Type 2 Diabetes

Question 1

what is an appropriate BP target for a patient with uncomplicated type 2 diabetes

Answer 1

140/80mmHg

Question 2

what is an appropriate BP target in a patient with type 2 diabetes and a history of MI and angioplasty

Answer 2

130/80mmHg

Question 3

what is the first line choice for antihypertensives in T2DM

Answer 3

ACE inhibitor

Question 4

what is the target LDL cholesterol for all patients with T2DM

Answer 4

2.0mmol/l

Question 5

what proportion of patients with type 2 diabetes will succumb to cardiovascular complication

Answer 5

75%

Question 6

which is the most important risk factor to control to reduce cardiovascular risk in a pt with T2DM

Answer 6

Cholesterol

Question 7

a 65 year old male attend diabetes clinic. He reports lower limb pain in the calf after walking approx 50 yards and is relieved by rest.
His co-morbidities include HTN and dyslipidaemia.
He smokes 10 cigarettes a day.
What is the likely diagnosis

Answer 7

intermittent claudication

Question 8

which study showed long term benefit of reduced ischaemic heart disease from early intensive glycemic control in pts with T2DM

Answer 8

UKPDS

Question 9

in a pt with newly diagnosed T2DM, following lifestyle intervention, what is the first line anti-diabetic treatment

Answer 9

Metformin

Question 10

which of these treatments is associated with hypoglycaemia as a potential side effect:
Gliclazide
Pioglitazone
Metformin
Sitagliptin
GLP-1 receptor angonist

Answer 10

Gliclazide (a sulfonylurea)

Question 11

A 21y/o with T2DM presents with a BMI of 36.

She has hyper pigmentation of the skin in the axilla bilaterally what is the most likely diagnosis

Answer 11

Acanthosis nigrans

strongly suggestive of insulin resistance

Question 12

which anti diabetic agent is associated with potential weight gains as an adverse effect

Answer 12

pioglitazone

Question 13

what causes weight gain with pioglitazone

Answer 13

saltwater retention

Question 14

which anti diabetic agent is theoretically associated with the risk of lactic acidosis

Answer 14

metformin

more likely to occur in pts with renal impairment

Question 15

at what level of eGFR should one stop metformin

Answer 15

30ml/min/1.73m2

Question 16

which study suggested an adverse outcome from intensive glucose monitoring in pts with longstanding T2DM

Answer 16

ACCORD

Question 17

how would you classify chronic kidney disease in a lady who is 60yrs with Hx of T2DM for 20yrs
Hb1ac = 7.9%
BP= 170/95
albumin:creatinine ratio of 40mg/mol
eGFR= 40ml/min/1.73m2

Answer 17

3b

the main management of this patient would be controlling her blood pressure

Question 18

what biochemistry finding would cause you to discontinue ACE inhibitor treatment in T2DM

Answer 18

Serum creatinine 215

Question 19

what clinical sign would be suggestive of cardiac autonomic neuropathy

Answer 19

absent beat to beat variation in pulse rate with deep respiration

Question 20

a pt is complaining of erectile dysfunction
investigation show normal gonadotrophin levels
you are considering treatment with a PD5 inhibitor
he has a history of IHD
which medication is a contraindication to PD5 inhibitor treatment

Answer 20

isosorbide mononitrate

Question 21

a 55y male who has been recently diagnosed with T2DM.
Hx: HTN and dyslipidaemia
today:
BP= 160/90
Ab1ac = 7.4%
eGFR >90ml/min/1.73m2
persistently raised alb:creat (10-15mg/mol)

what is his risk of progression to macroalbuminuria over the next 10 years

Answer 21

30%

in this patient irbesartan would be the most effective agent to attenuate this risk (angiotensin-II receptor antagonist)

Question 22

the use of ACE inhibitor has gained widespread acceptance as the first line treatment of hen in pts with early or advance diabetic nephropathy.
This class of agents help to lower BP and attenuate proteinuria
how are these benefits achieved

Answer 22

improved renal perfusion

Question 23

which electrolyte disturbance is a potential concern when dosing ACE inhibitors

Answer 23

hyperkalaemia

Question 24

what level of HbA1c is the aim to reduce the microvascular complications of diabetes

Answer 24

53mol/mmpl (7.0%)

Question 25

what are the actions of insulin

Answer 25

promotes peripheral uptake of glucose into muscle

Question 26

at what time of day are basal levels of insulin at their highest

Answer 26

4am - 10am

the dawn phenomenon

Question 27

which gut peptides are associated with the incretin effect

Answer 27

GLP-1

Question 28

ankle brachial index values are falsely elevated in which situation

Answer 28

calcified atherosclerotic arteries

Question 29

what makes up the ominous octet

Answer 29

MUSCLE –> decreased glucose uptake via GLUT 4
LIVER –> increased hepatic glucose production
BETA CELL –> dysfunction begins 12 yrs before diagnosis
FAT CELL –> increased free FAs –> stimulates gluconeogenesis and impairs insulin secretion and promotes resistance
GIT –> decreased GLP-1
ALPHA CELLS –> increased glucagon
KIDNEYS –> overexpression of SGLT2 receptors –> increased glucose reabsorption
BRAIN –> impaired appetite regulation

Question 30

signs of hyperglycaemia

Answer 30

polydipsia
polyuria
weightloss
fatigue

Question 31

microvascular complications of T2DM

Answer 31

retinopathy
nephropathy
neuropathy

Question 32

macrovascular complications of T2DM

Answer 32

coronary artery disease
cerebrovascular disease (stroke)
peripheral arterial disease (claudication)

Question 33

which ethnic group living in the UK are more at risk of developing T2DM

Answer 33

south asian, african and caribbean