Diabetes
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1
A 28 year old woman is 26 weeks pregnant and undergoes a routine test for gestational diabetes.
How is the test conducted?
How is the test conducted?
- Blood glucose measurement without fasting
- Blood test to check HbA1c
- Eight/Twelve hours fasting and measurement of blood glucose levels
- Eight/Twelve hours fasting, sugary drink and measurement of blood glucose after 2 hours
- Fasting, blood glucose measurement, sugary drink, blood glucose measurement after 2 hours
2
A 55 year old man has a BMI of 30 ( normal value for his ethnic group is 18.5-24.9) and has a HbA1c value of 44 mmol/mol ( normal value is less than 48mmpl/mol).
Which cellular mechanism keeps the latter in the normal range?
Which cellular mechanism keeps the latter in the normal range?
- Less glucagon secreted by the pancreatic alpha cells
- Increased activation of the insulin receptors in peripheral tissues
- More insulin receptors are expresed in peripheral tissues
- Pancreatic Beta cells increase in size to secrete more insulin
- Peripheral insulin sensitivity is increased by activation of AMPK
3
A 65 year old woman has a BMI of 26 ( normal values for ethnic group is 18.5 to 22.9) and has a waist to height ratio of 0.55 ( healthy : 0.4-0.49).
Which is one of the factors that increase her risk for developing type 2 diabetes?
Which is one of the factors that increase her risk for developing type 2 diabetes?
- Acute inflammation
- Decreased release of adipokines
- Increased mitochondrial activity
- Oxidative stress
- Reduced circulating free fatty acids
4
A 60 year old man with type 2 diabetes has struggled to meet his HbA1c targets and has been prescribed several medications since his diagnosis many years ago. Recent;y, two blood tests have shown HbA1c values greater than 75mmol/mol and a period of self monitoring has confirmed continuous high blood glucose levels.
Which new medication is required and why?
Which new medication is required and why?
- GLP1 receptor agonist to potentiate the glucose induced insulin secretion
- Insulin the compensate for the autoimmune disruption of pancreatic beta cells
- Insulin to counteract the effect of glucotoxicity on pancreatic beta cells
- SGLT2 inhibitor to redyce blood glucose reabsorption
- Sulfonylurea to enhance insulin secretion
5
A 70 year old man with type 2 diabetes was prescribed the DPP4 inhibitor, Linagliptin, ten years ago, Recently his Gp replaced it with Mounjaro, a GIP,GLP1 receptor agonist.
Why does the GP change his medication?
Why does the GP change his medication?
- Linaglitin increases gastric emptying
- Linagliptin can cause weight gain
- Mounjaro produces a stronger incretin effect
- Mounjaro reduces risk of hypoglycaemia
- Mounjaro stimulates insulin secretion in the absence of glucose
6
A 45 year olf woman with type 1 diabetes keep sher blood glucose lower than it should be for fear of complications of hyperglycaemia. She thinks her body has adapted as she is not experiencing sweating, tremor or hunger anymore.
What is she most at risk of and why?
What is she most at risk of and why?
- Coronary heart disease - her poor blood glucose management increases atherosclerosis risk
- Diabetic ketoacidosis - low blood glucose availability promotes ketone synthesis
- Recurrent hypoglycaemia - increased counter regulatory threshold
- Retinopathy - prolonged exposure to improper glucose levels damages retinal pericytes
- Severe hypoglycaemia episode - impaired awareness of hypoglycaemia
7
A 65 year old woman with type 2 diabetes and central obesity undergoes some tests to assses her liver function.
Why is this necessary?
Why is this necessary?
- All type 2 diabetes patients develop MASLD
- Insulin resistance can cause MASLD
- MASLD is driven by pancreatic beta cell dysfunction
- There is increased lipogenesis in the liver
- Type 2 diabetets is associated with acute inflammation that can cause liver fibrosis
8
A 55 year old man with type 1 diabetes experienced an episode of severe hypoglycaemia. Worried that this could happen again, he adjusts his medications to maintain his blood glucose slighlty over his recommened limit.
Which chronic complication can he develop and why?
Which chronic complication can he develop and why?
- Diabetic ketoacidosis- if he skips insulin injections ro reduce glucose uptake
- Myocardial infarction - hyperglycaemia promotes cholesterol clearance in atheroscleortic plaque
- Nephropathy - high glucose levels lead to AGE mediate podocyte loss
- Neuropathy - accumulation of AGE prevents them to bind to their receptors
- Retinpathy - excess blood glucose inhibits PKC actvation
9
Identify the most correct sentence in relation to AGEs.
- Affect cellular structure and function by directly cross linking collagen
- Derive from glycation of proteins
- Induce endoplasmic reticulum stress directly or indirectly
- Inhibit cellular processes because they cannot bind and activate RAGE
- Reduce oxidative stress and inflammatory pathways
10
Which of the following correctly describes mechanisms by which hyperglycaemia can cause cellular damage. Select all that appy.
- Inhibits Protein kinase C activation leading to ROS accumulation
- Hyperactivates the polyol pathway leading to ROS accumulation
- Prevents non enzymatic reaction between sugars and proteins
- Promotes enzymatic glycoslylation of proteins and lipids
- Increases glycolysis that leads to ROS accumuation
11
Which of the following are likely pathophysiological contributors to the high plasma glucose level?
Select all that apply.
Select all that apply.
- Glucotoxicty is damaging the pancreatic beta cell
- Increased insulin demand has caused beta cell metabolic stress
- Pancreatic beta cell compensation is failing, in part due to genetic predisposition
- There is no insulin secretion due to pancreatic beta cell damage
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