Diabetes Management and Therapeutics

Question 1

Why aren’t you as aggressive with HbA1c target in patient with Hx of IHD?

Answer 1

A hypoglycaemic event might trigger another ischaemic event

Question 2

How do you screen for the risk of pancreatic complications prior to starting GLP-1 agonists?

Answer 2

Ask about Hx of pancreatic cancer

Ask about hx of unexplained pancreatitis

Question 3

How do SGLT2 inhibitors promote glycosuria?

Answer 3

Inhibit glucose reabsorption in the kidneys

Question 4

What are the long acting insulins?

Answer 4

Glargine (lantus)

Determir (levemir)

Question 5

What are the current principles of glycaemic control over the course of a patient’s disease?

Answer 5

Tight control early <=7 (as low as 6 if otherwise healthy)

Loosen control later in the disease

Question 6

What is the HbA1c cutoff for diagnosis of diabetes?

Answer 6

>6.5%

Question 7

What is the best second line therapy in T2?

Answer 7

There is none, taylor to each patient

Question 8

When are people “cured” of diabetes?

Answer 8

When they’ve had the disease for a short period, 2-5 years maximum

Question 9

What did the DCCT study show?

Answer 9

Marked reduction in microvascular complications with good glucose control

A “legacy” effect of good glucose control at the start of the disease

Question 10

How is insulin initiated in T2DM?

Answer 10

Basal long acting insulin

Question 11

Which SU is prefered?

Answer 11

Gliclazide

Question 12

What is the principle behind of basal bolus insulin?

Answer 12

Imitates the background physiological insulin level present in non-diabetics

Question 13

What is novomix? What is the typical treatment regimen?

Answer 13

30% novarapid (aspart), 70% NPH (median acting)

Twice daily

Question 14

What are the rapid acting insulins?

Answer 14

Aspart

Glulisine

Lispro

Question 15

Which cohort of patients, T1 and T2, are more sensitive to insulin administration?

Answer 15

T1 - as they are still insulin sensitive

Question 16

What is the limitations of alpha-glucosidase inhibitors?

Answer 16

GI side effects

Question 17

What is the EGR cut off from dose reduction and ceasation of metformin?

Answer 17

<40 dose reduce

<30 cease

Question 18

Why is twice a day, mixed insulin not ideal?

Answer 18

Risk of hypo’s if lunch isn’t eaten

High glycose late in the day

Question 19

When optimizing someone’s insulin therapy, what should be done about the dose?

Answer 19

Keep it the same

Question 20

What is the average insulin requirement in a type I patient?

Answer 20

0.5-1 unit per kilogram

Question 21

What did the ACCORD trial show?

Answer 21

Aiming for a HbA1C of 6.4% increases mortality secondary to hypoglycaemic events

Question 22

Reducing blood glucose affects which diabetic complications most?

Answer 22

Microvascular

Question 23

Which diabetes drugs are the gliptins?

Answer 23

DPP4i

Question 24

What is the evidence behind weight loss in diabetes?

Answer 24

5-10% weight loss will cause HbA1c reduction and reduced insulin requirement

Question 25

Which diabetes medications reduce weight?

Answer 25

GLP1 agonists

Question 26

Which diabetic drugs increase insulin sensitivity?

Answer 26

Metformin

TZD (glitazones)

Question 27

What is the HbA1c target in pregnancy?

Answer 27

<6

Question 28

Why does Bcell function reduce over time?

Answer 28

Exhaustion and apoptosis of beta cells due to chronic hyperglycaemia