Diabetes

Question 1

What is diabetic ketoacidosis?

Answer 1

Complication of untreated T1 diabetes where the body has insufficient insulin for glucose to enter cells, so the body starts burning fatty acids and producing acidic ketone bodies - can lead to coma or even death.

Question 2

Name some symptoms of ketoacidosis.

Answer 2

• hyperventilation
• n+v
• dehydration
• abdo pain

Question 3

Name some symptoms of hyperglycaemia.

Answer 3

• extreme thirst
• dry mouth
• blurred vision
• drowsiness

Question 4

Name some symptoms of hypoglycaemia.

Answer 4

• sweating
• feeling weak
• nausea
• shaky/tremors

Question 5

What is lactic acidosis?

Answer 5

Low pH of bloodstream due to increased lactate, caused by acute or chronic underlying medical condition.

Question 6

Describe the synthesis of insulin.

Answer 6

• pre-proinsulin synthesised in ribosomes on rER
• signal peptide (pre) removed once inside rER
• folding of proinsulin
• proinsulin transport to Golgi for modification
• C-peptide cleaved from middle of proinsulin to create 2 shorter chains joined by disulphide bonds
• C-peptide and insulin released in equimolar amounts

Question 7

What measure in the blood is a good indicator of how much insulin is being produced?

Answer 7

C-peptide

Question 8

What is the common history of someone being diagnosed with T1 diabetes?

Answer 8

Classically a young person with a recent history of viral infection (caused by genetic predisposition + environmental trigger).

Question 9

Name the triad of symptoms for T1 diabetes.

Answer 9

Polyuria
Polydipsia
Weight loss

Question 10

What are the symptoms of people with T2 diabetes?

Answer 10

Can have the triad, but more likely to have a lack of energy or recurrent infections.

Question 11

How is T1 diabetes treated?

Answer 11

Insulin injections.

Question 12

What is metabolic syndrome?

Answer 12

A group of symptoms and diseases e.g. Insulin resistance, hypertension etc. Associated with central adiposity.

Question 13

Explain why diabetes can cause cataracts.

Answer 13

Some cells e.g. In the eye don’t require insulin and their glucose uptake is determined by extracellular glucose concentration. Extra glucose is metabolised by aldose reductase - this reaction depletes NADPH and produces sorbitol - less NADPH can lead to cataracts.

Question 14

What is the use of measuring HbA1c?

Answer 14

Measures the amount of glycation in the blood - the higher the levels of glucose over the last few months, the higher HbA1c (more glucose has reacted with Hb).

Question 15

Name the different types of insulin available.

Answer 15

Animal - from pigs or cows.

Recombinant DNA - ultrafast, rapid, short, intermediate, long or very long acting.

Question 16

What does ultrafast, rapid, short, intermediate, long or very long acting mean?

Answer 16

Reflects the rate of absorption.

Question 17

How does the rate of absorption affect when insulin needs to be given?

Answer 17

Slower acting insulin needs to be given earlier before a meal as it takes longer for the peak to be reached.

Question 18

What is Novomix 30?

Answer 18

A combination of insulins - contains 30% rapid acting and 70% slow acting - this means that you can inject it fewer times a day.

Question 19

Name a rapid acting insulin.

Answer 19

Novorapid.

Question 20

Name a short-acting insulin.

Answer 20

Actrapid.

Question 21

What class of drug is metformin?

Answer 21

Biguanide.

Question 22

What is the MOA of metformin?

Answer 22

• decreases insulin resistance
• decreases gluconeogenesis
• limits weight gain
• decreases risk of CVS events

Question 23

Name some side effects of metformin.

Answer 23

• GI symptoms
• nausea
• lactic acidosis (rare)

Question 24

Which diabetic drug would be suitable for someone with renal impairment e.g. CKD?

Answer 24

Sulphonylureas - they are metabolised by the liver.

Question 25

Name a sulphonylurea.

Answer 25

Glicazide

Question 26

What is the MOA of glicazide?

Answer 26

Sulphonylurea - stimulates beta cells to release insulin by antagonising ATP sensitive K+ channels and decreasing K+ efflux.

Question 27

What diabetic drug is most suitable for someone who has a higher BMI?
Which drugs should not be given to these people?

Answer 27

Biguanides

Don’t give sulphonylureas as they stimulate appetite slightly.

Question 28

What is the MOA of alpha-glucosidase inhibitors?

Answer 28

Blocks action of enzyme alpha-glucosidase, which inhibits glycogenolysis.

Question 29

Name some side effects of alpha-glucosidase inhibitors.

Answer 29

GI side effects e.g. Flatulence, loose stools, diarrhoea.

Question 30

What type of drug is pioglitazone and rosiglitazone?

Answer 30

Glitzones - used for T2DM.

Question 31

What is the MOA of glitazones?

Answer 31

• increase insulin sensitivity

- decrease insulin resistance

Question 32

Name 2 glucagon like peptide 1 therapies.

Answer 32

Exenatide

Liraglutide

Question 33

What is the MOA of GLP1 therapies?

Answer 33

• increases insulin secretion

- decreases glucagon production

Question 34

Name some side effects of GLP1 therapies.

Answer 34

• GI symptoms e.g. Loose stools, GORD

- nausea

Question 35

What class are Linagliptin and Sitagliptin and what are they used for?

Answer 35

DPP4 inhibitors

T2DM

Question 36

What is the MOA of DPP4 inhibitors?

Answer 36

-inhibit DPP4 activity, which increases GLP1 concentrations (which increases insulin secretion and decreases glucagon production).

Question 37

If the therapies for T2DM are no longer working, what should be given to the patient?

Answer 37

Start them on insulin.