Diabetes

Question 1

Who is involved in the care of a diabetic patient?

Answer 1

Nurse, GP, Dietician, Podiatrist, optometrist and pharmacist

Question 2

What are the dietary aims in a patient with diabetes?

Answer 2

Reduce cholesterol, reduce BMI and reduce HbA1c

Question 3

What are the benefits of a 10kg loss in weight?

Answer 3

Reduction in risk of developing DM (30-50%) and fall in fasting blood glucose 15% fall in HBA1c.
Also a blood pressure reduction of 20mmHg diastolic
91% reduction in angina and 33% increased exercise tolerance.
Also 10% decrease in T cholesteral and 15% decrease ni L cholesteral and 8% increased in HDLs

Question 4

What is the aim cholesterol for a patient with diabetes?

Answer 4

<4/ other people <5

Question 5

When would you start someone on a sulphonylurea over metformin?

Answer 5

If they had symptoms because gliclazide brings downs sugars really quickly, therefore helping with symptoms. They can then switch to metformin when they start to feel better.

Question 6

What is involved in dual therapy of diabetes?

Answer 6

Metoformin plus
Sulphylurea or
DDP-4 inhibitor (sitagliptin/alogliptin or use lintagliptin in renal impairment) or
Thiazolidinedione (pioglitazone) or
SGLT2 inhibitors (dapalifozin)
or GLP agont (liraglutide or exenatide)

or if sulphonylurea pathway
- add DDP4 inhib or
Pioglitazone or
GLP-1 agonsit

Question 7

Which diabetes medication causes weight gain?

Answer 7

Insulin and gliclazide and gliptins (DDP-4 inhibitors)

Question 8

Which diabetic medication causes weight loss?

Answer 8

GLP-1 agonists (liraglutide or exenatide) it slows down gastric emptying so increases fullness, caution in GORD!. Also given as injection

Question 9

Which meds are given as injections?

Answer 9

Insulin and GLP-1 agonists (liraglutide). (causes gord!!)

Question 10

In which patients should pioglitazone not be used?

Answer 10

Patients with HF as is causes retention of fluid. (it is also linked to osteoporosis and fractures).

Question 11

How do thiazolidinediones work?

Answer 11

Thiazolidinediones (e.g. rosiglitazone) decrease insulin resistance in adipose tissue, skeletal muscle and liver. In addition, they may have a beneficial effect on -cell function. They are direct insulin sensitizers that act as agonists for the nuclear receptor peroxisome proliferator-activated receptor-gamma (PPARg). PPARg increases the transcription of certain insulin-sensitive genes, thereby improving insulin sensitivity.
eg (pioglitazone)

Question 12

How do biguanides work? (metformin)

Answer 12

Primarily suppress hepatic glucose output. In addition, they enhance insulin sensitivity and stimulate insulin-mediated glucose disposal. They do not stimulate insulin secretion

Question 13

How do sulphonylureas work?

Answer 13

Sulphonylureas and meglitinides both lower fasting blood glucose concentrations, primarily by stimulating insulin secretion from the pancreas

Question 14

How do alpha-glucodase inhibitors work?

Answer 14

Alpha-glucosidase inhibitors such as acarbose delay digestion and absorption of carbohydrates in the gastrointestinal tract. They inhibit the enzyme a-glucosidase, responsible for the metabolism of complex carbohydrates into absorbable monosaccharides.

Question 15

How do GLP-1s work?

Answer 15

analogues mimic GLP-1, a gastrointestinal hormone that increases insulin secretion from the pancreas and inhibits glucagon release.