Type 2 Diabetes

Question 1

Which type of diabetes has an insidious onset?

Answer 1

T2

Question 2

List common symptoms / presentations of T2DM

Answer 2

Tired, lethargic
Polyuria and polydipsia
Drink lucozade / coke bcos of thirst

Question 3

List signs of T2DM

Answer 3

High glucose
High sodium
Dehydrated

Question 4

Recall the osmolality equation

Answer 4

2 (Na + K) + glucose + urea = osmolality

Question 5

List complications of T2DM

Answer 5

Microvascular - retinopathy, nephropathy, neuropathy

Macrovascular = IHD, CVA, gangrene

Question 6

List features of background diabetic retinopathy

Answer 6

Hard exudates (cholesterol)
Microaneurysms
Blot haemorrhages

Question 7

What is the treatment of background diabetic retinopathy

Answer 7

Better BGC control

Question 8

What do cotton wool spots indicate?

Answer 8

Ischaemia

Question 9

What is the treatment for proliferative and pre proliferative diabetic retinopathy? What is the logic?

Answer 9

Pan retinal photocoagulation

To kill off peripheral cells in order to spare central vision

Question 10

Name the famous UK diabetes study

Answer 10

UKPDS - UK prospective diabetes study

Question 11

What did UKPDS show?

Answer 11

Tight BGC control from the moment of diagnosis will have ‘LEGACY EFFECTS’ throughout life, even if the control is then slackened

Question 12

What did the Accord study show?

Answer 12

Sudden tight control of BGC in people who had already suffered cardiac events lead to more sudden death

Question 13

List the management for T2DM

Answer 13

1. diet and exercise
2. metformin
3. gliclazide
4. Insulin sensitiser
5. Insulin
6. Incretins
7. Gliptins

Question 14

What type of drug is metformin?

Answer 14

Biguianide

Question 15

What type of drug is gliclazide?

Answer 15

Sulphonureas

Question 16

What are gliptins and what do they do?

Answer 16

Dipeptidyl peptidase 4 inhibitors, which prevent your own GLP1 breakdown

Question 17

Describe the different types of insulin analogues

Answer 17

Long acting - zinc suspension
Slow acting - actrapid (soluble)
Delayed insulin subcut

Question 18

List 2 advantages of insulin

Answer 18

HbA1c control

No side effects as its a natural product

Question 19

List side effects of metformin and sulphonureas

Answer 19

Metformin = diarrhoea 
Sulphonureas = skin reactions

Question 20

List disadvantages of insulin

Answer 20

Can’t drive HGVs
Hypoglycaemia is common if control is good
Weight gain

Question 21

List effects of GLP1 analogues

Answer 21

Increase insulin secretion

Slows stomach down so you eat less

Question 22

What are the effects of SGLT2 inhibitors?

Answer 22

SGLT2 is the transporter that reabsorbs glucose from tubules in nephron –> blocking it makes you pee out glucose IN HEART FAILURE PTs ONLY

Question 23

List positives of SGLT2 inhibitors

Answer 23

Prevents death in 6 months (!!!)
HbA1c drops 
BP drops (its a diuretic) 
lose weight and waist circumference shrinks 
prevents heart failure and renal disease