T2DM

Question 1

What happens in T2DM

Answer 1

Insulin resistance
•insulin sensitivity tissues/organs fail to respond to insulin
• this occurs due to impaired insulin signalling

Beta cell dysfunction/death

Question 2

What is the cause:mechanism behind beta cell death/dysfunction

Answer 2

•lipotoxicity
•inflammation
•ER stress
•amylis deposits out side beta cell, affecting function
• beta cell exhaustion

Question 3

According to WHO, what is the fasting and 2h post prandial in T2DM

Answer 3

Fasting: >7mmol
2hr post prandial: >11.1mml

Question 4

What methods are used in diagnosing T2DM

Answer 4

• fasting glucose test
• OGTT
• random glucose test
• HbA1c test

Question 5

Insulin resistance risk factors?

Answer 5

• obesity
• low birth weight
• gastrointestinal diabetes
• low economic status ~ ethnicity in west
• HTN
• Meds: corticosteroids

Question 6

Describe step 1 of management

Answer 6

Give insulin for hyperglycaemia

Question 7

Describe step 2 of management

Answer 7

Assess:
• HbA1c
• CVD risk
• renal function

Question 8

Describe step 3 of management, for those not at high risk of CVD

Answer 8

• give metformin (or metformin MR)
• if metformin is CI, then give:
- DPP4 inhibitors (gliptins) OR
- sulponylurea OR
- pioglitazone

Question 9

Describe step 3 of management, for those at risk of CVD, including: HF, atherosclerosic, CVD and QRisk >10%

Answer 9

• give metformin (or metformin MR)
• once metformin is tolerated, the five SGLT2 inhibitor

if metformin is CI, give SGLT2 inhibitor alone

Question 10

Which drugs increase insulin sensitivity

Answer 10

• metformin
• pioglitazone

Question 11

Which drugs increase insulin secretion

Answer 11

• sulfonylurea
• DPP4 inhibitors
• GLP-1 agonist

Question 12

Which drugs decreases glucose reabsorption

Answer 12

SGLT2 inhibitors

Question 13

Which 2 drugs can are in injection form

Answer 13

insulin and GLP-1 agonist (this can also be tablet)

Question 14

Which drug delays carbs absorption?

Answer 14

Acarbose

Question 15

Which class of drugs are involved in the incretin affect?

Answer 15

• DPP4 inhibitors
• GLP-1 agonist

Question 16

Which drugs increase weight?

Answer 16

• Sulfonylurea
• pioglitazone (TZDs)
• insulin

Question 17

Which drugs reduced weight

Answer 17

• GLP-1 agonist
• SGLT2 inhibitors

Question 18

Which drug have the highest hypo risk

Answer 18

Insulin

Question 19

Which class of drug reduces cardiac events?

Answer 19

SGLT2 inhibitors

Question 20

Which drug that increases insulin secretion requires glucose too?

This drug also increases intercellular ca

(Glucose-dependent)

Answer 20

GLP-1 agonist

Question 21

Which peptide hormones are a part of the incretin effect?

Answer 21

GLP-1 and GIP

Question 22

What is the incretin affect?

Answer 22

The incretin hormones release from the intestinal cells in response to food intake (fat mainly)

They boost insulin release and reduce glucagon release

Helps in weight reduction

Question 23

GLP-1 and GIP can be inactived by…

Answer 23

DPP4

Question 24

If triple therapy (performing and 2 other drugs) is CI or not affective. What would you switch one of the drugs to and in which sort of patients

Answer 24

GLP-1 mimic, in those with:
• BMI over 35
• BMI lower than 35
- where insulin would have big implications OR weight loss would be benifical to other obesity relatives conditions