Diabetes

Question 1

High blood sugar levels quantified

Answer 1

fasting >7mM, random glucose test >11mM

Question 2

T1DM classified

Answer 2

• Early onset
• Low serum insulin
• Auto-immune disease
• Insulin dependent
• Prone to ketoacidosis

Question 3

T2DM classified

Answer 3

• Usually presents after 50
• Can have high serum insulin
• Diet, drugs or insulin for treatment

Question 4

Insulin Preparations used in T1DM (Short Acting)

Answer 4

Short acting - Insulin lispro, aspart and glulysine

Question 5

Issues with insulin treatment

Answer 5

Hypoglycaemic episodes
Weight Gain
Lipohypertrophy at injection site

Question 6

Drugs used in T2DM and MOA (6 Drugs)

Answer 6

Sulphonylureas (increase insulin secretion by closing ATP K channels)
Biguanides (promotes muscle G uptake + decreases hepatic G production)
Thiazolenediones (glitazones, sensitise muscle/adipose to insulin)
alpha-glucosidase inhibitors (slows complex carb breakdown to reduce postprandial G rise)
Incretin analogues (activate incretin/GLP-1 receptors + increase insulin release)
Gliptins (inhibit DPP-4)

Question 7

Sulphonylurea used when

Answer 7

Used in close to ideal weight patient failing to control hyperglycaemia with just diet

Question 8

Meglitinides MOA and drug name

Answer 8

Same MOA as sulphonylureas but faster dissociation

Includes Rapaglinide

Question 9

Biguanides MOA

Answer 9

Metformin reduces hepatic glucose production + increases peripheral G uptake

Question 10

Thiazolenediones (glitazones) drugs

Answer 10

Pioglitazone and Rosiglitazone

Question 11

alpha-glycosidase inhibitors MOA and use

Answer 11

Acarbose inhibits intestinal enzyme so complex carb metabolism is slowed to prevent sharp G rise
Taken with meals

Question 12

Incretin analogues MOA

Answer 12

Exenatide/liraglutide are GLP-1 analogues, GLP-1R activation increases insulin release

Question 13

DPP-4 inhibitors (gliptins) names

Answer 13

Sitagliptin, Vildagliptin, Saxagliptin

Question 14

T2DM obese treatment lines

Answer 14

Obese: Diet+weight loss -> metformin -> metformin + sulphonylureas -> insulin/glitazones/gliptins/exenatide

Question 15

Insulin Preparations used in T1DM (Intermediate Acting)

Answer 15

Intermediate - insulin-zinc suspension

Question 16

Insulin Preparations used in T1DM (Long Acting)

Answer 16

Long-acting - insulin-zinc preparation (crystalline), glargine, detemir

Question 17

T2DM non-obese treatment lines

Answer 17

Non-obese: Diet+weight loss -> sulphonylureas -> metformin + sulphonylureas -> insulin/glitazones/gliptins/exenatide

Question 18

Sulphonylureas (drug names and when used)

Answer 18

Glipizide and Gliclazide tried first, short half lives like Tolbutamide
Glibenclamide has longer duration, lower beta cell K channel specificity than gliclazide

Question 19

Sulphonylureas SE

Answer 19

SE: weight gain, hypos

Question 20

Thiazolenediones (glitazones) MOA

Answer 20

Pioglitazone and Rosiglitazone work by increasing insulin sensitivity via PPAR-gamma binding, derepression of insulin sensitive genes

Question 21

Thiazolenediones (glitazones) SE

Answer 21

SE: weight gain, water retention, sight problems, increased bladder cancer/CV events

Question 22

Thiazolenediones (glitazones) Uses

Answer 22

Given to patients who can’t tolerate metformin/sulphonylurea combos

Question 23

Biguanides Used when

Answer 23

Used first line for overweight patients, avoid in heart/renal failure

Question 24

Biguanides SE

Answer 24

SE: nausea, diarrhoea, vomiting, very rarely lactic acidosis

Question 25

alpha-glycosidase inhibitors SE

Answer 25

SE: flatulence, GI disturbance

Question 26

Incretin analogues administration

Answer 26

Given subcutaneously with metformin/sulphonylureas

Question 27

Incretin analogues SE

Answer 27

SE: Weight loss, expensive, nausea

Question 28

DPP-4 inhibitors (gliptins) MOA

Answer 28

Sitagliptin, Vildagliptin, Saxagliptin inhibit enzyme which inactivates GLP-1

Question 29

DPP-4 inhibitors (gliptins) administration

Answer 29

Taken orally

Question 30

DPP-4 inhibitors (gliptins) SE

Answer 30

SE: DPP-4 has other uses in gut too, and not very specific to just DPP-4, other DPPs affected too