Diabetes type 2

Question 1

Pathogenesis

Answer 1

• Increased resistance from cells to insulin: Over time cells are less likely to take up glucose
• Beta cells in pancreas- begin to produce less insulin

SO: Chronic hyperglycaemia.

Question 2

Risk factors

Answer 2

No- modifiable: age, ethinicity, family history

Modifiable: obesity, sedentary lifestyles, high carb diets

Question 3

Testing

Answer 3

Hb1ac test > 48mmol/mol
Oral glucose tolerance test - > 11mmol/l
Fasting glucose> 7mmmol/l
Random> 11mmol/l

Question 4

How to manage in early stages

Answer 4

Reverse with diet and exercise interventions

Question 5

Signs which help identify early diabetes

Answer 5

Fatigue 
Polyuria 
Polydipsia 
Slow healing 
Glucose in urine

Question 6

How does the oral glucose tolerance test work?

Answer 6

Morning, prior to breakfast

1- Check Plasma glucose
2- Give them a 75g glucose drink
3- Check plasma glucose again

Question 7

Lifestyle management

Answer 7

• increase veg and oily fish
• Low glycemic and high fibre diet
• optimise weight and exercise
• Smoking
• Manage underlying conditions e.g. hyperglycaemia, hyperlipidemia …

Question 8

What do we screen for?

Answer 8

• Diabetic retinopathy
• Diabetic foot
• Kidney disease

Question 9

Medical management

Answer 9

1st line - Metformin from 500mg per day to as high as the patient tolerates
2nd line - Add sulfonyurea, DPP- 4 inhibitor, SGLT2 inhibitor, pioglitazone
3rd line- triple therapy: metformin + 2 of the above drugs or metformin + insulin

Question 10

Metformin

Answer 10

Increases insulin sensitivity
Decreases liver production of glucose
It is weight neural

SE : lactic acidosis, not hypoglycaemia

Question 11

Pioglitazone

Answer 11

Decrease liver production of glucose and increases insulin sensitivity

Question 12

Sulfunylurea

Answer 12

e.g. gliclazide
Increase insulin release from pancreas.
Can cause hypoglycaemia
Increased risk of amid and CVD when used by itself

Question 13

What are Incretins?

Answer 13

Produced by GI tract in response to large meals
Increase insulin secretion
Decrease glucagon secretion
Slow down absorption in the GI tract

Question 14

Which drugs are incretins?

Answer 14

• DDP4 : DDP4 inhibitors are use in diabetes to prevent the action of DDP4 which is an incretin antagonist
• GLP1 mimetics

Question 15

SGLT2 inhibitors

Answer 15

End in Glyflozin

• SGLT2 Absorbs glucose from urine back into blood
• Inhibitors prevent this so increase loss of glucose into urine

Question 16

RA insulin

Answer 16

• work after 10 mins
• last a few hours

e.g. Novarapid, Humalog

Question 17

SA insulin

Answer 17

• 30 mins after taken
• Act for 8 hours

e.g. Humulin S, Act rapid

Question 18

IA insulin

Answer 18

• 1 hour after taken

- Act for 16 hours

Question 19

LA insulin

Answer 19

• 1 hour after taken

- 24 hours

Question 20

Combination insulin

Answer 20

LA and IA insulin