(4.1) Diabetic Managements

Question 1

Suggest two regimes for Type 1 Diabetes.

Answer 1

Insulin Injection

• Basal Bolus Regime: long-acting as a background + fast-acting before 3 meals
• Pre-mixed Insulin Regime: long-acting + fast-acting together, only need 2 injections a day

Question 2

What is the first medication choice of Type 2 Diabetes?

Answer 2

Bigutanide e.g. Metformin -> +insulin sensitivity

Question 3

Suggest some ADRs of Bigutanide

Answer 3

• GI complaints
• Lactic acidosis
• Vitamin B12 deficiency

Question 4

Which diabetic drugs can cause Hypoglycaemia if given in excess?

Answer 4

• Sulphonyureas
• Meglitidine
• Incretin-like substances (Gliptin & Exantinide)

Question 5

What is the action of Sulphonyureas? Give two examples of drugs.

Answer 5

• Stimulate Insulin release
• Gliclazide
• Tolbutamide

Question 6

In what patients should Sulphonyureas be avoided? Hence suggest an alternative option that works in similar mechanism as Sulphonylureas.

Answer 6

• Pregnancy

- Meglitidine

Question 7

How does Thiazolidinedione work? Give two examples of drug.

Answer 7

• Increase insulin sensitivity

- Rosiglitazone & Pioglitazone

Question 8

Suggest some ADRs of Rosiglitazone.

Answer 8

• Fluid retention -> Oedema

- +LDL -> CVS risk

Question 9

What actions does Incretin has? What drugs take actions via its effects?

Answer 9

• • beta cells -> + Insulin
• -alpha cells -> - Glucagon
• Gliptin & Exantinide

Question 10

Suggest some of the symptoms that can occur due to Hyperglycaemia (5).

Answer 10

• Polyuria
• Polydipsia
• Urogenital infection (extra glucose ideal for bacteria growth)
• Dry skin
• Blurred vision

Question 11

Suggest some chronic macrovascular complications of diabetes.

Answer 11

• Stroke
• Myocardial Infarction
• Poor peripheral circulations

Question 12

Suggest some chronic Microvascular complications of diabetes (3).

Answer 12

• Neurology (diabetic feet)
• Nephrology (glomerular damage)
• Retinopathy (Blindness due to ischaemia & Glaucoma due to high oncostic pressure & Cataract due to disulphate bridge formation)

Question 13

Suggest 3 causes of Type 1 Diabetes.

Answer 13

• Autoimmune
• Pancreatitis
• Pancreatectomy

Question 14

Describe the production of mature insulin (including its structural changes).

Answer 14

• Translation of DNA sequence by mRNA -> Preproinsulin (Signal sequence + AB+C peptides)
• Signal peptidase cleaves -> Proinsulin (AB+C peptides)
• Endopeptidase cleaves -> Insulin (A+B peptides joined by 2 disulphide bridges)

Question 15

Suggest actions of insulin on the body.

Answer 15

• +GLUT4 onto cell membrane -> + glucose uptake into skeletal & adipose cells
• +Glucogenesis & -Glycolysis in the liver
• +Lipogenesis & -Lipolysis in adipose
• +Protein synthesis & -Proteolysis in muscles

Question 16

Describe the process stimulating insulin production.

Answer 16

• +[Glucose]o of beta cells
• Via GLUT2 glucose diffuse into beta cells
• Glucose metabolism -> ATP production
• ATP closes K+ channels
• Reduced K+ efflux -> depolarisation of cell
• Increased [Ca2+]i -> vesicle exocytosis

Question 17

Why might someone with Type 1 diabetes have skin issue?

Answer 17

Polyuria -> + water loss -> - tensile strength & dryness of skin

Question 18

How may Hyperglycaemia causes cataract?

Answer 18

Excess Glucose metabolism -> via alternative pathway using Aldose Reductase -> depleted NADPH -> disulphate bridge formation