Diabetes

Question 1

Suggest how someone who has diabetes may present.

Answer 1

• Polyuria
• Polydipsia
• Polyphagia
• UTI (glucose in pee)

Question 2

What is the first line pharmacological treatment for someone with Type 2 diabetes?

Answer 2

• Initiate therapy on metformin or a sulphonylurea (only put them on sulphonylurea if they aren’t overweight or they are resistant to metformin)

Question 3

Suggest some possible ADRs of metformin.

Answer 3

• GI symptoms
• Lactic acidosis
• Vitamin B12 deficiency
• Renal impairment

Question 4

When should acarbose be considered? Why is it not used more frequently?

Answer 4

Considered when the person is unable to use any other glucose lowering drugs. It is not used much as it has ADRs such as:

• Flatulence
• Abdominal discomfort
• Loose stools/diarrhoea

Question 5

Suggest why a DPP-4 inhibitor or glitazone (thiazolidinedione) might be started, rather than a sulphonylurea, for second line therapy in diabetes type 2.

Answer 5

• If they are at significant risk of hypoglycaemia

- Cannot tolerate a sulphonylurea OR cannot tolerate metformin

Question 6

Describe how sulphonylureas can be used in the management of type 2 diabetes.

Answer 6

• Block K+ entry via K+ ATPase channels
• Increased level of Ca2+ intracellularly
• Increased Ca2+ leads to increased release of insulin as it stimulates the insulin granules to approach the membrane and degranulate

Question 7

Suggest some possible ADRs of sulphonylureas (gliclazide, glimepiride, tolbutamide) .

Answer 7

• Weight gain (increased appetite)

- Hyponatraemia

Question 8

Suggest some possible microvascular complications of diabetes.

Answer 8

• Retinopathy
• Neuropathy
• Nephropathy

Question 9

Suggest some possible macrovascular complications of diabetes.

Answer 9

• Stroke

- MI

Question 10

Explain why cataracts may occur in diabetes?

Answer 10

Loss of reducing power (NADPH) which results in sorbitol formation via aldose reductase. This sorbitol in the lens leads to cataracts, an opacity in the lens.

Question 11

Suggest an intermediate acting insulin formulation.

Answer 11

Isophane

Question 12

Suggest a long-acting insulin formulation.

Answer 12

Detemir/glargine

Question 13

Suggest a rapid-acting insulin formulation.

Answer 13

Novarapid

Question 14

Suggest some common adverse effects of giving insulin.

Answer 14

• Lipodystrophy (lumps in subcut tissue where injection was)
• Hyper/hypoglycaemia
• Breast cancer (?)