Type 2 Diabetes

Question 1

what are the key physiological changes in T2DM?

Answer 1

insulin resistance

beta cell dysfunction

Question 2

what happens in a normal person when insulin binds to a receptor on a cell?

Answer 2

triggers production of glucose transport proteins to allow glucose to enter the cell

Question 3

what happens if someone is insulin resistant?

Answer 3

receptor is not as responsive to the insulin molecule & therefore less glucose enters the cell causes a build up of glucose in blood

Question 4

PCOS

Answer 4

polycystic ovarian syndrome

Question 5

what is beta cell dysfunction?

Answer 5

major defect in individuals with T2DM, reduced ability of beta-cells to secrete insulin in response to hyperglycaemia

Question 6

what happens initially for increasing insulin resistance?

Answer 6

initially the beta cells compensate

Question 7

what does insulin resistance lead to?

Answer 7

glucotoxicity (hyperglycaemia)

lipotoxicity (elevated FFA, TG)

Question 8

what do glucotoxicity & lipotoxicity lead to?

Answer 8

declining beta cell function

Question 9

which body shape is most commonly associated with T2DM?

Answer 9

apple body shape

Question 10

what is the metabolic syndrome?

Answer 10

high blood pressure
high triglycerides
low HDL
insulin resistance

Question 11

what 4 complications of T2DM can be present at time of diagnosis?

Answer 11

retinopathy
neuropathy
erectile dysfunction
nephropathy

Question 12

what 4 lifestyle changes can be made to help with T2DM?

Answer 12

weight loss
exercise
smoking cessation
improve diet

Question 13

which ethnicity have lower BMI targets due to increased risk of diabetes?

Answer 13

SE Asian populations

Question 14

what can we do to help patients better their self-management?

Answer 14

education
behaviour change
motivational interviewing
personal information sharing

Question 15

health literacy

Answer 15

the wide range or skills & competencies that people develop to seek out, comprehend, evaluate & use health information & concepts to make informed choices, reduce health risks & increase quality of life

Question 16

give an example of a biguanide?

Answer 16

metformin

Question 17

give some examples of sulphonylureas

Answer 17

glicazide
glibenclamide
glimeparide

Question 18

give an example of thiazolidinediones

Answer 18

pioglitazone

Question 19

what is metformin derived form

Answer 19

guanidine

Question 20

what does metformin do

Answer 20

improves sensitivty to insulin

Question 21

what are the doses of metformin tablets that can be given

Answer 21

500mg
850mg
1000mg

Question 22

what is the normal starting dose of metformin?

Answer 22

500mg od or bd

Question 23

what are the effects of metformin

Answer 23

reduces HbA1c by lowering insulin resistance

prevents microvascular & macrovascular complications

Question 24

when metformin is used as a monotherapy, does it cause hypos?

Answer 24

no

Question 25

is metformin do in pregnancy?

Answer 25

nothing it's safe

Question 26

what does metformin do to BP?

Answer 26

minor reduction

Question 27

what does metformin to to triglycerides & LDL?

Answer 27

reduces them

Question 28

what GI side effects does metformin do?

Answer 28

anorexia, nausea, vomiting, diarrhoea, abdo pain, taste disturbance

Question 29

what substances does metformin interfere with?

Answer 29

Vit. B12 & folic acid absorption

Question 30

what other adverse affects can metformin do?

Answer 30

rarely lactic acidosis liver failure rash

Question 31

at what eGFR/serum creatinine should metformin be stopped?

Answer 31

eGFR 150

Question 32

at what level of eGFR should metformin dose be halved?

Answer 32

30-45 ml/min

Question 33

what is 1st line management of T2DM?

Answer 33

lifestyle changes

Question 34

what is 1st line therapeutic in T2DM?

Answer 34

metformin

Question 35

what are the 2 most widely used sulphonylureas (SUs)?

Answer 35

glicazide | glipizide

Question 36

what effects do SUs have?

Answer 36

reduced HbA1c more rapid reduction in hyperglycaemia compared to insulin sensitisers prevents microvascular & macrovascular complications

Question 37

how do SUs work?

Answer 37

increase insulin secretion

Question 38

what are the adverse affects of SUs?

Answer 38

hypoglycaemia weight gain GI upset headaches

Question 39

when would SUs be first line?

Answer 39

in underweight T2DM

Question 40

what are the rarer adverse effects of SUs?

Answer 40

hypersensitivity blood dyscrasias live dysfunction

Question 41

when should SUs be avoided?

Answer 41

severe renal or hepatic failure

Question 42

why was rosiglitazone taken off the market?

Answer 42

concerns over increased risk of MI

Question 43

what are the effects of thiazolidinedones (TZDs)?

Answer 43

reduces HbA1c | prevents macrovascular complications

Question 44

do TZDs cause hypos?

Answer 44

not if used without an SU

Question 45

what happens to weight with TZDs?

Answer 45

increase is very common

Question 46

what is the effect of TZDs on heart conditions?

Answer 46

reduces heart attacks but will make heart failure worse

Question 47

how do TZDs work?

Answer 47

increase insulin sensitisation

Question 48

what MSK problem do glitazone drugs increase the risk of?

Answer 48

hip fractures

Question 49

give an example of an SGLT2 inhibitor?

Answer 49

dapagliflozin | empagliflozin

Question 50

give an example of a drug based on incretins (GLP-1 receptors agonists)?

Answer 50

exenatide exendin liraglutide lixisenatide

Question 51

what is the incretin effect?

Answer 51

the amount of glucose given intravenously to bring the glucose blood level to the same as that of oral glucose will stimulate less insulin to be produced

Question 52

what are incretins?

Answer 52

intestinal secretions of insulin or hormones that help this

Question 53

what cells secrete GIP?

Answer 53

K cells

Question 54

what cells secrete GLP-1?

Answer 54

L cells

Question 55

what is the issue for patients with GLP-1 receptor agonists?

Answer 55

they have to be given by injection

Question 56

give an example of a glitazone

Answer 56

pioglitazone

Question 57

what are the benefits of GLP-1 receptor agonists?

Answer 57

promote insulin secretion from pancreas without hypoglycaemia suppress glucagon decrease gastric emptying (early satiety) act on hypothalamus to reduce appetite, results in weight loss

Question 58

what are the problems with GLP-1 receptor agonists?

Answer 58

nausea injectable pancreatitis

Question 59

give an example of a drug based on incretins (DPP4 inhibitors)?

Answer 59

vildagliptin sitagliptin saxagliptin linagliptin

Question 60

what are the benefits of DPP4 inhibitors?

Answer 60

``` promote insulin secretion from pancreas without hypoglycaemia suppress glucagon weight neutral can be taken orally nausea not as bad as other drugs ```

Question 61

what are the problems with DPP4 inhibitors?

Answer 61

not that potent no weight loss pancreatitis

Question 62

where in the body do SGLT2 inhibitors act?

Answer 62

in the kidneys to reduce uptake of sugar by about one quarter

Question 63

what's the downside of SGLT2 inhibitors?

Answer 63

causes sugar in the urine which increases thrush & UTIs

Question 64

what insulin regimen is used in T2DM?

Answer 64

basal inulin