Endocrine 1 (Diabetes)

Question 1

4 anatomical regions of the pancreas

Answer 1

Head, Neck, Body and Tail

Question 2

Define: Endocrine pancreas, including cell types

Answer 2

The hormonal function of the pancreas. Secreting insulin (beta cells) and glucagon (alpha cells) directly into the blood vessels.

Question 3

Define: Exocrine pancreas, including cell type

Answer 3

The digestive function of the pancreas. Consists of acinar cells that secrete digestive enzymes into the pancreatic ducts, into the intestine.

Question 4

How is type 1 diabetes defined?

Answer 4

Autoimmune destruction on pancreatic beta cells (insulin producing)

Question 5

How is type 2 diabetes defined?

Answer 5

The amount of insulin secreted by the beta cells can be low, normal or high, but there is a blunted response to insulin on cell membranes which contributes to impaired/reduced glucose uptake.

Question 6

Name some risk factors for developing type 2 diabetes (7)

Answer 6

Ethnicity
Family history
Obesity 
Sedentary lifestyle
Previous glucose intolerance
Hypertension 
Hypercholesterolemia

Question 7

Modifiable risk factors for type 2 diabetes

Answer 7

Physical activity
Obesity/Weight
Hypertension
Hypercholesterolemia

Question 8

(9) Symptoms of diabetes

Answer 8

Polydipsia
Polyuria
Polyphagia
Glucosuria
Fatigue
Unintentional weight loss
Blurry vision
Tingling in extremities
Wounds that won't heal

Question 9

(8) Potential physical findings of a patient with diabetes

Answer 9

Central obesity (T2DM)
Hypertension
Eye changes (retinopathy)
Acanthosis Nigricans
Candida Infections
Neuropathy
Muscle Atrophy
Ulcers

Question 10

Blood glucose criteria for diagnosing diabetes

Answer 10

Random Plasma Glucose: >11 mmol/L

OGTT: >11 mmol/L

Fasting Plasma Glucose: >7 mmol/L

HbA1c: >48 mmol/L

Question 11

With regards to the medical management of type 2 diabetes, according to NICE Guidelines, what treatments options are available? (1st, 2nd, 3rd line)

Answer 11

1st Line: Metformin

2nd: Metformin + Sulfonylurea, Piogitazone, DPP-4i OR SGLT2i
3rd: Metformin + two of the second line medications OR metformin + insulin

Question 12

In type 1 diabetes, adults presenting with hyperglycaemia typically have one or more of the following (5):

Answer 12

Ketosis
Rapid weight loss
<50 years old
BMI <25
Personal/FH of autoimmune disease

Question 13

What are the 3 MOA of Metformin

Answer 13

Decrease glucose production by liver​

Decrease glucose absorptionfrom GI-tract​

Increase glucoseuptake into cells (skeletal muscle)​

Question 14

What are the 3 side effects of Metformin

Answer 14

GI Upset​

ReducedVit B12 absorption​

Lactic Acidosis

Question 15

What are the 3 MOA of Sulphonylurea (Gliclazides)

Answer 15

Stimulate beta-cells of pancreas tosecrete insulin
​
Decrease glucose production by liver​

Increase peripheral utilisation of glucose​

Question 16

MOA of DPP-4 Inhibitors

Answer 16

DPP-4 enzyme usually breaks down GLP which is responsible for stimulating insulin release and inhibiting glucagon. Inhibiting DPP-4 means that more insulin is released into the bloodstream.

Question 17

MOA of SGLT-2Inhibitors

Answer 17

Acts upon theKidneys to block reabsorption ofglucose ​

Results in glucose excretion and therefore lowers plasma glucose​

Question 18

(4) Side effects of SGLT-2Inhibitors

Answer 18

Hypoglycaemia
​
UTIs

Hypotension​

Dehydration​

Question 19

(2) MOA of Pioglitazone​ (Rarely used)

Answer 19

Decreases glucose production and output by liver​

Acts as an Insulin sensitizer. DOES NOT stimulate insulin secretion​

Question 20

3 main treatments for the acute management of hypoglycaemia

Answer 20

1. Patient conscious and NOT at risk of choking = Oral Glucose
   - Sugary drink or snack or oral glucose gel.
2. Unconscious, at risk of choking, severe hypoglycaemia = IV Glucose
3. Alternatives when oral glucose unavailable = IM/SC Glucagon

Question 21

(3) Size effects of Sulphonylureas (Gliclazides)

Answer 21

Weight gain– patient must eat regularly to decrease

Hypoglycaemia risk​

GI Upset​