Type 2 diabetes

Question 1

pathophysiology

Answer 1

repeated exposure to glucose and insulin makes cells resistant to insulin effects
body requires more insulin
pancreas fatigued and produces less

Question 2

non-modifiable risk factors

Answer 2

age
ethnicity
FH

Question 3

modifiable risk factors

Answer 3

obesity
sedentary lifestyles
high CHO

Question 4

presentation

Answer 4

fatigue 
polydipsia and polyuria 
unintentional weight loss
infections 
slow healing 
glucose in urine

Question 5

OGTT

Answer 5

morning prior to breakfast
baseline fasting plasma glucose
give 75g glucose
measure plasma glucose 2 hours later

Question 6

pre-diabetes diagnosis

Answer 6

HbA1c 42-47mmol/l or impaired OGTT
fasting glucose 6.1-6.9
glucose tolerance 7.8-11.1

Question 7

diabetes diagnosis

Answer 7

HbA1c >48mmol/l
random glucose >11mmol/l
fasting glucose >7mmol/l
OGTT 2 hour >11mmol/l

Question 8

management

Answer 8

education 
diet/lifestyle 
stop smoking
optimise bp
monitor for complications

Question 9

when to start treatment?

Answer 9

48mmol/l for new type 2

53mmol/l metformin

Question 10

medical management

Answer 10

metformin 500mg
sulfonylurea, pioglitazone, SGLT-2 inhibitor or DDP-4 inhibitor
insulin

Question 11

metformin

Answer 11

biguanide increase insulin sensitivity

decrease liver producing glucose

Question 12

does metformin cause weight gain?

Answer 12

no

Question 13

side effects of metformin

Answer 13

lactic acidosis

GI - diarrhoea and abdo pain

Question 14

pioglitazone

Answer 14

TZD

works similar to metformin

Question 15

pioglitazone side effects

Answer 15

weight gain 
fluid retention
bladder cancer 
heart failure 
anaemia

Question 16

most common sulfonylurea

Answer 16

gliclazide

Question 17

how do sulfonylureas work?

Answer 17

stimulate insulin release from pancreas

Question 18

sulfonylurea side effects

Answer 18

weight gain
hypoglycaemia
CVD and MI

Question 19

What are incretins?

Answer 19

hormones produced by GI tract in response to large meals to increase insulin, inhibit glucagon and slow absorption

Question 20

main incretin

Answer 20

GLP-1

Question 21

what enzyme inhibits incretins?

Answer 21

DDP-4

Question 22

example of DDP-4 inhibitor

Answer 22

sitaglipin

Question 23

DDP-4 side effects

Answer 23

GI tract upset
URTI
pancreatitis

Question 24

side effects of GLP-1 mimetics

Answer 24

GI tract upset
weight loss
dizziness

Question 25

How do SGLT-2 inhibitors work?

Answer 25

SGLT-2 reabsorb glucose in proximal tubules

blocking this cause glucose to be excreted in urine

Question 26

side effects of SGLT-2 inhibitors

Answer 26

glucoseruia
DKA
lower limb amputation 
UTI
weight loss

Question 27

examples of rapid acting insulin and how long they work

Answer 27

work after 10 mins and last around 4 hours

novorapid, humalog and apidra

Question 28

short-acting insulin examples and how long they work

Answer 28

take 30 mins, last 8 hours

actrapid, humulin S

Question 29

Long acting isulins

Answer 29

levemir

last 24 hours