Adult - DM

Question 1

Of BUN and serum creatinine, which is more likely to be linked to hydration status?

Answer 1

BUN

Question 2

What is the most sensitive measure of renal function?

Answer 2

serum creatinine

Question 3

What are the normal levels for BUN and serum creatinine?

Answer 3

BUN ** 10 - 20 **

Creatinine **0.5 - 1.5 **

Question 4

What time frame does the A1c cover?

Answer 4

2 - 3 months

aka

8 - 12 weeks

Question 5

What is the normal range for A1c?

Answer 5

5.5 - 7 %

Question 6

What are important baseline studies to assess in a newly diagnosed diabetic?

Answer 6

• triglycerides
• cholesterol
• ECG
• renal studies
• baseline physical exam - neuro, peripheral pulses, eyes, feet

Question 7

What % of total calories should carbohydrates be (for diabetics and gen pop)?

Answer 7

55-60%

Question 8

What is the general rule of thumb for initiating insulin?

Answer 8

0.5 units / kg / day

split 2/3 in AM, 1/3 at HS

Question 9

What is the convential split for insulin mixtures?

Answer 9

in AM - 2/3 NPH, 1/3 regular

at HS - 1/2 NPH, 1/2 regular

Question 10

NPH insulin is _____ acting

Answer 10

short

Question 11

What are insulin analogs and what are two examples?

Answer 11

**genetically engineered **forms of insulin

not found in nature

glargine (Lantus) → prolonged duration

lispro (Humalog) → rapid onset

Question 12

Are insulin analogs suitable for new diabetics?

Answer 12

No, they have less room for error

(prolonged duration and rapid onset)

Question 13

What are the five components of metabolic syndrome?

How many involved for the diagnosis?

What is the significance?

Answer 13

• waist circumference
• BP
• Triglycerides
• Fasting blood glucose
• HDL

If 3 or more of the above are involved, the criteria is met.

Risk of diabetes and sudden cardio-embolic death are significantly increased in metabolic syndrome.

Question 14

Metabolic syndrome -

waist circumference

Answer 14

men - >/= 40 inches or 102 cm

women - >/= 35 inches or 89 cm

Question 15

Metabolic syndrome -

blood pressure

Answer 15

>/= 130/85

Question 16

Metabolic syndrome -

triglycerides

Answer 16

>/= 150

Question 17

Metabolic syndrome -

fasting blood glucose

Answer 17

>/= 100

Question 18

Metabolic syndrome -

HDL

Answer 18

men - < 40

women - **< 50 **

Question 19

What three lifestyle changes should be mentioned

to type II diabetics?

Answer 19

diet

exercise

weight control

Question 20

What is a benefit of starting early on metformin (Glucophage) in those with Impaired Glucose Tolerance?

Answer 20

delay of progression to type II diabetes

Question 21

Sulfonylureas -

examples (3)

mechanism of action

Answer 21

“the G group”

• glipizide (Glucotrol)
• gliburide (DiaBeta, Micronase)
• glimepiride (Amaryl)

stimulate insulin production

Question 22

**Biguanides - **

example (1)

mechanism of action

Answer 22

metformin (Glucophage)

decrease hepatic glucose output

increase** glucose utilization** in peripheral tissues

Question 23

**Alpha-glucosidase inhibitors - **

examples (2)

mechanism of action

Answer 23

acarbose (Precose)

miglitol (Glyset)

reduce glucose absorption

Question 24

Thiazolidinediones

“Glitazones”

examples

mechanism of action

Answer 24

rosiglitazone (Avandia)

pioglitazone (Actos)

decrease gluconeogenesis

Question 25

**Non-sulfonylurea insulin release stimulators** examples (2) mechanism of action

Answer 25

**repaglinide (Prandin)** **nateglinide (Starlix)** **mimics the effect** of rapid acting insulin {which insulin is rapid acting? lispro (Humalog)}

Question 26

Other anti-diabetics **exenatide (Byetta)** mechanism of action

Answer 26

injectable mimics the effects of **incretins** **increase insulin** secretion (pancreas) **decrease glucagon production** (liver)

Question 27

What are **incretins** and what do they do?

Answer 27

Naturally occurring GI hormone; decrease blood sugar by: * **increasing insulin secretion** * **decreasing glucagon production **

Question 28

What is the function of **glucagon?**

Answer 28

**glucagon → stored glycogen → glucose** signals the liver to convert glycogen to glucose which is released into the bloodstream

Question 29

What is the **major side effect of exenatide (Byetta)**?

Answer 29

**nausea**

Question 30

Other diabetic agents **pramlintide (Symlin)** mechanism of action? significan benefit?

Answer 30

_injectable_ slows **absorption of glucose** **inhibits glucagon** **significant benefit?** promotes weight loss "pram" the weight away / "Slimmin"

Question 31

Other antidiabetic agents **sitagliptin (Januvia)** mechanism of action?

Answer 31

**DD-4 inhibitor ** DD-4 breaks down incretins

Question 32

What is a **significant side effect** of **metformin** (Glucophage)? how is it manifested?

Answer 32

**lactic acidosis** manifested by **muscle pain**

Question 33

State of **intracellular dehydration** as a result of **significantly elevated blood glucose levels**.

Answer 33

Diabetic ketoacidosis (DKA)

Question 34

What are some hallmark signs and symptoms of DKA?

Answer 34

Kussmaul's breathing (deep, rapid) fruity breath

Question 35

What signs and symptoms do **DKA and HHNK** both feature?

Answer 35

tachycardia hypotension poor skin turgor altered LOC polyuria weakness

Question 36

DKA vs HHNK - which is **acidotic**?

Answer 36

**DKA** pH \< 7.3

Question 37

DKA vs HHNK - which is characterized by **extremely high blood glucose**?

Answer 37

**HHNK** commonly \>1000

Question 38

Four components of **treatment for DKA and HHNK**?

Answer 38

protect **airway** **O2** **fluid** resuscitation **insulin**

Question 39

State of greatly **elevated serum glucose**, **hyperosmolality**, and **severe dehydration** without **ketone production**.

Answer 39

**Hyperosmolar Hyperglycemic Non-Ketosis (HHNK)**