Diabetes

Question 1

What are the values for normoglycaemia and hypo/hyperglycaemia?

Answer 1

Hypo = <2.5 mmol/L
Normo = 3-5 mmol/L (Fasting) 
Normo = 7-8mmol/L (post-prandial)
Hyper = >10mmol/L

Question 2

Describe the homeostasis of Hyperglycaemia

Answer 2

Glucose Rise in blood
Insulin released from pancreatic B-cells
Increases glucose to Liver, Muscle, Adipocytes, CNS
Lowers blood glucose

Question 3

Describe the homeostasis of Hypoglycaemia

Answer 3

Fall in blood glucose
Glucagon released from a-cells (IoL)
Stimulates Exogenous glucose production - liver, muscles, adipocytes
Blood glucose rises

Question 4

What is the half life of insulin?

Answer 4

3-5 minutes

Question 5

Which endocrine cells make up the Islets of Langerhans and what do they secrete?

Answer 5

β-cells; release insulin
α-cell; release glucagon
δ-cells; release somatostatin
ε-cells; release ghrelin
PP-cells; release pancreatic polypeptide

Question 6

What do insulin secretagogues do?

Answer 6

Used to close K channels

Causes calcium influx and Insulin release

Question 7

What do Incretins do?

Answer 7

Activate GLP-q receptors on B-cells

Cause cell signalling and insulin release

Question 8

How does insulin increase glucose transport into cells?

Answer 8

Binds to receptors and activates them
Receptors have endogenous activity
Intrinsic kinase activity activated
Switches on transporters in the cell membrane
Causes more transporters in the cell membrane (Glut4)
Glucose enters the cell via Glut4

Question 9

What do insulin sensitixers do?

Answer 9

Work on insulin receptor expressing cells
Facilitate process of new transporters
So more glucose into cells

Question 10

In what ways does insulin promote hypoglycaemia?

Answer 10

Increases the transport of glucose into cells
Converts glucose to glycogen (in liver)
Decreases glycogen breakdown
Increases fat stores
Increases protein production

Question 11

Which tissues are involved in hyperglycaemia?

Answer 11

Increase of food intake = GIT, CNS
Glucose production = Liver, adipocytes
Glucose reabsorption = Kidney

Question 12

Which tissues are involved in hypoglycaemia?

Answer 12

Glucose utilization - Alll tissues
Deacreased food intake = GIT, CNS
Glucose storage = Liver, Adipocytes
Glucose Loss = kidney

Question 13

Where is excess glucose strored?

Answer 13

Converted to glycogen and stored in the liver

Question 14

What are the three underlying pathologies of hyperglycaemia?

Answer 14

Islet cell pathology
Insulin action pathology
Obese, unhealthy diet

Question 15

What are the 5 mechanisms of therapy for diabetes?

Answer 15

Promote glucose release
Delay glucose absorption
Promote insulin release
Sensitize to the actions of endogenous insulin
Replace islets

Question 16

What are the symptoms of hypoglycaemia?

Answer 16

Autonomic: Hunger, Sweating, Shaking, Increased Heart Rate, Headache, Nausea

Neuroglycopaenic: Confusion, Drowsiness, Odd behaviour, Incoherent speech, Poor co-ordination

Hypoglycaemic coma
Death

Question 17

Give eamples of two hyperglycaemia inducing therapies

Answer 17

Glucagon Therapy (Hypokit)
Diazoxide Therapy

Question 18

What are the symtpoms of T1DM?

Answer 18

Increased Urination 
Increased thirst
Increased Tiredness
Weight loss
Look for: oral thrush, buying vitamin drops/food supplements

Question 19

What are the symptoms of T2DM?

Answer 19

Often unsymptomatic
Symptoms are like T1 but slower onset and less extreme
Increased genital thrush
Slow wound healing

Question 20

What is the difference in insulin production between T1DM and T2DM?

Answer 20

T1DM - No Insulin

T2DM - Insulin is usually produced but body doesnt respond to it

Question 21

What are the advantages and disadvantages of metformin?

Answer 21

Advantages:
Cheap
Weight neutral,
Low risk of hypo

Disadvantages: 
GI SE's (Diarrhoea), 
Risk of lactic acidosis, 
TDS as short half life,
Caution if egfr<45, C
CI if egfr <30

Question 22

What are the advantages and disadvantages of Sulfonylureas?

Answer 22

Advantages:
OD or BD,
Quickly lowers cBG - fast symptom improvement
Fewer GIT

Disadvantages:
Hypos
Weight gain
Need residual pancreas function
Un-predictable in renal impairement and in the elderly

Question 23

What are the advantages and disadvantages of Pioglitazone?

Answer 23

Advantages:
OD
Low hypo risk
Suitable in renal impairment

Disadvantges:
Associated with Heart failure (fluid retention)
Increases risk of bladder cancer and fractures
Weight gain (fluid)
Liver toxicity - rare
3-6 months to show benefit

Question 24

What are the advantages and disadvantages of DPP-4 Inhibitors?

Answer 24

Advantages:
OD
No weight gain
Low risk of hypo
Some can be used in renal impairment
Few side effects

Disadvantages:
GI SE’s, rash, UTI
Pancreatic inflammation (rare)
Don’t work that well

Question 25

What are the advantages and disadvantages of SGLT-2?

Answer 25

Advantages:
Weight loss
Reduce BP
Only low hypo risk

Disadvantages:
Thrush and UTI's
Need resonable renal function
Lower BP = increased fall risk
Risk of DKA
Risk of kidney injury and foot ulcers

Question 26

What are the advantages and disadvantages of GLP-1?

Answer 26

Advantages:
Weight loss
OD/OW
Rarely cause hypos

Disadvantages:
Injections
GIT SE’s
Rarely cause pancreatitis

Question 27

What must BMI be to use GLP-1’s?

Answer 27

NHS = 30
Private = 25