Diabetes

Question 1

What cells are glucagon secreted from?

Answer 1

Alpha - islet of langerhan

Question 2

What cells produce insulin

Answer 2

Beta cells - islet of langerhan

Question 3

Summarise glucagons effect and pathway on the body

Answer 3

1) G alpha S pathway - cAMP
2) Glycogen released
3) glucogenolysis increased
4) Increased blood glucose
5) Increase in gluconeogenesis

Question 4

How does insulin promote glucose uptake?

Answer 4

1) GLUT 2 into cells
2)Glucose phosphorylation to ATP
3) ATP inhibits K+ channels
4) Depolarisation = activation Ca2+
5) Stimulates insulin vesicle release

Question 5

How does insulin get released by parasympathetic activation?

Answer 5

1) G alpha S pathway - cAMP
2) pka phosphorylates Ca2+ channels
3) stimulates release of insulin vesicles

Question 6

What does insulin inhibit?

Answer 6

1) Glycogenolysis - breakdown of glycogen
) Gluconeogenesis - making glucose

Question 7

What cells secrete somatostatin?

Answer 7

Delta - islet of langerhans

Question 8

What are the effects of somatostatin?

Answer 8

1) Inhibits insulin
2) Supresses gastric absoprtion

Question 9

What are the 4 main causes for reduction in insulin release?

Answer 9

1) Decrease in beta cells
2) Decreased cell glucose uptake
3) Glucose exceeds renal threshold
4) Insulin resistance

Question 10

What is the structure of insulin?

Answer 10

21 alpha chain peptide
30 beta chain peptide
linked with disulfide bonds

Question 11

Give example of RAPID insulin

Answer 11

Novorapid, Humalog

Question 12

Give example of SHORT insulin

Answer 12

Actarapid, humulin S

Question 13

Give example of INTERMEDIATE insulin

Answer 13

Humulin I, Insulatard

Question 14

Give example of LONG insulin

Answer 14

Lantus

Question 15

List the different equipment used for insulin

Answer 15

1) Vial and syrine
2) Reuseable pen
3) Disposable pen
4) innolet
5) insulin pump

Question 16

What is lipohypertrophy

Answer 16

When you inject into the same area.

Question 17

What are the implications of lipohypertrophy?

Answer 17

1) Decreases insulin absorption
2) Poor glucose control
3) Pain

Question 18

Summarise the 3 insulin regimes:

Answer 18

1) Basal-Bolus - Long acting insulin at night, rapid/short acting insulin with meals

2) Twice daily - Insulin taken morning and night

3) Inter - intermediate acting insulin 1/2 times daily

Question 19

Summarise MOA of metformin

Answer 19

1) Metformin inhibits mitrochondria chain complex 1
2) Decrease ATP, Increase AMP
3) AMPK activated
4) AMPK = decrease transcription for gluconeogenesis, Increase fat oxidation, Increase GLP-1

Question 20

Summarise MOA of sulfonylureas

Answer 20

1) Targets K+ Channels in beta cells
2) Inhibits channels
3) K+ cant leave - depolarisation
4) Ca2+ activate
5) Insulin released by vesicle exocytosis

Question 21

Summarise MOA of GLP-1 agonists

Answer 21

1) Targets Glucagon-like peptide receptor
2) Increase insulin secretion
3) Decreased gastric emptying and stops absorption of glucose in stomach

Question 22

Summarise MOA of DPP-4 inhibitors

Answer 22

1) Decreases breakdown of GLP-1 so that there is more incretin
2) Supresses gastric emptying and absorption
3) Increases insulin secretion - cAMP pathway

Question 23

Summarise MOA of PPAR gamma agonists

Answer 23

1) Enhances effectiveness of insulin
2) PPAR + RXR = receptor complex

Question 24

Summarise MOA of SGLT2 inhibitors

Answer 24

1) Inhibits SGL transporter in proximal tubule
2) Sodium and Glucose cant pass through from tubule into blood
3) Decreases glucose reabsorption in blood
4) Glucose excreted in urine

Question 25

Give examples of sulfonylureas

Answer 25

Gliclazide 'ZIDES'

Question 26

Give examples of SGLT2

Answer 26

Dapagliflozin 'FLOZINS'

Question 27

Give example of DPP-4 inhibitor

Answer 27

Sitagliptin 'GLIPTINS'

Question 28

Give example of PPAR agonist

Answer 28

Pioglitazone

Question 29

Give example of GLP-1 agonist

Answer 29

Ozempic semiglutide

Question 30

How would you treat hypoglycaemia if a person can swallow

Answer 30

Glucose tablets, fresh juice, sweets, 40% glucose gel

Question 31

How would you treat hypoglycaemia if a person can't swallow

Answer 31

Intramuscular glucagon 999 IV glucose

Question 32

Symptoms of DKA

Answer 32

ketone breath, nausea an vomiting, reduced consciousness, dehydration , hyperventilation

Question 33

Symptoms of Hypo

Answer 33

Confusion, impaired speech, mood changes, unconciousness

Question 33

Symptoms of T2 HHNKS

Answer 33

nausea and vomiting, dehydration, weakness and reduced consciousness

Question 34

What are the target glucose levels for non diabetics

Answer 34

3.4-5.8mmol/l

Question 35

What are target glucose level for diabetics

Answer 35

Before meals and waking - 4-7 90 mins after meals - 5-9

Question 36

What type of medication can cover up the symptoms of hypoglycaemia

Answer 36

Beta blockers - reduce sympathetic symptoms

Question 37

What blood glucose testing methods arent deemed appropriate for diagnosis

Answer 37

finger prick urine stick

Question 38

What should the value of a HbA1c test be and what does this show

Answer 38

<48 mmol/l shows average blood glucose levels over the past 8-12 weeks

Question 39

What are the 3 tests used for diabetes diagnosis and their results

Answer 39

1) Random plasma glucose = >11.1 2) Fasting plasma glucose = >7.0 3) Glucose tolerance test = >11.1

Question 40

When can HbA1c be used to diagnose

Answer 40

When value >48 + symptoms

Question 41

Summarise NICE guidelines for type 2 diabetes

Answer 41

1) METFORMIN 2) Sulfonylurea or pioglitazone or DPP-4 inhibitor 3) Up to triple therapy treatment 4) Insulin therapy 5) swapped to GLP-1 agonist if insulin isnt tolerated and BMI low enough (<35) SGLT2 added if any cardiovascular risk of heart problems

Question 42

What is first line therapy for when metformin isnt tolerated

Answer 42

Sulfonylurea or SGLT2