Diabetes

Question 1

Diagnosis of DMII made on…?

Answer 1

HbA1c > 48mmol/mol
Random plasma Glucose > 11.1mmol/mol
Fasting plasma glucose > 7mmol/mol

Question 2

Factors affecting HbA1c?

Answer 2

Haemolysis (low)
Iron deficiency anaemia
Renal impairment
Pregnancy
Blood transfusion

Question 3

Pre-diabetes HbA1c?

Answer 3

43-48mmol/mol

Question 4

HbA1c treatment target for patients taking hypoglycaemic-associated drugs?

Answer 4

53mmol/mol

Hypo-associated drugs eg sulfonylureas

Question 5

Initial diabetic drug treatment?

Answer 5

Metformin, titrated up to reduce risk of adverse GI effects

MONITOR RENAL FUNCTION BEFORE AND AFTER STARTING

Question 6

Drug treatment after metformin or if contraindicated?

Answer 6

1 - gliptin (DPP-4)
2 - pioglitazone
3 - sulfonylurea

Question 7

When to add insulin?

Answer 7

Consider when ineffective double/triple therapy (metformin + other x2),
(Or if other drugs are contraindicated/not tolerated)

Question 8

Metformin MOA

Answer 8

Metformin is a biguanide
(Acts on AMPK)
Decrease hepatic gluconeogenesis
Increase insulin sensitivity
Increase peripheral glucose uptake
Decrease gut absorption of glucose

Question 9

Sulfonylureas MOA

Answer 9

Bind to pancreatic receptors

Increase insulin production (hence hypo risk)

Question 10

Pioglitazone MOA

Answer 10

Pioglitazone is a thiazolidinedione
(Acts on PPAR alpha and gamma)
Increase insulin sensitivity in lots of tissues
Decrease visceral fat

Question 11

GLP-1 (Incretin) MOA

Answer 11

Glucagon-like-peptide mimetic
Causes insulin secretion
(minor hypo risk)

Question 12

Gliptin MOA

Answer 12

DPP-4 inhibitor

Prevents inactivation of endogenous GLP-1

Question 13

Sulfonylurea contraindications/cautions

Answer 13

Contra: acute porphyria
Cautions: renal impairment

Question 14

Metformin contraindications/cautions

Answer 14

Contra: ketoacidosis
Cautions: avoid in severe renal impairment

Question 15

Pioglitazone contraindications/cautions

Answer 15

Contra: Heart failure; bladder cancer
Cautions: monitor liver function, avoid if impairment/disease

Question 16

Gliptin contraindications/cautions

Answer 16

Caution: Pancreatitis

Question 17

DKA scenario - first line management?

Answer 17

Initial fluid resuscitation with normal saline

Question 18

DKA scenario - hyperkalaemic…principles of treating?

Answer 18

Serum K+ maybe high as insulin normally drives K+ into cells. But overall K+ is probably low (due to fluid loss), and needs careful replacement therapy and monitoring.

Question 19

Metformin adverse effects

Answer 19

• GI: nausea, diarrhoea, bloating
• Metallic taste
• Lactic acidosis

Question 20

Gliptin adverse effects

Answer 20

• GI disturbances
• Nasopharyngitis, URTI
• Peripheral oedema

NB - Pancreatitis

Question 21

Pioglitazone adverse effects

Answer 21

• Fluid retention
• Weight gain
• Anaemia
• Arthralgia
• GI disturbances

Question 22

Sulfonylurea adverse effects

Answer 22

Hypoglycaemia!

Others are mild and infrequent
GI disturbances
Hypersensitivity

Question 23

GLP-1 mimetic adverse effects?

Answer 23

Acute pancreatitis (rare but serious)
GI disturbances (lots)
Hypoglycaemia
GORD
Dizziness

Question 24

Sulfonylurea examples?

Answer 24

Glibenclamide
Gliclazide
Tolbutamide

Question 25

DPP-4 inhibitor examples?

Answer 25

Gliptins eg:
Linagliptin
Sitagliptin

Question 26

GLP-1 examples?

Answer 26

Liraglutide

Exenatide

Question 27

SGLT-2i examples?

Answer 27

Canagliflozin

Dapagliflozin