Abnormal blood sugar

Question 1

What is the pathophysiology of T2DM?

Answer 1

Repeated exposure to glucose and insulin causes insulin resistance. Over time, beta cells in the pancreas become fatigued and damaged so are less able to produce insulin. This causes chronic hyperglycaemia

Question 2

Non-modifiable risk factors for T2DM (3)

Answer 2

Old age
Ethnicity (Black, Chinese, South Asian)
FHx

Question 3

Modifiable risk factors for T2DM (3)

Answer 3

Obesity
High CHO diet
Sedentary lifestyle

Question 4

(8) Symptoms of T2DM

Answer 4

Polydipsia
Polyuria
Fatigue
Unintentional weight loss
Opportunistic infections
Slow wound healing
Glucose present on urine dipstick
Asymptomatic

Question 5

Explain the OGTT (timings, quantities, justifications)

Answer 5

1. Baseline fasting plasma glucose
2. 75g glucose drink prior to having breakfast
3. Plasma glucose measured 2 hours later
4. Tests ability to cope with high carbohydrate meal

Question 6

HbA1c for pre-diabetes and diabetes diagnosis

Answer 6

Pre-diabetes = HbA1c of 42-47 mmol/L

Diabetes = HbA1c of >48 mmol/L

Question 7

What are the relevant plasma glucose levels on an OGTT for impaired glucose tolerance and diabetes?

Answer 7

Impaired glucose tolerance = 7.8-11 mmol/L

Diabetes = >11 mmol/L

Question 8

Target HbA1c for newly diagnosed diabetics

Answer 8

48mmol/L

Question 9

Target HbA1c for diabetics on multi-drug therapies (more than just metformin)

Answer 9

53 mmol/L

Question 10

First line drug (and dosage) for T2DM

Answer 10

Metformin 500mg (titrated up)

Question 11

Second line drug options for T2DM

Answer 11

Metformin AND

sulfonylurea, pioglitazone, DDP-4 inhibitor, SGLT-2 inhibitor

Question 12

Third line drug options for T2DM

Answer 12

Triple therapy:
Metformin and combination of: sulfonylurea, pioglitazone, DDP-4 inhibitor, SGLT-2 inhibitor

OR metformin + insulin

Question 13

Fourth line drug options for T2DM

Answer 13

Metformin + insulin

Question 14

Which T2DM drugs are advised in patients with cardiovascular disease?

Answer 14

SGLT-2 inhibitorsandGLP-1 mimetics

Question 15

What effect does metformin have on body weight?

Answer 15

None

Question 16

How does metformin work?

Answer 16

It increases insulin sensitivity and decreases liver production of glucose

Question 17

Main SE of metformin (2)

Answer 17

Diarrhoea & abdominal pain

Lactic acidosis

Question 18

How does pioglitazone work?

Answer 18

It increases insulin sensitivity and decreases liver production of glucose

Question 19

Main SE of pioglitazone (5)

Answer 19

• Weight gain
• Fluid retention
• Anaemia
• Heart failure
• Extended use may increase the risk of bladder cancer

Question 20

What is the (name of) the most common sulfonyluria?

Answer 20

Gliclazide

Question 21

How do sulfonylurias work?

Answer 21

Sulfonylureas stimulate insulin release from the pancreas.

Question 22

Main SE of sulfonylurias (3)

Answer 22

• Weight gain
• Hypoglycaemia
• Increased riskofcardiovascular diseaseandmyocardial infarctionwhen used as monotherapy

Question 23

What is the (name of) the most common DDP-4 inhibitor?

Answer 23

Sitagliptin

Question 24

How do DDP-4 inhibitors work?

Answer 24

Inhibits DDP-4 enzyme which allows increased levels of GLP-1 (incretin that stimulates insulin secretion)

Question 25

Main SE of DDP-4 inhibitors (3)

Answer 25

GI tract upset
Sx of URTI
Pancreatitis

Question 26

Name 2x GLP-1 mimetics and how they are typically given

Answer 26

1. Exanatide - SC BD (or once weekly)

2. Liraglutide - SC OD