Diabetes

Question 1

type 1 diabetes

Answer 1

• autoimmune disorder where the insulin-producing beta cells of the islets of Langerhans in the pancreas are destroyed by the immune system
• absolute deficiency of insulin resulting in raised glucose levels

Question 2

type 2 diabetes

Answer 2

• relative deficiency of insulin due to an excess of adipose tissue
• isn’t enough insulin to ‘go around’ all the excess fatty tissue, leading to blood glucose creeping up

Question 3

type 1 diabetes in adults

Answer 3

Latent autoimmune diabetes of adults (LADA)

Question 4

type 2 diabetes in young people

Answer 4

Maturity onset diabetes of the young (MODY)

- genetic

Question 5

diabetes risk score

Answer 5

• male
• age
• waist circumference
• ethnicity
• first degree relative
• BMI
• hypertension

Question 6

diagnosing diabetes

Answer 6

if the patient is symptomatic:
- fasting glucose greater than or equal to 7.0 mmol/l
- random glucose greater than or equal to 11.1 mmol/l
if asymptomatic:
- same as above but on 2 occasions

HbA1c >47mmol/mol = diabetes (42-47 = prediabetes)

Question 7

type 2 medications

Answer 7

• metformin = increased insulin sensitivity
• sitagliptin (DPP4 inhibitor) = increases incretin levels which inhibit glucagon secretion
• gliclazide (sulphonylurea) = stimulate pancreatic beta cells to secrete insulin (cause of hypoglycaemia)
• empagliflozin (SGLT2 inhibitor) = inhibits reabsorption of glucose in the kidney
• pioglitaxone (thiazolidinediones) = activate PPAR-gamma receptor in adipocytes to promote adipogenesis and fatty acid uptake

Question 8

rapid-acting insulins

Answer 8

• novorapid

- humalog

Question 9

short-acting insulins

Answer 9

• actrapid

- humulin S

Question 10

intermediate-acting insulins

Answer 10

• isophane insulin

Question 11

long-acting insulins

Answer 11

• insulin determir (Levemir): given once or twice daily

- insulin glargine (Lantus): given once daily

Question 12

pre-mixed insulins

Answer 12

• Novomix 30
• Humalog Mix25
• Humulin M3