T2DM

Question 1

name the 2 things that contribute to insulin resistance in T2DM

Answer 1

genetic predisposition and obesity lifestyle factors

Question 2

insulin resistance -> compensatory ____-cell ____________ -> _____ beta-cell failure -> ____ beta-cell failure

Answer 2

insulin resistance -> compensatory BETA-cell HYPERPLASIA -> EARLY beta-cell failure -> LATE beta-cell failure

Question 3

compensatory beta-cell hyperplasia = ?

early beta-cell failure = ?

late beta-cell failure = ?

Answer 3

compensatory beta-cell hyperplasia = NORMOGLYCEMIA

early beta-cell failure = IMPAIRED GLUCOSE TOLERANCE

late beta-cell failure = DIABETES

Question 4

the ominous octet - increased or decreased?

neurotransmitter dysfunction

incretin effect

glucagon secretion

hepatic glucose production

insulin secretion

lipolysis

glucose reabsorption

glucose reuptake

Answer 4

INCREASED neurotransmitter dysfunction

DECREASEDincretin effect

INCREASED glucagon secretion

INCREASED hepatic glucose production

DECREASED insulin secretion

INCREASED lipolysis

INCREASED glucose reabsorption

DECREASED glucose reuptake

ALL RESULT IN HYPERGLYCEMIA

Question 5

beta cell dysfunction leads to what?

Answer 5

hyperglycaemia

Question 6

chronic hyperglycaemia leads to what?

Answer 6

microvascular disease

Question 7

what reduces the incidence and progression of microvascular complication of diabetes?

Answer 7

intensive glucose control

Question 8

CVD risk is best treated through use of what 2 drugs?

Answer 8

statins and anti-hypertensives

Question 9

54 year old male

P/W thirst/ polyuria and balanitis

No significant PMH
FHx T2DM

BMI 38
BP 146/98
RBG 16 mmol/l
Urinalysis: glucose +++, Protein +

diagnosis?

Answer 9

T2DM

Question 10

what drugs causes:

decreased gluconeogenesis and increased peripheral glucose uptake

Answer 10

metformin

Question 11

what drugs causes:

decreased HbA1c
neural weight
no hypoglycaemia
decreased Ca and CHD risk

Answer 11

metformin

Question 12

metformin adverse effects?

Answer 12

GI and lactic acidosis

Question 13

reduced HbA1c results in reduced risk of what 4 things?

Answer 13

retinopathy
nephropathy
neuropathy
CHD

Question 14

what is the SIGN 116 glycemic targets?

Answer 14

48-53 mmol/l

Question 15

what is the stage 1 drug used in T2DM?

Answer 15

metformin

Question 16

2 drug combination:

metformin + ? (5)

Answer 16

metformin + …

sulfonylurea
thiazolidinedione
DPP-4 inhibitors
GLP-1 receptor agonist
insulin

Question 17

what drug causes:

blocked beta cell Katp channel and increased 1st and 2nd phase insulin secretions

Answer 17

sulphonylurea

Question 18

does sulphonylurea cause weight gain?

Answer 18

yes

Question 19

name a sulphonylurea

Answer 19

gliclazide

Question 20

what is the estimated beneficial dose of gliclazide?

Answer 20

80-120mg

Question 21

what T2DM drug has a low incidence of hypoglycaemia?

Answer 21

gliptins

Question 22

name a SGLT-2 inhibitor

Answer 22

empagliflozin

dapagliflozin

Question 23

name a thiazolidinedione

Answer 23

glitazone

Question 24

what drug is a PPARgamma activator and causes increased peripheral glucose uptake?

Answer 24

glitazone

Question 25

does glitazone cause weight gain?

Answer 25

yes

Question 26

state the adverse side affect of glitazone

Answer 26

increased fracture risk

Question 27

what drug combination should someone with a history of CVD get?

Answer 27

metformin + SGLT2 inhibitor

Question 28

what drug is goof for T2DM and NAFLD?

Answer 28

pioglitazone

Question 29

BMI >30 (>28 asian) + insulin sensitive = drug?

Answer 29

MF/SGLT2/DPP4I/PIO

Question 30

BMI <30 (<28 asian) + insulin sensitive = drug?

Answer 30

SUs - low dose and do not step up