Diabetes

Question 1

Clinical features of DKA?

Answer 1

Hyperglycaemia

• Dehydration
• Tachycardia
• Hypotension
• Clouding of consciousness

Acidosis

• Kussmaul respiration
• Acetone on breath
• Abdominal pain
• Vomiting

Question 2

Diagnosis of diabetes, indicators?

Answer 2

Glycated Hb (HbA1c) > 48mmol/mol
Fasting blood glucose > 7mmol/L

Question 3

Genetic and environmental factors that contribute to NIDDM?

Answer 3

Genetic factors:

• Defect of b-cells
• Insulin resistance

Environmental factors:

• Obesity
• Stress
• Reduced PA

Question 4

Classical presentation of Type 2 DM?

Answer 4

Thirst/polyuria
Malaise, fatigue
Infections e.g. Candidiasis
Blurred vision
Complications

Question 5

Drug classes for DM

Answer 5

Sulphonylureas
Biguanides 
Alpha-glucosidase inhibitors 
Thiazolidinediones
GLP1 agonists
SGLT2 inhibitors
Insulin

Question 6

Acute complications of DM?

Answer 6

Diabetic ketoacidosis

Hypoglycaemia

Question 7

Chronic complications of DM?

Answer 7

Microvascular: Eyes, kidneys, nerves (affecting the feet specifically)
Macrovascular (at heart, brain + feet)

Question 8

Biochemistry of ketoacidosis?

Answer 8

Low bicarbonate, high glucose

Acidotic

Question 9

3 aspects of treatment for DKA

Answer 9

Correct hyperglycaemia
-IV insulin with 6U/hr

Address dehydration

• Saline/Hartmanns initially
• Dextrose 5% subsequently

Monitor K+ losses
-Replace as required

Question 10

Symptoms of hypoglycaemia?

Answer 10

Adrenergic (Fight or flight)

• Tachycardia
• Palpitations
• Sweating
• Tremor
• Hunger

Neuroglycopaenic (lack of glucose to brain)

• Dizziness
• Confusion
• Sleepiness
• Coma
• Seizure

Question 11

Treatment of hypoglycaemia?

Answer 11

IV 50% dextrose

Question 12

Main Type 1 DM treatment

Answer 12

Different formulations of insulin depending on length of action (Either rapid, intermediate, long)

Question 13

Main Type 2 DM drug?

Answer 13

Metformin (an oral hypoglycaemic agent)

MoA:

• Increases insulin sensitivity
• Decreases gluconeogenesis in liver
• Increase glucose uptake in skeletal muscle
• FFA oxidation

Question 14

T2DM drug’s given with metformin, Insulin secretagogues?

Answer 14

Insulin secretagogues:
-Sulphonylureas e.g. tolbutamide
-Meglitinides e.g. repaglinide
Blocks K+ATP channels to depolarise pancreatic beta cells –> Insulin release

Question 15

T2DM drug’s given with metformin, Thiazolidinediones ?

Answer 15

Thiazolidinediones e.g. rosiglitazone
Acts as PPAR-gamma to increase insulin sensitivity of fat, muscle and liver tissue. reduces glucose and FFA levels in blood, increase glucse uptake

Question 16

T2DM drug’s given with metformin,Alpha-glucosidase inhibitor ?

Answer 16

Alpha-glucosidase inhibitor e.g. acarbose

Inhibits glucose absorption in SI

Question 17

T2DM drug’s given when metformin is contraindicated, SGLT2 inhibitors?

Answer 17

Selective Na glucose cotransporter 2 inhibitors e.g. canaglifozin

Blocks glucose reabsorption at proximal tubule

Question 18

T2DM drug’s given with metformin, incretin mimetics?

Answer 18

E.g. exentide

MoA: Analogue for endogenous incretins, which:
- Increase insulin secretion @ pancreas
- Inhibit glucagon secretion @ pancreas
- Delay gastric emptying
- Indirectly increase muscle insulin sensitivity
- Decrease gluconeogenesis in liver
Rapidly degraded by DPP-4

Question 19

T2DM drug’s given, DPP-4 inhibitors?

Answer 19

E.g. Sitagliptin

Inhibits the degradation of endogenous incretins which lower [glucose]

Question 20

Type of insulin regimens?

Answer 20

Once daily: In morning, T2DM

Twice daily: Morning/Evening, T1/2DM, short action mixed with intermediate

Basal-bolus: Throughout day, T1DM, mixed of durations

Insulin pump: Automated throughout day, T1DM, short actioj

Question 21

Rapid acting insulin?

Answer 21

Aspart

Lispro

Question 22

Intermediate acting insulin?

Answer 22

Isophane

Question 23

Long acting insulin

Answer 23

Detemir

Glargine