Type 2 Diabetes

Question 1

what is Type 2 diabetes?

Answer 1

combination of insulin resistance and reduced insulin production

Question 2

pathophysiology of t2d?

Answer 2

more and more insulin is required to insensitive cells and pancreas is fatigued and insulin output decreases

Question 3

risk factors for t2d?

Answer 3

older age
ethnicity (black african, or caribbean and south asian)
FH
obesity
sedentary lifestyle
high carb diet

Question 4

presenting features of diabetes?

Answer 4

tiredness, polyuria, polydipsia, unintentional weight loss, opportunistic infection, slow wound healing, glucose in urine.

acanthosis nigricans- insuin resistance

Question 5

prediabetes level?

Answer 5

42-47 mmol/mol

Question 6

what level diagnoses HbA1c?

Answer 6

48 mmol/mol, typically repeated after 1 month

Question 7

Treatment targets for t2d?

Answer 7

48, but if on more than 1 antidiabetic drug then 53
measured every 3-6 months

Question 8

medical management for t2d?

Answer 8

1st line- metformin
plus sglt2 inhibitors if cardiovascular disease/HF/ Qrisk greater than 10%

2nd line- add sulofnylurea, pioglitazone, DPP4 inhibitor, SGLT2 inhibitor

3rd line- triple therapy- metformin/ 2 secondline
insulin therapy

Question 9

if triple therapy fails and BMI is above 35kg/m3?

Answer 9

option to switch one of drugs to GLP1 mimetic (liraglutide

Question 10

side effect of sglt2 inhibitor?

Answer 10

diabetic ketoacidosis

Question 11

how does metformin work?

Answer 11

increases insulin sensitivity and decreases glucose production (biguanide)

Question 12

side effects of metformin?

Answer 12

gastrointestinal symptoms, lactic acidosis ( secondary to AKI)

patients with GI side effects can try to modified release instead of standard release

Question 13

how do SGLT2 inhibitors work?

Answer 13

drug works on sodium glucose co-transporter 2 protein in proximal tubules causing more glucose to be excreted. lowers blood glucose, reduced bp, weight loss and improves heart failure. canc ause hypoglycaemia when used with insulin and sulfonylureas.

Question 14

side effects of SGLT2 inhibitors?

Answer 14

genital and UTI
weight loss
DKA
lower limb amputation (canagliflozin)
fournier’s gangrene (infection of genitals and perineum)

Question 15

pioglitazone?

Answer 15

thiazolidinedione, increases insulin sensitivity and reduces production of glucose in liver.

Question 16

side effects of SGLT2 inhibitors?

Answer 16

weight gain, HF, bone fracture riskincreases, bladder cancer risk increases

Question 17

sulfonylureas action?

Answer 17

gliclazide, stimulate insulin release from pancreas.

Question 18

side effects of sulfonylureas?

Answer 18

weight gain
hypoglycaemia

Question 19

how do incretins work?

Answer 19

hormone that reduced glucagon production, increase insulin secretion, slowing absorption by GI tract

Question 20

what is the main incretin?

Answer 20

glucagon like peptide 1

Question 21

What are incretins inhibited by?

Answer 21

dipeptidyl peptidase 4 DPP4

Question 22

DPP 4 inhibitors side effects?

Answer 22

sitagliptin, alogliptin
headache, low risk of acute pancreatitis

Question 23

GLP1 mimetic exenatide/liraglutide side effects?

Answer 23

reduced appetite, wight loss and Gi symptoms

Question 24

rapid acting insulins NovoRapid works?

Answer 24

after 10 minutes and last 4 hours

Question 25

short acting insulins Actrapid works?

Answer 25

30 minutes and last 8 hours

Question 26

intermediate acting insulins (humulin I) works?

Answer 26

1 hour and lasts 16 hours

Question 27

long acting insulins (levemir/lantus) works?

Answer 27

1 hour and lasts 24 hours or longer

Question 28

combination insulins include?

Answer 28

rapid acting and intermediate acting
Humalog 25 (25:75)
Humalog 50 (50:50)
Novomix 30 (30:70)

Question 29

complications of type 2 diabetes?

Answer 29

infections
diabetic retinopathy
peipheral neuopathy
autonomic neuropathy
chronic kidney disease
diabetic foot
gastroparesis
hyperosmolar hyperglycaemic state

Question 30

what to use to manage HTN in TD2?

Answer 30

ACEi
and in CKD when albumin:creatnine ratio is above 3mg/mmol

Question 31

when are SLGT2i started in CKD?

Answer 31

when albumin: creatinine ratio is. above 30mg/mmol

Question 32

what to use in erectile dysfunction?

Answer 32

phosphodiesterase 5 inhibitors sildenafil or tadalafil

Question 33

what can be used for fgastroparesis?

Answer 33

prokinetic drugs: domperidone/ metoclopramide
used in caution due to cardiac side effects

Question 34

options for neuropathic pain?

Answer 34

amitryptyline -tricyclic antidepressant
duloxetine-SNRI antidepresant
gabapentin
pregabalin anticonvulsant

Question 35

Hyperosmolar hyperglycemic state?

Answer 35

T2D fatal complication, hyperosmolarity, hyperglycaemia and absence of ketones

presents with polyuria, polydipsia, weight loss, dehydration tachycardia hypotension and confusion

treatment with iv fluids and careful monitoring

Question 36

how to diagnose t2d?

Answer 36

if symptomatic: fasting glucose more than 7
random glucose =>11.1

if not symptomatic then above proven on 2 different occasions

Question 37

other conditions can cause elevated HbA1c?

Answer 37

haemolytic anaemia
haemoglobinopathies
untreated iron deficiency anaemia
suspected gestational diabetes
children
HIV
CKD
medication that cause hyperglycaemia corticosteroids

Question 38

what is impaired fasting glucose?

Answer 38

greater than or equal to 6.1mmol/l but less than 7

Question 39

impaired glucose tolerance?

Answer 39

fasting glucose less than 7 then oral glucose tolerance test levels between 7 .8 and 11.1