Diabetes

Question 1

4 ways T2 DM is diagnosed?

Answer 1

1. 2 FBS levels > 125 mg/dL
2. Single FBS level > 200 mg/dL + p/w Polyuria, Polyphagia, & Polydipsia
3. Glucose tolerance testing with blood glucose > 200mg/dL
   (Blood glucose 140-199 mg/dL indicates insulin resistance)
4. HbA1C > 6.5%

Question 2

~ what % of T2 DM cases are controlled by weight loss alone?

Answer 2

~ 25%

Question 3

Why are Sulfonylureas not used as 1st line Tx?

Answer 3

B/c they cause insulin release, driving glucose intracellularly & causing obesity.
Metformin used as 1st line instead.

Question 4

Contraindications of Metformin? MOA?

Answer 4

c/i = Renal dysfunction (b/c it can accumulate & cause metabolic acidosis)

MOA = blocks gluconeogenesis

Question 5

Contraindications of Thiazoladinediones (glitazones)?

Answer 5

CHF

because they increase fluid overload

Question 6

Nateglinide MOA?

Answer 6

Stimulates insulin release in a manner similar to sulfonylureas (but does not contain sulfa)

Question 7

Repaglinide MOA?

Answer 7

Stimulates insulin release in a manner similar to sulfonylureas (but does not contain sulfa)

Question 8

Drug(s) w/ same MOA as sulfonylureas to use in a patient allergic to sulfa?

Answer 8

• Nateglinide

- Repaglinide

Question 9

Acarbose MOA?

Answer 9

alpha-glucosidase inhibitor — blocks glucose absorption in the bowel
(same as miglitol)
- can be used in renal insufficiency

Question 10

Miglitol MOA?

Answer 10

alpha-glucosidase inhibitor — blocks glucose absorption in the bowel
(same as acarbose)
- can be used in renal insufficiency

Question 11

Alpha glucosidase inhibitors (acarbose/miglitol):

- effect on HbA1C?

Answer 11

• reduce by ~0.5

Question 12

T2 DM drugs that can be used in renal insufficiency?

Answer 12

Alpha glucosidase inhibitors

acarbose/miglitol

Question 13

Exenatide MOA?

Answer 13

GLP-1 agonist (incretin)

• inc’s insulin secretion
• dec’s glucagon secretion
• dec’s gastric motility & aids in weight loss

Question 14

Sitagliptin MOA?

Answer 14

DPP-4 inhibitor (incretin — which normally breaks down GLP-1)

• inc’s insulin secretion
• dec’s glucagon secretion
• dec’s gastric motility & aids in weight loss

Question 15

Saxagliptin MOA?

Answer 15

DPP-4 inhibitor (incretin — which normally breaks down GLP-1)

• inc’s insulin secretion
• dec’s glucagon secretion
• dec’s gastric motility & aids in weight loss

Question 16

Linagliptin MOA?

Answer 16

DPP-4 inhibitor (incretin — which normally breaks down GLP-1)

• inc’s insulin secretion
• dec’s glucagon secretion
• dec’s gastric motility & aids in weight loss

Question 17

Exenatide side effects?

Answer 17

Pancreatitis

Question 18

Pramlinitide MOA?

Answer 18

Amylin analog (protein that is secreted normally w/ insulin)

• Dec’s gastric emptying
• Dec’s glucagon levels
• Dec’s appetite

Question 19

Glargine - what is it?

Answer 19

Long-acting insulin given 1x/day 
(usually in combo w/ a short-acting insulin)
Onset = 1-2 hrs
Peak = 1-2 hours
Duration = 24 hours

Question 20

Lispro - what is it?

Answer 20

Short acting insulin
Onset = 5-15 min
Peak = 1hr
Duration = 3-4hrs

Question 21

Aspart - what is it?

Answer 21

Short acting insulin
Onset = 5-15 min
Peak = 1hr
Duration = 3-4hrs

Question 22

Glulisine - what is it?

Answer 22

Short acting insulin
Onset = 5-15 min
Peak = 1hr
Duration = 3-4hrs

Question 23

Regular insulin onset, peak, & duration?

Answer 23

Onset = 30-60 min
Peak = 2 hours
Duration = 6-8 hours

Question 24

NPH onset, peak, & duration?

Answer 24

Onset = 2-4 hours
Peak = 6-7 hours
Duration = 10-20 hours

Question 25

Describe a person’s potassium levels in diabetic ketoacidosis

Answer 25

Hyperkalemia in blood but decreased total body potassium b/c of urinary spillage

(In Tx: Replace K+ when the K+ level comes down to a level approaching normal)

Question 26

Tx for Diabetic Ketoacidosis

which CAN but doesn’t usually p/w T2 DM

Answer 26

1. Large volume saline & Insulin replacement
2. Replace K+ once it comes down to a level approaching normal
3. Correct underlying cause: Noncompliance w/ meds, infection, pregnancy, or any serious illness

Question 27

Best way to measure severity of DKA?

Answer 27

Serum Bicarbonate levels

• if very low, there’s a risk of death (high anion gap)
• if high, then doesn’t matter how high glucose is (lower anion gap)

Question 28

Diabetic tests + for microalbuminuria — how should you treat this?

Answer 28

Start them on an ACE-inhibitor or ARB.

These decrease the rate of nephropathy by decreasing intraglomerular hypertension & decreasing damage to the kidney.

Question 29

How does Gastroparesis occur in diabetics & what is it?

Answer 29

After several years, DM decreases the ability of the gut to sense the stretch of the walls of the bowel. Stretch is the main stimulant to gastric motility.

Gastroparesis = immobility of the bowels that leads to bloating, constipation, early satiety, vomiting, & abdominal discomfort

Question 30

Gastroparesis Tx in DM?

Answer 30

Metoclopramide & Erythromycin

which increase gastric motility

Question 31

What is proliferative retinopathy? Tx?

Answer 31

It is when neovascularization & vitreous hemorrhages are present.

Tx = Laser photocoagulation, which markedly retards progression of blindness

Question 32

How do you treat the pain in Diabetic Neuropathy?

Answer 32

Pregabalin, Gabapentin, or Tricyclic Antidepressants