diabetes

Question 1

T1DM vs T2DM

Answer 1

T1DM - autoimmune disease where pancreatic b-cells are attacked and therefore undergo destruction –> inadequate insulin secretion
- triggered by perciptating life event e.g. resp infection
- pt often underweight

T2DM - caused by reduced tissue sensitivity to insulin and/or impaired secretory response of pancreatic b-cells
- pt often overweight
- caused by genetics + lifestyle factors
- initial increase in insulin production —> body cannot uphold –> impaired long-term response

Question 2

gestational diabetes

Answer 2

• most common in 2nd or early 3rd trimester
• can cause maternal complications e.g. pre-eclampsia
• can cause fetel development problems
• managed through insulin therapy, diet and exercise
• high risk of developing diabetes in future following birth

Question 3

drugs increase BGL

Answer 3

glucocorticoids e.g. prednisolone
atypical antipsychotics e.g. clozapine

Question 4

symptoms

Answer 4

T2DM often aysmptomatic
- blurred vision
- fatigue
- loss of sensation in extremities
- increased thirst and urination
- metallic breath
- acanthosis nigricans
- hirutism
- skin tags
- increased BGL, IFG
- menstrual irregularities

Question 5

T1DM specific symptoms

Answer 5

• ketoacidosis - elevated ketones

Question 6

Testing

Answer 6

fasting blood glucose - above 7
random blood glucose - above 11
IGT, IFG, oral glucose tolerance test

Question 7

Chronic complications

Answer 7

macrovascular - CAD, cerebrovascular disease, PAD
microvascular - neuropathy, nephropathy, eye disease
other - gastroparesis, cataracts, glaucoma, peridontal disease

Question 8

Insulin (SA vs LA, BB vs SM)

Answer 8

SA vs LA
short acting - more flexibility/control, increased risk of hypos, more injections

long acting - less flexibility/control, reduced risk of hypos, less injections

BB vs SM
basal-bolus regime
- 4 total injection - 60% SA / 40% LA (bed-time)
- increased risk of hypos, does not account for snacks, better flexibility and control
- mimics how the body produced insulin - 4 times a day
requires more frequent BGL monitoring

split-mixed regime
- 2 injections - 2/3 w/ breakfast / 1/3 w/ dinner
- reduced risk of hypos, reduced flexibility
- cannot skip meals

Question 9

3 side effects of insulin + management

Answer 9

lipohypertrophy - rotate injection site
weight gain - lifestyle modifications
hypoglycaemia - proper BGL monitoring, no skipping meals, patient education

Question 10

first-choice medications for T2DM

Answer 10

metformin, DPP-4 inhibitors, GLP-1 inducer, acarbose, sulfonylureas, glitazones, SGLT2 inhibitors

Question 11

Metformin

Answer 11

first choice for T2DM management
- increases tissue sensitivity to insulin
- oral
- slow onset - 2 weeks for full effect
- can cause nausea, vomiting and diahorrea
- renally cleared

Question 12

DPP-4 inhibtors

Answer 12

Inhibit DPP-4 enzyme (enzyme that metabolises incretin hormones)
- linagliptin, sitagliptin
- no weight gain
- renally cleared
- no hypo risk

Question 13

GLP-1 agonist

Answer 13

promote incretin secretion - promote insulin secretion + reduce appetite
- semaglutide
- promote weight loss
- renally cleared
- nausea and vomiting in beginning
- injectables
- reduces gastro motility
- large CV benefit

Question 14

Acarbose

Answer 14

• last option
• stops glucose absorption in gut
• AE - GI disturbance - bloating, nausea

Question 15

glitazides

Answer 15

• used in metformin sensitivity
• high AE
• pioglitazone

Question 16

Sodium glucose co-transporter 2 inhibitors

Answer 16

• prevent glucose reabsorption at the kidney’s
• diarrhoea, sweet smelling urine
• high CV benefit
• reduced CKD but can worsen renal outcomes if GFR is too low
• risk of DKA
• weight loss due to diuretic effect
• dapagliflozin, empagliflozin

Question 17

sulfonylureas

Answer 17

increase insulin production
- weight gain risk
- hypo risk
- gliclazide, glipizide