Diabetes

Question 1

Name 3 microvascular complications of diabetes and how do these present?

Answer 1

Retinopathy- cloudy, vision, blurred vision, reduced vision, Nephropathy- Protein in urine and Neuropathy- pain, numbness, wounds on feet not noticed- infection

Question 2

What screening programmes does the NHS have to detect the complications of diabetes and how often do these take place?

Answer 2

Retinopathy- diabetic eye screening, once a year
Neuropathy- foot examinations- checked once a year but pt to check feet daily
Nephropathy- Urine dipstick for protein, bloods for GFR at least once a year
Atherosclerosis- Bloods for lipids alongside HbA1c, every 3 months
Blood pressure- screening at least yearly

Question 3

Mr Jackson is 49 years old, he works in an office and has a BMI of 30kg/m², he smokes around 10 cigarettes a day since the age of 20 and drinks around 16 units a week. He admits his diet is mostly processed food as he doesn’t feel like he is a good cook and uses alcohol to relax. He has recently been diagnosed with type 2 DM, what lifestyle advice would you give to him?

Answer 3

Weight loss- healthy balance diet, reducing the amount of sat fats, carbohydrates, sugary sweets and drinks and processed foods

Exercise- at least 150 mins of exercise of his choice

Reducing alcohol intake- will help reduce amount of carbs/ calories, reduce chance of fatty liver

Stop smoking- reduce atherosclerosis and reduce the chance of lung malignancies

Question 4

How do you diagnose a pt with Type 2 DM?

Answer 4

Clinical features: polydipsia, polyuria, blurred viison, recurrent infections (e.g. UTIs) tiredness, acanthosis nigricans.

In clinic: IF SYMPTOMATIC- single abnormal HbA1c or fasting plasma glucose

IF ASYMPTOMATIC- 2 abnormal HbA1c or fasting plasma glucose

Question 5

What is the first line drug treatment for diabetes

Answer 5

Metformin

Question 6

What is the mechanism of action of metformin?

Answer 6

Decrease hepatic glucose production by inhibiting gluconeogenesis
Supress appetite so limit weight gain

Question 7

What are the ADRs of metformin?

Answer 7

GI upset, dizziness

Question 8

When is metformin contraindicated?

Answer 8

When the eGFR is < 30mL/min

Question 9

How is metformin excreted and what does this mean?

Answer 9

It is excreted unchanged by the kidney, therefore needs to be stopped in AKI

Question 10

What class of drug is gliclazide and how does it work?

Answer 10

Sulfonylurea and it works by stimulating Bcell pancreatic insulin secretion by blocking ATP dependent K+ channels therefore need residual pancreatic function to work.

Question 11

When would you use gliclazide

Answer 11

First line if metformin is contraindicated

Or second line alongside metformin

Question 12

What dual therapy would you use if Metformin by itsef was not working?

Answer 12

Metformin + gliclazide (SU) 
OR
Metformin + gliptins (DDP4 inhibitor) 
OR 
Metformin + gliflozin (SGLT2 inhibitor) -if gliclazide is contraindicated

Question 13

How do SGLT2 inhibitors work? What is an example of one

Answer 13

Dapagliflozin-works by reducing glucose absorption from tubular filtrate- you pee out more glucose

Question 14

How do DDP4 inhibitors work? What is an example of one?

Answer 14

Prevent incretin degradation, this means that the levels in the plasma increase which causes insulin to be released. Sitagliptin

Question 15

ADRS of SGLT2 inhibitors

Answer 15

UTI and genital infection , thirst and polyuria (sx of DM)

Question 16

ADRS of DDP4

Answer 16

GI upset and small pancreatitis risk

Question 17

How do glitazones work? What is an example of one

Answer 17

Insulin sensitisation in muscle and adipose, reduces hepaticv glucose output by activation of PPAR-y–> gene transcription. Pioglitazone

Question 18

ADRS of gliztazones

Answer 18

Weight gain, GI upset, fluid retention, fracture risk and bladder cancer