Pharmacology of non-insulin options in T2 DM

Question 1

What is the first manifestation of cardiovascular complications in T2 DM?

Answer 1

Cardiorenal
eGFR drops and albuminuria associated with increased risk of CV events

Question 2

Objectives of treating T2 DM alongside managing blood glucose levels are:

Answer 2

Reducing risk of CV, CKD and microvascular complications
Weight reduction through physical activity and decreasing dietary fat

Question 3

The 4 pillars of DM management

Answer 3

1) Glycaemic management

2) Blood pressure management

3) Lipid management

4) Agents with CV and Kidney benefit

Question 4

Risk of diabetic complications _____ with mean HbA1c

Answer 4

increases

Question 5

What 2 drugs help the body to respond better to its own insulin?

Answer 5

Metformin and pioglitazone

Question 6

What drugs stimulate the pancreas to secrete more insulin?

Answer 6

Sulphonylureas
DPP-4 inhibitors
GLP-1 receptor agonists

Question 7

What drug can help remove excess glucose and is independent of insulin?

Answer 7

SGLT2 inhibitors

Question 8

What drug can be promote uptake and storage of glucose in liver and muscle?

Answer 8

Insulin

Question 9

Intensive diet and e_____ programmes can delay onset or prevent T2DM

Answer 9

excersise

Question 10

T2Dm prevention can include using metformin and ___

Answer 10

TZDs (Thiazolidinediones AKA glitazones)

Question 11

What are the hormones secreted by intestinal endocrine cells in response to nutrient intake?

Answer 11

Incretins

Question 12

Incretins influence glucose homeostasis through ways like glucose-dependent insulin secretion, postprandial glucagon suppression and slowing of g____ e______

Answer 12

gastric emptying

Question 13

Give an example of an incretin

Answer 13

GLP-1

Question 14

DPP-4 is an enzyme in vascular endothelial lining which _____ GLP-1 and GIP

Answer 14

inactivates

Question 15

DPP-4 inhibitors are competitive antagonists of the DPP-4 enzyme to enhance the effects of ___ and ____

Answer 15

GLP-1 and GIP

Question 16

Do DPP-4 inhibitors change body weight?

Answer 16

No

Question 17

DPP-4 inhibitors are taken orally and lead to a small ____ in endogenous GLP-1 with little effect on gastric emptying

Answer 17

increase

Question 18

GLP-1 analogues are taken through _____ only to create a large increase in GLP-1 levels and delays gastric emptying

Answer 18

injections

Question 19

GLP-1 analogues may cause side effects of…

Answer 19

Nausea/vomiting
Weight loss

Question 20

What do SGLT-2 inhibitors do?

Answer 20

Inhibit the reabsorption of glucose in the renal tubules (PCT)

Question 21

What is a common complication of SLGT-2 inhibitors?

Answer 21

Candidiasis/ thrush due to glycosuria
However if occurs, SGLT-2 should be continued.