Diabetes Melitus Type II

Question 1

Pathophysiology of Type I DM

Answer 1

Autoimmune beta cell destruction

Question 2

Pathophysiology of type II DM

Answer 2

Insulin resistance and decreased insulin secretion (beta cell dysfunction)

Question 3

Diagnosis of type II DM:
Symptoms
Random glucose test
Fasting glucose test
2hr oral glucose test
HbA1c

Answer 3

Symptoms:
Of hyperglycaemia - polyuria, polydypsia, unexplained weight loss
Visual blurring
Genital thrush (recurrent)
Lethargy

Random glucose:
>= 11.1mmol/L

Fasting glucose:
>=7mmol/L

2 hr oral glucose:
>=11.1mmol/L

HbA1c:
>=48mmol/L

Question 4

Treatment for type I DM

Answer 4

Insulin

Question 5

Ideal treatment option for type II diabetic with irregular mealtimes and poor glycemic control

Answer 5

Sulphonylureas

Nateglinide, repaglinide

Question 6

1st line treatment for type II diabetics

Answer 6

Diet and exercise - lifestyle changes

Question 7

1st line pharmacological treatment for type II if no (or not enough) effect from lifestyle changes

Answer 7

Metformin

NB. Avoid if eGFR

Question 8

Side effects of metformin

Answer 8

Nausea, diarrhoea, abdo pain

Not: hypoglycaemia

Question 9

MOA of metformin

Answer 9

Increases insulin sensitivity (and helps weight, esp in those with weight loss)

Question 10

Benefit of using DPP4 inhibitors in obese type II diabetics

Answer 10

They decrease appetite - help weight loss

Question 11

MOA of GLP-1 analogues

Answer 11

They mimic gut peptides that are released in response to eating - these peptides increase insulin secretion from beta cells in the pancreas

Question 12

Benefit of using GLP-1 analogues

Answer 12

Weight loss

Question 13

Medication for type II that causes weight gain

Answer 13

Pioglitazone

Question 14

Example of GLP-1 analogue

Answer 14

Exenatide

Question 15

Example of DPP4 inhibitors

Answer 15

Sitagliptin

Vilagliptin