T2DM

Question 1

What is the histological picture of T2DM?

Answer 1

amyloid dispostition in islet cells

Question 2

What causes T2DM?

Answer 2

genetic predisposition
obesity
lifestyle factors

Question 3

What happens to beta cells in T2DM?

Answer 3

compensatory B cell hyperplasia

Question 4

How is T2DM diagnosed?

Answer 4

Fasting plasma glucose (FPG) >7 mmol/L

Random plasma glucose ≥11.1 mmol/L

Question 5

What is the target HbA1c?

Answer 5

below 48

Question 6

What is the first line drug for T2DM?

Answer 6

metformin

Question 7

What is the action of metformin?

Answer 7

decreases hepatic gluconeogenesis and increases peripheral glucose uptake by stimulating AMP activated protein kinase
can cause weight loss

Question 8

What are the side effects of metformin?

Answer 8

lactic acidosis

GI upset

Question 9

What drugs can be added on to Metformin?

Answer 9

Sulphonylurea - Glipizide and Glicizide
Thiazolidinine - Glitazone
DPP-4 inhibitors - Sitagliptin 
Incretin analogues - Extenatide
SGLT-2 inhibitors - Empagliflozin

Question 10

Describe the action of SGLT-2 inhibitors?

Answer 10

selectively blocks reabsorption of glucose by SGLT-2 in the proximal tubule of the kidney nephron
causes glucosuria
s.e. UTI

Question 11

Describe the action of TZDs?

Answer 11

agonist of PPARy making the PPARy-RXR complex that encodes for the transcription factor that binds to DNA to promote expression of genes involved in insulin signalling and lipid metabolism

causes weight gain and fluid retention
reduces insulin resistance
reduced hepatic gluconeogenesis

Question 12

Describe the action of sulphonureas?

Answer 12

block the KATP channel by displacing the binding of ADP-Mg from the SUR1 subunit
this stimulates insulin release
may cause hypoglycaemia

Question 13

Describe the actions of Glinides?

Answer 13

bind to SUR1 to close the KATP channel and trigger insulin release
avoided in pregnancy, breast feeding, severe hepatic impairment

Question 14

Describe the action of DPP-4 inhibitors?

Answer 14

prolong the effect of GLP-1 and GIP (inhibited by DPP-4)

this enhaced insulin secretion from beta cells and decreases glucagon release

Question 15

Describe the action of incretin analogues?

Answer 15

mimic the action of GLP-1 and bind as an agonist to GPCR GLP-1 receptors to increase intracellular cAMP concentration in beta cells

cause weight loss

Question 16

How does T2DM cause microvascular complications?

Answer 16

reduced blood flow causing damaged nerves

Question 17

What are the 4 types of neurophathy that T2DM can cause?

Answer 17

peripheral
autonomic
focal
proximal

Question 18

Describe autonomic neuropathy?

Answer 18

affects the nerves regulating the heart rate and BP as well as the control of internal organs e.g. those involved with gastric mobility, respiratory function, urination, sexual function and vision

Question 19

Give examples of problems caused by autonomic neuropathy?

Answer 19

gastroperesis
sweat glands lose their ability to regulate temperature
postural hypotension

Question 20

Describe peripheral neuropathy?

Answer 20

tingling and pain
loss of balance and coordination
sensitive to touch

Question 21

Describe focal neuropathy?

Answer 21

appears suddenly and affects specific nerves

commonly on head, torso or leg (sometimes behind eye - Bells palsy)

Question 22

Describe Proximal neuropathy?

Answer 22

pain in thighs/buttocks/legs

Question 23

What is diabetic nephropathy?

Answer 23

a progressive kidney disease causing damage to the capillaries in the kidneys glomeruli
causes protein leakage and imprired renal function

Question 24

How is diabetic nephropathy screened for?

Answer 24

albumin creatine ratio

- if they have microalbinuria or proteinuria - commence ACEI or ARB

Question 25

What are the stages of diabetic retinopathy?

Answer 25

mild non proliferative - haemorrhages and microaneurysms
moderate non proliferative - haemorrhages, micro aneurysms and hard exudates
severe non proliferative - IRMA, venous bleeding, haemorrhages
proliferative
- new vessel formation, sudden change in vision

Question 26

What is the treatment for diabetic retinopathy?

Answer 26

laser treatment for localised coagulation of blood cells/vessels
vitrectomy and anti-VEGF injections

Question 27

What affect can diabetes have on cataract development?

Answer 27

develops earlier in diabetics

Question 28

What can diabetes lead to in men?

Answer 28

erectile dysfunction