Diabetes

Question 1

Name secondary causes of diabetes

Answer 1

Pancreatic disease (CF, chronic pancreatitis, pancreatic carcinoma)
Endocrine - Cushings, thyrotoxicosis, phaeochromocytoma
Drug-induced
Genetic

Question 2

Describe the signs and symptoms of diabetes

Answer 2

Polyuria, polydipsia, lethargy, prolonged infections, weight loss

Question 3

Describe the stepwise escalation of treatment for T2DM

Answer 3

1. Lifestyle interventions, if still >48mmol/l
2. Metformin, still greater than 6.5%/48
3. Metformin + sulfonylurea , if greater than 7.5% or 58
4. Consider adding a sitagliptin or a thiazolidinedione, if HbA1c still >7.5%/ 58
5. Add insulin as last resort
6. Consider pioglitazone if blood glucose control is inadqeute with insulin

Question 4

Describe the MOA of thiazolidinediones ‘glitazones’ (e.g. rosiglitazone)

Answer 4

Decrease insulin resistance in adipose tissue, skeletal muscle, and liver.
May have beneficial effects on Beta-cell function.
They are direct insulin sensitizers that act as agonists for the nuclear receptor PPARg.

Question 5

Describe the MOA of biguanides (e.g. metformin)

Answer 5

Primarily suppress hepatic glucose output.

Enhance insulin sensitivity and stimulate insulin-mediated glucose disposal. They do not stimulate insulin section.

Question 6

Describe MOA sulphonylureas (i.e. gliclazide) and meglitinides

Answer 6

Both lower fasting blood glucose concentrations, primarily by stimulating insulin secretion from the pancreas

Question 7

Describe MOA alpha-glucosidase inhibtors (i.e. acarbose)

Answer 7

Delay digestion and absorption or cabs in the GIT. They inhibit the enzyme alpha-glucosidase, responsible for the metabolism of complex carbs into absorbable monosaccharides