Week 141 - Diabetes Mellitus

Question 1

What is the BP target for a patient with uncomplicated T2DM?

Answer 1

140/80

Question 2

What is the first line antihypertensive for a patient with T2DM?

Answer 2

ACE I

Question 3

What is the target LDL Choleterol for a patient with T2DM?

Answer 3

2mmol/L - LDL

4mmol/L - Total Cholesterol

Question 4

What is the most important thing to reduce to reduce the risk of cardiovascular events?

Answer 4

Cholesterol

Question 5

What drugs may precipitate/exacerbate hyperglycaemia?

Answer 5

Thiazides

Diuretics

Question 6

What are the two types of ulcers in T2DM?

Answer 6

Neuropathic

Ischaemic

Question 7

What symptoms can intermittent claudication present with?

Answer 7

Calf pain
Allodynia (interfering with sleep)
This is due to atherosclerotic blockages resulting in peripheral arterial disease

Question 8

What did the the HOPE trial investigate?

Answer 8

The efficacy of ACE Inhibitors

Question 9

What did the UK Prospective Diabetes Study show?

Answer 9

Tight glycaemic control is good, but takes time to become significant

Question 10

What did the ACCORD trial show?

Answer 10

Tight glycaemic control increases mortality

Question 11

What is Acanthosis nigricans?

Answer 11

Brown to black hyperpigmentation of the skin

Associated with insulin-like activity

Question 12

What is Necrobiosis lipoidica diabeticorum?

Answer 12

Necrotising skin condition that usually occurs in diabetes (ulcers)

Question 13

Which finding is suggestive of cardiac autonomic neuropathy?

Answer 13

Absent beat to beat variation in pulse rate with deep resipiration

Question 14

At what level of eGFR should one stop Metformin?

Answer 14

30ml/min/1,31m2

Question 15

What drug is contraindicated with PD5 inhibitor (Viagra)?

Answer 15

Isosorbide mononitrate (nitrate used for angina pectoris)

Question 16

Which agent is most effective in attenuating the risk of progression to macroalbuminuria?

Answer 16

Irbesartan (angiotensin II receptor antagonist)

Question 17

Which electrolyte disturbance is a potential concern when dosing ACE inhibitors?

Answer 17

Hyperkalaemia

Question 18

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

Answer 18

4am-10am (Dawn phenomenon)

Question 19

What are the features of Type I Diabetes?

Answer 19

Skinny
Blood ketones
GAD antibodies

Question 20

What can an Oral Glucose Tolerance Test?

Answer 20

After 2 hrs:
>7.8 = impaired glucose tolerance
>11.1 = Diabetes mellitus

Question 21

What is the life-span of a RBC?

Answer 21

120 days

Question 22

What factors affect HbA1c levels?

Answer 22

Haemolysis
Iron deficiency anaemia
Renal Impairment (erythropoiesis affected)
Pregnancy (high cell turn over)
Blood transfusion

Question 23

What are the actions of Insulin?

Answer 23

↑ Peripheral Glucose Uptake
↑Glycogen storage
↑Protein Synthesis
↑Triglyceride storage
↓Breakdown of glycogen

Question 24

What counter-regulatory hormones give the features of aggressiveness, sweating during a hypo?

Answer 24

Adrenaline
Noradrenaline
Cortisol

Question 25

How is insulin secretion triggered?

Answer 25

Glucose enters via GLUT2 ATP is synthesised, closing the ATP-sensitive K+ channel Depolarisation leads to Ca channel opening Insulin is exocytosed

Question 26

What is the mechanism of action of Sulphonylureas drugs?

Answer 26

Binding to its receptor subsequently blocks the ATP sensitive potassium channels

Question 27

What happens to the GLUT4 transporter in diabetes

Answer 27

It is downregulated Glucose needs to be transported into cells GLUT4 is regulated by insulin

Question 28

Where are SGLT2 found and what is their function?

Answer 28

Reabsorb glucose in the proximal convoluted tubule | SGLT2 inhibitors can block this process

Question 29

How does T2DM develop?

Answer 29

1) Hyperinsulinaemia (body compensates for insulin resistance) 2) Hyperglycaemia (failure to compensate) 3) Diabetes Mellitus

Question 30

Name a biguanide drug, its mechanism of action and side-effects

Answer 30

Metformin ↑Insulin Action S/E - GI disturbance

Question 31

Name a sulphonylureas drug, its mechanism of action and side-effects

Answer 31

Gliclazide, Glimepiride ↑Insulin Production S/E - Hypoglycaemia, weight gain

Question 32

Name a Metaglinide drug, its mechanism of action and side-effects

Answer 32

Rapaglinide, Nateglinide Similar to sulphonylureas action S/E - Hypoglycaemia, GI-disturbance

Question 33

Name a alpha-glucosidase inhibitor, its mechanism of action and side-effects

Answer 33

Acarbose Delays glucose absorption S/E - GI-disturbance

Question 34

Name a Thiazolidinedione drug, its mechanism of action and side-effects

Answer 34

Glitazones (Pioglitazone) ↑Peripheral Sensitivity to insulin S/E - Peripheral oedema, anaemia, fractures

Question 35

Name a DPP-4 Inhibitor and its effects

Answer 35

Silagliptin, Vildagliptin, Saxagliptin, Linagliptin | Protect native GLP-1 from inactivation by DPP-4

Question 36

Name a GLP-1 Agonist and its effect

Answer 36

Exenatide, Liraglutide, Lixisenatide | ↓Weight Loss, ↓HbA1c

Question 37

Name an SGLT2 inhibitor and its mechanism of action

Answer 37

Canagliflozin, Dapagliflozin, Empagliflozin Stops SGLT2 reabsorbing glucose in the prox con tubule Contraindicated in genital and urinary infections