Management Of Type 2 Diabetes

Question 1

Why is Metformin usually first choice?

Answer 1

Improves outcome
Well tolerated
Cheap

Question 2

Wheat are the defects in T2DM?

Answer 2

Beta cell dysfunction
Diminished incretin effect
Excess glucagon
Insulin resistance

Question 3

Where does Metformin mainly work?

Answer 3

The liver and muscles

Question 4

What type of drug is Metformin?

Answer 4

Biguanide

Question 5

What does Metformin do?

Answer 5

Improve insulin sensitivity

Question 6

How does Metformin improve insulin sensitivity?

Answer 6

Affects glucose production, decrease fatty acid synthesis
Improve receptor function
Inhibit gluconeogenic pathways

Question 7

What is Metformin half life?

Answer 7

6 hours

Question 8

What are the advantages of Metformin?

Answer 8

Improves CV outcomes and mortality in obese T2DM
Efficacious
Well tolerated
Not associated with weight gain
HbA1c 12-17% reduction
Used in pregnancy
Cheap

Question 9

What are disadvantages of Metformin?

Answer 9

GI side effect
Risk of lactic acidosis by inhibiting lactic acid uptake by liver
-hypoxia
-renal failure
-hepatic failure
-alcohol abuse
Risk vit B12 malabsorption

Question 10

What are sulphonylureas?

Answer 10

The gli…ides - glimepiride, gliclazide, glipizide

Question 11

When to use sulphonylureas?

Answer 11

If osmotic symptoms or HbA1c increase rapidly titration based on home blood glucose monitoring

Question 12

What does sulphonylureas do?

Answer 12

Increase insulin release

Question 13

Where does sulphonylureas act?

Answer 13

On the pancreas

Question 14

What is the mechanism of action of sulphonylureas?

Answer 14

Bind to sulfonylurea receptors (SUR-1) on functioning pancreatic beta cells
Binding closes the linked ATP- sensitive potassium channel
Decreased potassium influx depolarisation of the beta cell membrane
Voltage- dependent calcium channels open and result in an influx of calcium
Translocation and exocytosis of secretory granule of insulin to the cell surface

Question 15

What are the advantages of sulfonylurea?

Answer 15

Rapid improvement of control
Rapid improvement if symptoms
Rapid titration
Cheap
Generally well tolerated

Question 16

What a re the disadvantages of sulfonylurea/

Answer 16

Hypoglycaemia risk
Weight gain
Caution in renal and hepatic disease
CI in pregnancy and breast feeding
SE
-hypersensitivity and photosensitive reactions
-blood disorders

Question 17

What are thiazolidinediones?

Answer 17

The …glitazones

Question 18

What do thiazolidinedones do?

Answer 18

Improve insulin action

Question 19

What do glitazones act on?

Answer 19

Muscle, liver and adipose tissue

Question 20

What is a thiazolidinediones?

Answer 20

Pioglitazone

Question 21

What is the mechanism of pioglitazone?

Answer 21

Selectively stimulates the nuclear receptor peroxisomes proliferator- activated receptor gamma and the a lesser extent PPAR-alpha
Modulates the transcription of insulin sensitive genes involved in the control of glucose and lipid metabolism in the muscle, adipose tissue and the liver

Question 22

What does pioglitazone cause?

Answer 22

Reduce insulin resistance in the liver and peripheral tissues
Increase the expense of insulin dependent glucose
Decrease the withdrawal of glucose from liver
Reduce quantity of glucose, insulin and glycogen Haemoglobin in the bloodstream

Question 23

What are the advantages of pioglitazone?

Answer 23

Good for signicant insulin resistance
HbA1c by o.6-1.3%
Cheap
CV safety established

Question 24

What are the disadvantages of pioglitazone/

Answer 24

Increase risk of bladder cancer
fluid retention
Weight gain
Fractures in females

Question 25

Is insulin treatment the last resort?

Answer 25

No

Question 26

What does insulin have a low risk of/

Answer 26

Hypoglycaemia

Question 27

What is the treatment regimen of insulin in t2dm?

Answer 27

Once daily injection Usually at bedtime

Question 28

What are different types of gliflozins?

Answer 28

Canaglifolozin, dapagliflozin and empagliflozin

Question 29

What do gliflozins do?

Answer 29

Selectively inhibit SGLT2 in the renal proximal tubule

Question 30

What are the effects of SLGT2 inhibitors?

Answer 30

Gets rid of glucose/ more glycosuria - lowers HbA1c Gets rid of water/ osmotic diuresis - hypotension and dehydration Gets rid of calories/ wastes glucose - lose weight with same intake Gets rid of sodium/less reuptake - lowers systolic bp Greater risk of urogenital infection - cystitis and candidiasis

Question 31

What is the primary CV outcome of SGLT2 inhibitors?

Answer 31

Composite of CV death, nonfatal MI, or non fatal stroke

Question 32

What is the CV outcome of SGLT2 inhibitors?

Answer 32

Composite of primary + hospitalisation of unstable angina

Question 33

What are the renal outcomes of canagliflozin?

Answer 33

Composite of end stage kidney disease, doubling of serum creatinine level, death from renal or CV causes

Question 34

What is the dose of canagliflozin?

Answer 34

Question 35

What renal impairment does canagliflozin cause?

Answer 35

Question 36

What is the dose of empagliflozin?

Answer 36

Question 37

What is the renal impairment of empagliflozin?

Answer 37

Question 38

What is the does of dapagliflozin?

Answer 38

Question 39

What renal impairment does dapagliflozin cause?

Answer 39

Question 40

When are SGLT2-I used

Answer 40

2nd line therapy in thsoe at high CVrisk 1st line in those of high cv risk when Metformin not tolerated

Question 41

What is the advantage of SGLT2 - I

Answer 41

Weight loss No risk of hypoglycaemia Good effect on glycaemic control Beneficial on cv mortality and renal outcomes 2nd or 3rd line agent Can add to insulin regimes in T2DM

Question 42

What are the disadvantages of SGLT2 inhibitors?

Answer 42

Expensive SE -UTI, fungal infection, osmotic symptoms Risk of digital amputation Risk of DKA CI in pregnancy and BF Cannot use in renal impairment

Question 43

How do gliflozins interfere in renal glucose handling?

Answer 43

Block the Na glucose transporter 2 in the proximal tubule => increase urinary glucose excretion

Question 44

What type of drugs are GLP1 and DPP IV?

Answer 44

Incretin mimetics

Question 45

What are incretins?

Answer 45

GLIPTINS TIDES

Question 46

What are example of DPPIV- inhibitors

Answer 46

Saxagliptin, sitagliptin, vildagliptin

Question 47

What do gliptins do?

Answer 47

Increase insulin release

Question 48

What do gliptins act on?

Answer 48

Pancreas

Question 49

What is the mode of action of DPPIV-I?

Answer 49

Increase insulin from beta cells -> insulin increases peripheral glucose uptake -> decrease glucose Decrease glucagon from alpha cells -> increase insulin and decreased glucagon reduce hepatic glucose output -> decrease glucose

Question 50

What are the advantages of DPPIV-I?

Answer 50

Well tolerated Used 2nd or 3rd line Can be used in renal impairment No risk of hypoglycaemia Weight neutral

Question 51

What are disadvantages of DPPIV- inhibitors?

Answer 51

Trial data shows relatively effects of glycaemic control CI in pregnancy and BF SE - nausea

Question 52

What are examples of GLP-1 analogues?

Answer 52

Exenatide, liraglutide, lixisenatide

Question 53

What do GLP-I cause/

Answer 53

Increase insulin release

Question 54

What is the mode of action of GLP1 analogues?

Answer 54

Increase insulin from beta cells -> insulin increases peripheral glucose uptake -> decrease glucose Decrease glucagon from alpha cells -> increase insulin and decreased glucagon reduce hepatic glucose output -> decrease glucose

Question 55

What are the advantages of GLP-1 analogue?

Answer 55

Weight loss No risk of hypoglycaemia 3rd line agent Can be used with basal insulin Some have benefited for CV disease

Question 56

What are disadvantages of GLP-1 analogues?

Answer 56

Injection Expensive CI in preg and BF Se -nausea, vomiting