Q5 DM

Question 1

Alpha cells secrete ____
Beta cells ____
Delta cells _____
PP cells _____

Answer 1

Glucagon
Insulin
Somatostatin
Pancreatic polypeptide (PP)

Question 2

In an insulin resistant person, a ____ amount of insulin is needed to push glucose into cells.

Answer 2

Larger than usual

Question 3

C-peptide in type I DM?
C-Peptide in type II DM?

Answer 3

Not present in T1
Present in normal or high amounts in T2

Question 4

Secreted by delta cells, inhibits release of insulin and glucagon?

Stored and secreted with insulin, delays gastric emptying, regulates food intake?

Answer 4

Somatostatin

Amylin

Question 5

T/F: Incretins are released from cells in the pancreas
Degraded by?

Answer 5

False. They are released in the GUT. Examples:
GIP, GLP1.
DPP-4

Question 6

Normal A1C =
Prediabetic A1C
DM A1C

Answer 6

<5.7
5.7-6.4
>=6.5

Question 7

goals for diabetics:

A1C, FBG, and 2h PPBG?

Answer 7

A1C <7
FBG 80-130
2h PPBG <180

Question 8

Why do diabetics with high blood sugar get DKA?

Answer 8

without enough insulin to get glucose into the cells, the cells think they are starving so the body starts to break down fats for energy, but the ketones overwhelm.

Question 9

All DM patients should lose _____

Answer 9

5% of body weight

Question 10

T1DM basal and bolus dosing: calculate?

Answer 10

Calculate the total daily dose (TDD) = 0.4-0.5u/kg/day.
Usual TDD = 0.4-1u/kg/day.
Give 40-50% of TDD as basal insulin and the remaining 50-60% as bolus insulin.

Question 11

Which insulins have no peak?

Answer 11

Long acting glargine, and degludec.

Question 12

Most common SEs of insulin:
CI?

Answer 12

Weight gain, peripheral edema, hypoglycemia, hypoK, local injection site reactions.
Monitor for HypoK with concomitant loop diuretic use.

Question 13

Metformin is a Biguanide. 1st line in DM. MOA? SE? CI? BBW?

Answer 13

Decrease hepatic glucose production, decrease intestinal absorption of glucose and increase sensitivity to insulin.
SE: d/n, upset stomach, vit b12 deficiency.
CI - eGFR <30, DKA, chronic metabolic acidosis.
BBW: Lactic acidosis.

Question 14

Contrast procedures, HF, impaired kidney fxn can increase risk for ________ when taking metformin.

Answer 14

Lactic acidosis

Question 15

Sulfonylureas - Glipizide, Glimepiride, Glyburide.
MOA, SE, CI

Answer 15

Used to be 2nd line but not anymore (does not preserve Bcell fxn)
Stimulate insulin release from pancreas
SE: Hypoglycemia, weight gain
CI: T1DM, DKA, sulfa allergies.

Question 16

GLP1 Agonists:
Dulaglutid (Trulicity)
Exenatide (Byetta, Bydureon)
Liraglutide
Semaglutide
Lixisenatide

Question 17

DPP4 Inhibitors:
Sitagliptin (Januvia)
Linagliptin (Tradjenta)
Saxagliptin (onglyza)
Alogliptin (Nesina)

Question 18

SGLT2 Inhibitors:
Empagliflozin(Jardiance)
Dapagliflozin
Ganagliflozin
Ertugliflozin

Question 19

SGLT2 Inhibitor MOA, SE, CI

Answer 19

Inhibit sodium-glucose cotransporter protein 2.
Decrease reabsorption of glucose in the kidneys
SE: Hypotention, TUI, genital mycotic infection (nec fasciitis), increased urination, dehydration
CI: severe renal impairment, ESKD or dialysis.

STAY HYDRATED. Cardiovascular and renal protection

Question 20

Meglitinide: MOA, SE, CI

Answer 20

MOA: Stimulate insulin release from the pancreas (T2 DM not T1)
SE: Hypoglycemia, weight gain
CI DKA, T1DM, not in combo with NPH insulin.
Repalinide, Nateglinide.

Question 21

Which DM drugs have the most A1C lowering effects?

Answer 21

Metformin>sulfonylurea>TZD>GLP1agonists.

Question 22

New DM med that has cardiac and renal benefits?

Answer 22

Finerenone

Question 23

_____ can be added to insulin regimen to T1DM patients to decrease fluctuations in BG levels.

Answer 23

Injected amylin