T2DM

Question 1

What two things does metformin do? (bridge)

Answer 1

reduces hepatic gluconeogenesis

increases peripheral glucose uptake

Question 2

what does metflormin do to weight? (—)

Answer 2

weight neutral

Question 3

what two things does metformin reduce risk of?

Answer 3

cancer risk and cvd risk

Question 4

2 adverse affects of metformin?

Answer 4

GI side effects

lactic acidosis

Question 5

lowering ba1c with metformin in overweight patients reduces chances of ? (2)

Answer 5

MI and microvascular disease

Question 6

what is lada?

Answer 6

latent autoimmune diabetes of adults (25-40)

Question 7

peak age for type 1 diabetes?

Answer 7

0-4 and 10-14

Question 8

what 2 antibodies would you test for in type 1 diabetes?

Answer 8

GAD and IA2

Question 9

when would c peptide be present and why would it be absent?

Answer 9

its part of the pre insulin, cleaved out. If insulin is still being produced it will still be present

Question 10

which cells attack islet cells and what kind of deposition do you get in type 1?

Answer 10

lymphocytes and amyloid deposition

Question 11

the triad of type 1 diabetes?

Answer 11

polydypsia, polyuria and weight loss

Question 12

ideally keep HBA1C between?

Answer 12

48-58

Question 13

Intensive glucose control significantly reduces the incidence and progression of microvascular complications

Answer 13

insulin resistance is strongly associated with the development of microvascular complications

Question 14

why do you get balanitis in diabetes?

Answer 14

high sugar in urine

Question 15

do you get hypoglycaemia when using metformin as mono therapy?

Answer 15

no

Question 16

what is the reduction in glycated haemoglobin using metformin?

Answer 16

0.8-2%

Question 17

what is the foundation of any type 2 diabetes treatment programme?

Answer 17

diet and exercise

Question 18

gLITazone (PRG). what effect does this have?

Answer 18

increased peripheral glucose uptake

Question 19

what does gLITazone do to weight?

Answer 19

increases by 3-5kg

Question 20

3 risks of glitazone?

Answer 20

increases fracture risk (by 2-3x)
hepatotoxicity
fluid retention

Question 21

what kind of drug is glitazone?

Answer 21

PPARy activator

Question 22

majority of urine reabsorbed by which channels in kidney?

Answer 22

SGLT2

Question 23

what do sulphonylureas do to weight?

Answer 23

increase by 3-5 kg

Question 24

sulphonylurea mode of action?

Answer 24

blocks the B cell Katp channel. depolarises cell membrane. causing insulin secretion

Question 25

sulphonulurea can increase chance of?

Answer 25

hypoglycaemia

Question 26

name a DDP 4 inhibitor

Answer 26

anything that ends in “glipten”

Question 27

what is the link between obesity, insulin resistance and diabetes?

Answer 27

Obese people are resistant to the actions of insulin. This causes a compensatory rise in secretion of insulin as pancreas tries to overcome the resistance. Eventually the pancreas can no longer keep up, and it is at this point that the patient becomes hyperglycaemic and develops diabetes.

Question 28

adipose tissue is not inert. it secretes a whole range of things. what is the best known?

Answer 28

leptin

Question 29

how does orlistat work?

Answer 29

inhibition of lipases blocks absorption of dietary fat