Diagnosis and Treatment of Type II Diabetes

Question 1

Which body shape type is most prone to type II diabetes?

Answer 1

The apple shape body type (with fat heavily deposited around the waist)

Question 2

What does metformin do? Which is better to prevent type II diabetes: lifestyle changes or metformin?

Answer 2

. Metformin is a biguanide used to treat T2D by decreasing liver glucose production (decrease gluconeogenesis) and by increasing glucose usage by skeletal muscle (some B-pancreatic cells still need to be present)
. Lifestyle changes were proven to be better than treatment with metformin

Question 3

Is type 2 diabetes reversible?

Answer 3

Evidence has suggested that it is reversible with lifestyle changes to alter the visceral fat levels in the body

Question 4

Name 4 types of drug that stimulate insulin secretion.

Answer 4

Sulphonylureas, meglitinides, DPP4-inhibitors, GLP-1 analogues

Question 5

Name 2 types of drug that decrease insulin resistance.

Answer 5

Biguanides (e.g. metformin) and Glitazones

Question 6

What does alpha glucosidase inhibitors do?

Answer 6

Inhibit alpha-glucosidase, which usually converts oligosaccharides and disaccharides to monosaccharides. This reduces the uptake of glucose in the small intestine.

Question 7

What do GLP-analogues do?

Answer 7

They stimulate insulin secretion, suppress appetite, and delay gastric emptying

Question 8

What do SGLT2 inhibitors do?

Answer 8

Inhibit SGLT2 transporters so more glucose is excreted in the urine

Question 9

What are biguanides? Give an example of a biguanide.

Answer 9

Biguanides decrease insulin resistance by decreasing hepatic glucose output and increasing glucose uptake by skeletal muscle

Question 10

What do Sulphonylureas do?

Answer 10

Stimulate insulin secretion

Question 11

What do meglitinides do?

Answer 11

Stimulate insulin secretion

Question 12

What does Pioglitazone do?

Answer 12

Binds to specific receptor on muscle and adipocyte cells, which promotes the expression of genes involved in carbohydrate and lipid metabolism (glycolysis and lipolysis)

Question 13

What does GLP-1 stand for? What does it do?

Answer 13

GLP-1 is glucagon-like peptide. Incretin hormone that stimulates insulin secretion.

Question 14

What are incretin hormones? Give an example of an incretin hormone.

Answer 14

Hormones that stimulate insulin secretion in response to meals. An example is GLP-1.

Question 15

What are DPP-4 inhibitors and what do they do?

Answer 15

Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) stimulate insulin secretion

Question 16

Which is the most effective hypoglycaemic agent for controlling blood glucose? At what stage in treatment of T2D is it used?

Answer 16

Insulin is the most effective hyperglycaemic agent. It is usually the final addition to the drug regimen when oral drugs can’t control blood glucose sufficiently.

Question 17

Give the main negatives seen in drugs used to treat type II diabetes.

Answer 17

Not tolerated well, avoid if have renal disease, can induce weight gain, increased risk of CVD, weak agents, fluid retention, increased risk of bone fractures and bladder cancer

Question 18

Give one key benefit of using GLP-1 agonists.

Answer 18

They have a consistent effect on lowering blood pressure.

Question 19

What happens to SGLT2 receptors in diabetics?

Answer 19

The SGLT2 receptors are up-regulated, which increases glucose absorption

Question 20

What are SGLT2 transporters?

Answer 20

Channel proteins used to co-transport glucose from the kidney nephron tubules with sodium ions. (SGLT1 is in intestines)

Question 21

Describe SGLT1 channels. Where are they found?

Answer 21

. Low capacity, high affinity

. Found in the intestine

Question 22

Describe SGLT2 channels. Where are they found?

Answer 22

. High capacity, low affinity

. Found in kidneys

Question 23

What is the difference between basal and prandial insulin? Which is more effective?

Answer 23

. Basal insulin is long-acting whereas prandial insulin is short-acting
. Basal is injected once/twice a day to keep blood glucose constant when not eating, prandial insulin taken at mealtimes
. Basal insulin is more effective at controlling blood glucose

Question 24

What is the usual combination of drugs given to type II diabetics?

Answer 24

Insulin and metformin

Question 25

Which drugs increase risk of weight gain?

Answer 25

(Think jiggly, siggly, SIGG)
. S- sulphonylureas
. I- insulin
. G- glitazones
. G- glinides

Question 26

Which drugs increase risk of hypoglycaemia?

Answer 26

(Think SIG)
. S- Sulphonylureas
. I- insulin
. G- glinides

Question 27

Which drug can be used even if the patient has renal disease?

Answer 27

Pioglitazones

Question 28

What do pioglitazones do?

Answer 28

Promotes metabolism of carbohydrates and fats (glycolysis and lipolysis)