Circadian Rhythms and Diabetes T2 Treatment and Microvascular

Question 1

When should serum testosterone be measured?

Answer 1

At 9am because of circadian rhythm

Question 2

What is adrenal insufficiency?

Answer 2

Adrenocortical insufficiency seeing a reduction in: Mineralocorticoids, glucocorticoids and androgens

Question 3

What are the main symptoms of adrenal insufficiency?

Answer 3

1) Tanned (Pigment)
2) Tired
3) Tearful
4) Weight Loss
5) Headaches
6) Abdominal Cramps
7) Myalgia
8) Vomiting
9) Lethargy and Weakness

Question 4

What are the main causes of adrenal insufficiency?

Answer 4

1) Addison’s disease (AI destruction of adrenal cortex)
2) TB
3) Drugs
4) Haemorrhage, Infection, Adrenal Metastases and Congenital Adrenal Hyperplasia

Question 5

What investigations would be recommend for someone with adrenal insufficiency?

Answer 5

1) Blood Levels (FBC and U&E [V Na+, ^K+ as reduced aldosterone ^ Ca2+, ^ Urea])

Question 6

What is the main treatment for adrenal insufficiency?

Answer 6

Hormone Replacement Therapy (Steroids e.g. Hydrocortisone) (100 mg!)

Question 7

How does a steroidal prescription for an adrenal insufficiency patient if they’re already taking steroids?

Answer 7

Double the dosage!

Question 8

What cycle does cortisol follow in the body?

Answer 8

Plummets after midnight, and begins increasing at 3am, building up to morning before gradually decreasing throughout the day.

Question 9

Why is the human body clock not 24 hours?

Answer 9

It is slightly offset so it can adjust to changing time zones etc, due to suprachiasmatic nuclei controlling nuclei in viscera

Question 10

What is the most common and severe complication of diabetes?

Answer 10

CVD –> Commonest cause of death and high financial burden

Question 11

What are the 2 main ways to prevent T2 diabetes?

Answer 11

1) Weight Reduction

2) Reduce complications

Question 12

What are the 4 methods of treating diabetes?

Answer 12

1) Sensitise: Metformin ^ response to insulin
2) Secrete: Sulphonylurea: ^ secretion
3) Replace: Inject insulin to promote uptake and storage of glucose
4) Excretion: SGLT2: Remove excess glucose with Insulin Inhibitors

Question 13

What are the the 2 T2 diabetes treatment methods without insulin?

Answer 13

1) Lifestyle Interventions
2) Pharmacotherapy (Usally 2-3 tablets due to losing initial effect)
- GLP-1, inhibitor of DPP-4 so GLP-1 can slow G emptying and allow Beta cells to increase in insulin production

Question 14

What are the problems seen with Acute and Chronic Hyperglycaemia?

Answer 14

Acute: Diabetic Ketoacidosis and Hyperosmolar Coma
Chronic: Macro and Microvascular complications