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| Question | Answer |
| List FOUR non-modifiable factors that may contribute to the onset of type 2 diabetes mellitus | Age. •Ethnicity. •History of polycystic ovary disease. •Family history (parents or sibling). •Gestational diabetes. •Large birthweight baby. |
| Describe the mechanism of action of the incretins | Incretins are peptide hormones. Produced by endocrine cells in epithelium of small intestines in response to meals. Stimulate beta cells to release more insulin in response to same glucose load. |
| List FOUR modifiable factors that may contribute to the onset of type 2 diabetes mellitus | Overweight or obese - BMI > 25 kg/m2 Lack of physical activity Hypertension or dyslipidaemia Pre-diabetes |
| Describe the MOA of first-line hypoglycaemic agent for Type 2 Diabetes? | Metformin - Biguanide Oral Hypoglycaemic Agent especially for patients with >25-BMI. Stimulation of the AMPK enzyme involved in insulin signalling and hepatic glucose production. |
| What is the dose for Metformin? | 500 mg OD with food for 2 weeks, then 500 mg BD for 2 weeks and then 500 mg TDS with food; max 2g/day. |
| What are the Side Effects for Metformin? | Anorexia, GIT, reduced vitamin B12 absorption. (No Hypos). |
| What are the Cautions and Contraindications of Metformin? | Cautions: Renal impairment. CI: Ketoacidosis |
| What is the first OHA if the patient is not overweight (<25 BMI)? Example? | Sulphonylureas; Gliclazide. Insulin secretagogues, require functioning B-cells. |
| What is the MOA (Mode of Action) of Sulphonylureas? | Stimulate the pancreas to release insulin. Bind to SUR on K-ATP channels on cell membrane of pancreatic B-cells. Block K-ATP channels, this depolarises B-cells activating voltage sensitive Ca2+ channels which leads to influx of Ca2+ and insulin secretion. Insulin enters the portal circulation, where it inhibits hepatic glucose production. |
| What are the side effects and caution of Sulphonylureas? | Dose related hypoglycaemia most common side effect. Appetite stimulate - weight gain. GIT. Caution - mild to moderate renal disease and in liver disease. |
| What is the MOA of Meglitinides? Examples of drug names? | Non-sulphonylurea secretagogues. Stimulate insulin release from the pancreas relative to glucose levels. Decreased insulin release at low blood glucose levels, therefore less risk of hypoglycaemic episodes. Repaglinide and Nateglinide. |
| Side effects for Meglitinides? | Risk of hypoglycaemia. Hypersensitivity reactions (rash, itch. urticaria) GI effects with repaglinide. |
| Define Diabetes | A chronic disease characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. |
| Counter-regulatory hormones are...? And they do...? | Glucagon, Adrenaline, Cortisol and Growth Hormone. Increase liver glucose production |
| What is normal blood glucose? | 18mg/dl = 1mmol/L |
| Describe the microvascular and macrovascular complications of Type 2 Diabetes | Macrovascular disease: Myocardial infarction, stroke and peripheral vascular disease Microvascular disease: Retinopathy, Nephropathy |
| What are the early signs of hypoglycaemia? | Early signs include weakness, hunger, anxiety, dizziness, sweating, palpitations, irritability and tremor (Early signs are due to effects of adrenaline/NA) Blurred vision, drowsiness, confusion, lack of judgement & self control due to low brain glucose (CNS effect). |
| What blood glucose level does early signs of hypoglycaemia begin? | Symptoms are not apparent until blood glucose levels fall below 3.5 mmol/L |
| What is the management of hypoglycaemia if patient is conscious? | 10-20g oral glucose: •2 teaspoons of sugar •100ml coca cola •200ml milk Repeat in 10-15 min if symptoms persist Follow with carbohydrate meal until recovery |
| What is the management of a hypoglycaemic patient if unconscious? | It is a medical emergency. Glucagon s.c, i.m., or IV for acute insulin. OR 50ml glucose 20% IV infusion |
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