Diabetes

Question 1

sulphonylureas

Answer 1

inhibit the potassium ATP pump on beta cells > +insulin secretion
may cause weight gain
e.g. glibenclamide, glicazide

Question 2

metformin

Answer 2

biguanide
increase the uptake of glucose by skeletal muscle
acts on the liver to inhibit glucneogenesis
25% develop GI side effects

Question 3

pioglitazone

Answer 3

TF for genes involved in triglyceride storage. Stops deposition of lipids in non-adipose tissue, helping to reduce insulin resistance and the development of ALD.
works over a period of months
Side effects: increased long bone fractures, water retention and bladder cancer

Question 4

DPP-IV inhibitors

Answer 4

DPP-IV normally degrades GLP-1 so inhibiting it allows GLP-1 to act for longer.
Well tolerated - weight neutral, oral tablet and provide a fairly stable glucose level
e.g. sitagliptin

Question 5

GLP-1 agonists

Answer 5

GLP-1 normally secreted upon ingestion of food, causing:
beta: enhanced glucose-dependent secretion of insulin
alpha - decreased secretion of glucagon
liver - decreased hepatic glucose output
brain - promotes satiety and reduced appetite
stomach - slows gastric emptying
Drugs works very well and lead to weight loss as well.
Issue as they must be injected
e.g. exenatide

Question 6

SGLT-2 inhibitors

Answer 6

Channel in the PCT that normally reabsorbs up to 90% of the glucose in the tubule.
have additional benefit of osmotic diuresis which can be beneficial in the context of hypertension.
can have issue where kidneys and pancreas cross-talk leading to release of glucagon, increasing chances of DKA developing
e.g. empaglifozin

Question 7

what is whipple’s triad

Answer 7

 Symptoms known or likely to be caused by hypoglycemia especially after fasting or heavy exercise (Autonomic or neuroglycopaenic symptoms)
 A low plasma glucose measured at the time of the symptoms
 Relief of symptoms when the glucose is raised to normal

Question 8

name a rapidly acting insulin analogue

Answer 8

norvorapid

Question 9

name a long-acting insulin analogue used as a basal insulin

Answer 9

lantus

Question 10

how is hypoglycaemia defined in a diabetic on insulin therapy

Answer 10

<4.0 mmol/l of glucose

Question 11

at what blood glucose level can you begin to see autonomic symptoms and what causes this

Answer 11

3.9 mmol/l - 3mmol/l (most occur at 3)

Caused by the release of the counter-regulatory hormones glucagon and adrenaline

Question 12

at what blood glucose level will cognitive function begin to be disrupted

Answer 12

2.5-2.8 mmol/l.

Question 13

at what blood glucose level will people begin to have seizures

Answer 13

<2 mmol/l of glucose

Question 14

what are the diagnostic criteria for DKA

Answer 14

metabolic acidosis: Venous bicarbonate < 18mmol, H+ > 45 mEq/L, pH < 7.3
plasma glucose: >13.9 mmol/l
Urinary/plasma ketones: ≥2+ urinary / >3mmol/L

Question 15

list the clinical features of DKA

Answer 15

• Osmotic Symptoms - Polydipsia and polyuria
• Weight Loss
• Breathlessness – Kussmaul respiration
• Abdominal pains, especially in children
• Leg cramps
• Nausea and vomiting
• Confusion

Question 16

how do you treat DKA

Answer 16

insulin, potassium, fluids

Question 17

what is the major electrolyte deficiency in DKA

Answer 17

potassium

Question 18

what is the major electrolyte deficiency in HHs

Answer 18

sodium

Question 19

what is Autoimmune Polyendocrine Syndrome Type 2

Answer 19

triad of addison’s, autoimmune thyroiditis and type 1 DM

Question 20

name some associations of Autoimmune Polyendocrine Syndrome Type 2 and who is more likely to develop the syndrome

Answer 20

pernicious anaemia, coeliac disease, alopecia, primary hypogonadism, myasthenia gravis and Stiff man syndrome
Women are more likely to have and it normally presents in aduthood.

Question 21

what are the main causes of DKA except for a new presentation of type 1 DM

Answer 21

pregnancy, non-compliance, inappropriate alterations in insulin, MI, infection

Question 22

if a patient with diabetes requires an anti-hypertensive what drugs could they be placed on

Answer 22

ACE inhibitor, calcium channel blocker or a thiazide diuretic

Question 23

what are the risk factors for gestational diabetes

Answer 23

1. BMI >30 kg/m2
2. Previous macrosomic baby weighing 4.5 kg or more
3. Previous GDM
4. Family history of diabetes (first degree relative)
5. Minority ethnic origin with high prevalence of diabetes (South Asian, black Caribbean, Middle Eastern).