in ketoacidosis
caution in heart failure

Question 17

What is a key side effect of DPP-4i

Answer 17

pancreatitis - stop if symptoms occur

Question 18

What is the action of pioglitazone

Answer 18

reduces peripheral insulin resistance

Question 19

What is a contraindication for pioglitazone

Answer 19

C/I in history of heart failure

Question 20

What are the 4 risks with taking pioglitazone

Answer 20

increased risk of bladder cancer
increased risk of bone fractures
increased risk of infection
increased risk of liver toxicity

Question 21

What are examples of sulphonylureas

Answer 21

Long acting: glibencamide, glimepiride

Short acting: gliclazide, tolbutamide

Question 22

What is a key side effect of sulphonylureas

Answer 22

HYPOglycaemia

Question 23

What is avoided for sulphonylureas

Answer 23

avoid prescribing in acute porphyria

avoid in hepatic and renal failure

long acting avoided in elderly

Question 24

What are examples of SGLT2-i

Answer 24

canagliflozin
dapagliflozin
empagliflozin
ertugliflozin

Question 25

What is the action of SGLT2-i

Answer 25

inhibits SGLT2 in the renal proximal convolute tubule

Question 26

what are the MHRA warnings for SGLT2-i

Answer 26

life threatening and fatal cases of DKA Monitor ketones if treatment interrupted for surgical procedures or illness fourniers gangrene - necrotising fascitis of genitalia or perineum canagliflozin ONLY - risk of lower limb amputation mainly toes

Question 27

what needs to be correct prior to SLGT2-i initiation

Answer 27

SGLT2-i can cause volume depletion correct hypovolaemia before starting

Question 28

What is there an increased risk of when taking SGLT2-is

Answer 28

increased risk of urinary tract infections

Question 29

what needs to be monitored in SGLT2-i

Answer 29

renal function as can cause renal impairment

Question 30

what are examples of GLP-1 agonist

Answer 30

dulaglutide exenatide liraglutide lixisenatide semaglutide tirzepatide

Question 31

What is the action of GLP-1 agonists

Answer 31

increase insulin secretion, suppresses glucagon secretion and slows gastric emptying

Question 32

what are the 3 MHRA warnings for GLP-1 agonists

Answer 32

DKA risk when concomitant insulin was rapidly reduced reminder of side effects and potential misuse - weight loss risk of pulmonary aspiration during general anaesthesia or deep sedation

Question 33

What are the potential side effects of GLP-1 agonists

Answer 33

acute pancreatitis GI effects - weight loss, delayed gastric emptying, N&V dehydration - avoid fluid depletion

Question 34

what are 2 other unconventional antidiabetics

Answer 34

acarbose meglitides - repaglinide and nateglinide

Question 35

What is the action of acarbose

Answer 35

delay digestion and absorption of starch and sucrose

Question 36

what is the action of meglitide

Answer 36

stimulates insulin secretion

Question 37

Which antidiabetic medications make you gain, neutral and lose weight

Answer 37

gain - pioglitazone, sulphonylureas neutral - DPP-4i, metformin loss - SGLT2-i, GLP-1 agonists

Question 38

Which antidiabetic medication is withdrawn if hypoxia is likely

Answer 38

metformin