Pharmacology Week 9 - Diabetes

Which of these pathophysiological failures contribute to Hyperglycaemia?

• Increased Insulin secretion

• Decreased Glucagon secretion

• Decreased Incretin effect

• Decreased Lipolysis

Answer explanation

Decreased Incretin Effect is correct. All of the other answers are incorrect.

Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood-glucose–dependent mechanism.

Which of these is a common side effect of Metformin?

• Diarrhoea

• Insomnia

• Headache

• Anaemia

• Muscle Fasciculations

Answer explanation

Gastro-intestinal side effects such as Diarrhoea are common with Metformin and may be reduced with a different formulation such as a Modified-Release version of Metformin.

Which of these Diabetic treatments has the highest risk of causing Hypoglycaemia?

• Metformin

• Sulphonylureas (such as Gliclazide)

• Thiazolidinediones (such as Pioglitazone)

• DPP-4 inhibitors (such as Sitagliptin)

Answer explanation

Sulphonylureas such as Gliclazide carry a risk of causing Hypoglycaemia. Patients must be counselled on this risk and be made aware of the symptoms of this.

Which of these is NOT an aim of Insulin therapy in Diabetics?

• Target HbA1c less than 48 mmol/mol

• Measure blood glucose at least 4 times per day

• Aim for a blood glucose range between 7-9 mmol/l upon waking

• Aim for a blood glucose level above 5 mmol/l when driving

Answer explanation

The target for fasted morning blood glucose levels should be between 5 - 7 mmol/l

Which TWO of these statements is true regarding Insulin therapy?

• Continuous subcutaneous insulin infusions are available to all Type 1 Diabetics

• A Biphasic insulin regime is the first-line recommended therapy for Type 1 Diabetics

• Lipodystrophy is a possible side effect of Insulin

• 
• Insulin should be prescribed by its brand name

Answer explanation

Continuous subcutaneous insulin infusions are available to patients with disabling hypoglycaemia or high HbA1c levels (above 69 mmol/mol)

Basal-bolus insulin regimes are recommended first line, not Biphasic regimes.

The image is an example of a Biphasic regime.