Endocrinology

Question 1

diagnostic criteria for DM2

Answer 1

Fasting plasma glucose (FPG) > 7.0 mmol/l
2-h plasma glucose (2PG) >11.1 mmol/l during OGTT
HbA1c> 6.5%c
Random plasma glucose (RPG) >11.1 mmol/l if classic symptoms or hyperglycaemic crisis

Question 2

metabolic syndrome

Answer 2

Hyperinsulinaemia
Impaired glucose tolerance
Hypertension
Increased plasma TGs
Decreased HDL cholesterol
Truncal obesity

Question 3

insulin secretagogues

Answer 3

Sulphonylureas, Meglitinides

Increase the secretion of endogenous insulin, as long as pancreatic beta –cell function remain

Question 4

sulphonylurea

Answer 4

Alcohol and H2 blockers are competitive inhibitors of sulphonylurea metabolism, Hypoglycaemia is the most serious complication of sulphonylurea use

Question 5

meglitinides

Answer 5

Bind to the SUR at a different site than Sulphonylureas Given at mealtimes and mimics the physiological insulin response

Question 6

metformin (insulin sensitizing agents)

Biguanides

Answer 6

Always assess the kidney function. If the eGFR is less than 30 ml/ml avoid Metformin
The most common side effect is diarrhoea and abdominal cramps
safe in pregnancy
weight loss, no hypoglycaemia, decr thrombotic risk

Question 7

Thiazolidinediones (insulin sensitizing agents)

Answer 7

advantages- Reduce CV risk
Increase HDL, reduce TG, reduce LDL
Improve ovulation in PCOS

Adverse effects Fluid retention, Weight gain, Increased risk -of fractures

Question 8

alpha glucosidase inhibitors

Answer 8

Must be taken just before a meal
Slows the digestion of sucrose and starch and therefore delay absorption
Side effects- Flatulence, abdominal discomfort , diarrhoea
As mono-therapy will not cause hypoglycaemia but when used with other medicine (e.g. a sulphonylurea)

Question 9

GLP1

Answer 9

Improves beta-cell responsiveness to increasing glucose levels
Decreases glucagon secretion
Must be injected subcutaneously

Side effects- Nausea, Diarrhoea, Risk of hypoglycaemiawhen used with a sulphonylurea, Acute pancreatitis
Contraindications- End-stage kidney disease or renal impairment, Pregnancy, Severe gastrointestinal disease

Question 10

DPP4 Inhibitrs

Answer 10

Orally administered
Reduce plasma DPP-4 activity by up to 90%
Increase both GLP-1 and GIP
Lowers HbA1c by 0.5 to 0.8%

Question 11

SGLT2 Inhibitors

Answer 11

decr in cardiovascular death and hospitalisation
No increased risk for hypoglycaemia as monotherapy, but risk increase in combination with SU or Insulin
BP reduction

Adverse effects- Mycotic genital infections, UTI, Dehydration and hypotension in patients with cardiac disease, on loop diuretics, elderly

Question 12

indications for insulin therapy in type 2 DM

Answer 12

Persistent hyperglycemia with oral agents
Uncontrolled weight loss
Advanced renal or hepatic disease
Allergic reactions to oral agents
Intercurrent events: MI, CVA, acute illness, surgery

Question 13

Diabetic Neuropathy Rx

Answer 13

Pain Rx: Amitriptyline

Other options: gabapenting/pregabilin/valproate Gastroparesis: Metoclopramide

Question 14

antibiotics to use in diabetic foot ulcer

Answer 14

cloxacillin 
cephalexin
TMP-SMX
clindamycin
amoxiclav