glucose homeostasis (diabetes)

Question 1

What blood glucose level would diabetes be unlikely?
a) < 5.5 mmol/L
b) 5.5-6.9 mmol/L
c) >7 mmol/L

Answer 1

< 5.5 mmol/L

Question 2

What is the target HbA1c to aim for in most patients?

Answer 2

<6%

Question 3

HbA1c represents an integrated measure of approximately ______ months worth of glucose exposure

Answer 3

3 months

Question 4

what is metformin contraindicated in?

Answer 4

renal failure

Question 5

what is the MOA of metformin?

Answer 5

increase tissue sensitivity to insulin (MOA not fully understood)

Question 6

what drug can be given for patients allergic to suphonylureas?

Answer 6

glitinides

Question 7

what is gliclazide and its MOA?

Answer 7

suphonylureas
block ATP-sensitive K+ channels –> depolarisation and influx of Ca2+ –> excocytosis of insulin from pancreas

Question 8

what antidiabetic drugs are indicated for patients with atherosclerotic CVD, HF or CKD?

Answer 8

GLP-1 receptor agonist (Dulaglutide)
SGLT2 inhibitor (Dapagliflozin)

Question 9

what is dulaglutide and its MOA?

Answer 9

GLP-1 receptor agonist (incretin mimetic)
synthetic analogues of incretin hormones –> promote insulin release

Question 10

what drug is sitagliptin and its MOA?

Answer 10

incretin enhancer (DPP-4 inhibitor)
inhibit breakdown of incretin hormones –> increase release of insulin

Question 11

which antidiabetic drug causes UTI?

Answer 11

SGLT2 inhibitors (dapagliflozin)

Question 12

what is pioglitazone and its MOA?

Answer 12

thiazolidinedione TZD (insulin sensitiser)
increase tissue sensitivity to insulin and increase glucose transporters

Question 13

what is acarbose and its MOA?

Answer 13

a-glucosidase inhibitor
slows metabolism and breakdown of complex carbohydrates into glucose

Question 14

what are signs/symptoms of DKA?

Answer 14

Symptoms:
1. Polyuria, polydipsia, polyphagia
2. Nausea, vomiting, abdominal pain
3. Lethargy, drowsiness, confusion
4. Dyspnoea

Signs
1. Dehydration, tachy/bradycardia, hypotension
2. Ketotic breath
3. Hyperventilation, Kussmaul breathing
4. Impaired mental state, comatose

Question 15

what is the deficiency in diabetes insipidus?

Answer 15

ADH deficiency
central: failure to produce ADH
nephrogenic: failure of kidneys to respond to ADH

Question 16

Which symptoms may indicate hypoglycemia?
a) polyuria
b) polydipsia
c) sweating
d) dry skin

Answer 16

sweating
body perceives low blood sugar levels as threat/stressor –> trigger SNS which release adrenaline –> stimulate sweat glands (sweating to regulate body temperature, cool body down)

Question 17

which antidiabetic drug causes weight gain?

Answer 17

sulphonylureas

Question 18

which antidiabetic drug is associated with weight loss?

Answer 18

metformin

Question 19

what is the first thing to prescribe to a patient with diabetic ketoacidosis?

Answer 19

IV hydration

Question 20

Metformin is conjugated by the liver before it is excreted by the kidney - true or false?

Answer 20

False. Metformin is excreted by kidneys unchanged

Question 21

how is GLP-1 receptor agonist (incretin mimetics) administered?

Answer 21

injection

Question 22

what drugs are insulin secretion enhancers? (stimulate release of insulin from pancreas)

Answer 22

GLP-1 receptor agonist, DPP-4 inhibitor, sulfanylureas and glitinides

Question 23

what drugs are insulin sensitisers?

Answer 23

Metformin and glitazones/thiazolidinediones

Question 24

untreated hyperglycaemia may lead to all of the following complications except:
a. anorexia (loss of appetite)
b. coma
c. DKA
d. end stage renal disease
e. hyperosmolar syndrome

Answer 24

anorexia (loss of appetite)