Type 2 diabetes mellitus

Question 1

Recall the defining values of T2DM

Answer 1

1. Fasting glucose:
Impaired = 6-7
Diabetes = >7
2. GTT
Impaired = 7.8-11.1
Diabetes = >11.1

Question 2

Recall 4 risk factors for T2DM

Answer 2

1. Genetics (greater genetic component than T1DM)
2. Low birth weight
3. South asian ethnicity
4. Gut microbiota

Question 3

Describe how the gut microbiota can affect diabetes risk

Answer 3

GM responsible for lipopolysaccharide fermentation to FAs

FAs modulate bile acids in circulation –> modulate host metabolism

Question 4

Recall the inheritance of MODY

Answer 4

autosomal dominant (rare)

Question 5

What molecules modulate insulin resistance

Answer 5

adipocytokines

Question 6

What are the 2 main effects of elevated adipocytokine levels

Answer 6

dyslipidaemia and mitogenic pathway stimulation

Question 7

Recall the 2 main effects of the mitogenic pathway

Answer 7

SMC hypertrophy

Increased BP

Question 8

What is the first functional loss experienced in T2DM

Answer 8

Loss of phase 1 insulin

Question 9

Why is atheroma more prevalent in T2DM patients

Answer 9

FAs that enter liver cannot be used as substrates for GNG and so are used in vLDL production –> atherogenic

Question 10

What % of T2DM patients are obese?

Answer 10

80%

Question 11

What are the 4 main principals of T2DM treatment?

Answer 11

Education
Diet
Complication screening
Pharmacological treatment

Question 12

Recall the 5 main pharmacological treatments for tackling T2DM

Answer 12

1. Metformin
2. Sulphonylureas
3. GLP-1 analogues/ gliptins
4. Alpha-glucosidase inhibitors
5. PPAR agonists

Question 13

Recall the mechanism of action of metformin

Answer 13

Biguanide

Insulin-sensitiser

Question 14

Recall 3 contra-indications for metformin

Answer 14

Liver, cardiac, RENAL failure

Question 15

Recall the mechanism of action of sulphonylureas

Answer 15

Block ATP-sensitive K+ channel in beta cells - makes pancreas secrete more insulin

Question 16

Give an example of a sulphonylurea drug and one side effect

Answer 16

Glibenclamide - weight gain

Question 17

Recall the mechanism of action of alpha-glucosidase inhibitors and one side effect

Answer 17

Delay glucose absorption - side effect = flatus

Question 18

Recall the mechanism of action of PPAG agonists

Answer 18

Act on adipocytes to address insulin resistance in fat and muscle

Question 19

What does PPAR agonist stand for?

Answer 19

Peroxisome proliferator-activated receptor agonist

Question 20

Recall the mechanism of action of GLP-1 receptor agonists

Answer 20

Incretin effect to increase satiety - modified to increase half-life compared to GLP-1

Question 21

By what enzyme is GLP1 broken down?

Answer 21

DPPG4

Question 22

What are gliptins? Recall their mechanism of action

Answer 22

DPP4 inhibitors - prolong half life of existing GLP1