Diabetes

Question 1

Result of complete or near-total insulin deficiency

Answer 1

T1 DM

Question 2

Pregnant woman who meets the criteria for diagnosis of DM

Answer 2

Overt DM

Question 3

Diagnosed in a woman even before pregnancy

Answer 3

Pre-GDM

Question 4

Diagnosed in the 2nd or 3rd trimester of pregnancy not clearly overt DM

Answer 4

GDM

Question 5

Useful marker of insulin secretion and allows discrimination of endogenous and exogenous sources of insulin in hypoglycemia

Answer 5

C peptide

Question 6

Key regulator of insulin secretion by the pancreatic beta cell

Answer 6

Glucose

Question 7

Rate-limiting step that controls glucose-related insulin secretion

Answer 7

Glucose phosphorylation by glucokinase

Question 8

Most potent incretin

Answer 8

Glucagon-like peptide 1 (GLP1)

Question 9

Most important regulator of glucose homeostasis

Answer 9

Insulin

Question 10

Preferred insulin over regular insulin for prandial coverage

Answer 10

Insulin lispro, aspart, glulisine

short-acting thus LAGging

Question 11

Level of plasma glucose which symptoms of diabetes usually resolve

Answer 11

<11.1 mmol/L (200 mg/dL)

Question 12

Treatment goals for adults with DM

Answer 12

HbA1c: <7%
Preprandial CPG: 80-130 mg/dL
Peak postprandial CPG: <180 mg/dL

BP <140/90

LDL: <100 mg/dL
HDL men: >40 mg/dL
HDL women: >50 mg/dL
TGL: <150 mg/dL

Question 13

Major site for metabolic fuel consumption in the resting state

Answer 13

Skeletal muscle

Question 14

T1DM to avoid exercise-related hyper/hypoglycemia

Answer 14

Monitor blood glucose before, during and after meals

Delay exercise if glucose >250 mg/dL + ketones

Ingest carbs before exercise if glucose is <100 mg/dL

Decrease insulin doses before exercise

Increase food intake up to 24h after exercise

Question 15

Standard of care in diabetes management

Answer 15

Self-monitoring of blood glucose (SMBG)

Question 16

Standard method for assessing long-term glycemic control

Answer 16

HbA1c

Question 17

Lower incidence of hypoglycemia esp at night is noted when compared to NPH insulin

Answer 17

Insulin glargine

Question 18

Insulin not mixed with other insulin

Answer 18

Glargine

Detemir

Question 19

Supplied by Long-acting insulin

Answer 19

Basal insulin

NPH, Detemir, Glargine

Question 20

Supplied by short-acting insulin

Answer 20

Prandial insulin

Lispro, Aspart, Glulisine, Regular

Question 21

T1 DM insulin requirements

Answer 21

0.5-1 U/kg/day (50% given as basal)

Question 22

MOA of biguanides

Answer 22

Reduces hepatic glucose production

Improves peripheral glucose utilization slightly

Question 23

Major toxicity of Metformin

Answer 23

Lactic Acidosis

Question 24

MOA of oral insulin secretagogues (sulfonylureas)

Answer 24

Stimulate insulin secretion by interacting with the ATP-sensitive potassium channel on the beta cell

Reduce both fasting and postprandial glucose

Question 25

Sulfonylureas preferrably given to elderly

Answer 25

Glimepiride | Glipizide

Question 26

MC side effect of sulfonylureas

Answer 26

Weight gain

Question 27

MOA of parenteral insulin secretagogues (incretins)

Answer 27

Act ad GLP1 receptor agonist or enhance endogenous GLP1 activity (Exenatide, Liraglutide, Dulaglutide)

Question 28

MOA of a-Gluucosidase inhibitors

Answer 28

Reduce postprandial hyperglycemia by delaying glucose absorption (Acarbose, Voglibose)

Question 29

AE of a-Glucosidase inhibitors

Answer 29

Diarrhea, flatulence, abdominal distention related to increased delivery of oligosaccharides

Question 30

MOA of thiazolidinediones

Answer 30

Reduce insulin resistance by binding to the PPAR-y nuclear receptor Promote redistribution of fat from central to peripheral locations (Piolglitazone, Rosiglitazone)

Question 31

AE of thiazolidinediones

Answer 31

Weight gain, small reduction in HCT, mild increase in plasma volume Avoided in liver disease and CHF III and IV

Question 32

MOA of Sodium-Glucose Co-transporter 2 inhibitors (SLGT2)

Answer 32

*prox convoluted tubule Inhibits glucose reabsorption, lowers renal threshold for glucose, increased urinary glucose exretion (thus inc incidence of urinary or vaginal infections)

Question 33

Initial dose of insulin in inpatients

Answer 33

0.3-0.4 U/kg/day

Question 34

Prominent features of T2DM

Answer 34

Fasting hyperglycemia | Increased hepatic glucose production

Question 35

Level of plasma glucose which symptoms of diabetes usually resolve

Answer 35

<11.1 mmol/L (200 mg/dL)

Question 36

Treatment goals for adults with DM

Answer 36

HbA1c: <7% Preprandial CPG: 80-130 mg/dL Peak postprandial CPG: <180 mg/dL BP <140/90 LDL: <100 mg/dL HDL men: >40 mg/dL HDL women: >50 mg/dL TGL: <150 mg/dL

Question 37

Major site for metabolic fuel consumption in the resting state

Answer 37

Skeletal muscle

Question 38

T1DM to avoid exercise-related hyper/hypoglycemia

Answer 38

Monitor blood glucose before, during and after meals Delay exercise if glucose >250 mg/dL + ketones Ingest carbs before exercise if glucose is <100 mg/dL Decrease insulin doses before exercise Increase food intake up to 24h after exercise

Question 39

Standard of care in diabetes management

Answer 39

Self-monitoring of blood glucose (SMBG)

Question 40

Standard method for assessing long-term glycemic control

Answer 40

HbA1c

Question 41

Lower incidence of hypoglycemia esp at night is noted when compared to NPH insulin

Answer 41

Insulin glargine

Question 42

Insulin not mixed with other insulin

Answer 42

Glargine | Detemir

Question 43

Supplied by Long-acting insulin

Answer 43

Basal insulin | NPH, Detemir, Glargine

Question 44

Supplied by short-acting insulin

Answer 44

Prandial insulin | Lispro, Aspart, Glulisine, Regular

Question 45

T1 DM insulin requirements

Answer 45

0.5-1 U/kg/day (50% given as basal)

Question 46

MOA of biguanides

Answer 46

Reduces hepatic glucose production | Improves peripheral glucose utilization slightly

Question 47

Major toxicity of Metformin

Answer 47

Lactic Acidosis

Question 48

MOA of oral insulin secretagogues (sulfonylureas)

Answer 48

Stimulate insulin secretion by interacting with the ATP-sensitive potassium channel on the beta cell Reduce both fasting and postprandial glucose

Question 49

Sulfonylureas preferrably given to elderly

Answer 49

Glimepiride | Glipizide

Question 50

MC side effect of sulfonylureas

Answer 50

Weight gain

Question 51

MOA of parenteral insulin secretagogues (incretins)

Answer 51

Act ad GLP1 receptor agonist or enhance endogenous GLP1 activity (Exenatide, Liraglutide, Dulaglutide)

Question 52

MOA of a-Gluucosidase inhibitors

Answer 52

Reduce postprandial hyperglycemia by delaying glucose absorption (Acarbose, Voglibose)

Question 53

AE of a-Glucosidase inhibitors

Answer 53

Diarrhea, flatulence, abdominal distention related to increased delivery of oligosaccharides

Question 54

MOA of thiazolidinediones

Answer 54

Reduce insulin resistance by binding to the PPAR-y nuclear receptor Promote redistribution of fat from central to peripheral locations (Piolglitazone, Rosiglitazone)

Question 55

AE of thiazolidinediones

Answer 55

Weight gain, small reduction in HCT, mild increase in plasma volume Avoided in liver disease and CHF III and IV

Question 56

MOA of Sodium-Glucose Co-transporter 2 inhibitors (SLGT2)

Answer 56

*prox convoluted tubule Inhibits glucose reabsorption, lowers renal threshold for glucose, increased urinary glucose exretion (thus inc incidence of urinary or vaginal infections)

Question 57

Initial dose of insulin in inpatients

Answer 57

0.3-0.4 U/kg/day

Question 58

Prominent features of T2DM

Answer 58

Fasting hyperglycemia | Increased hepatic glucose production

Question 59

Subtype of DM characterized by early onset hyperglycemia, AD inheritance, impairment of insulin secretion and presence of GLUT2 glucose transporter

Answer 59

Maturity Onset Diabetes of the Young (MODY)

Question 60

Most convenient and reliable test for identifying DM in asymptomatic individuals

Answer 60

FBS and HbA1C

Question 61

In target tissue sites, binding on Insulin to its receptors stimulates activity of which enzyme

Answer 61

Tyrosine kinase

Question 62

Serves as an immunologic marker for the autoimmune process of T1DM

Answer 62

Islet cell autoantibodies

Question 63

Usual fluid deficit in DKA as contrasted to HHS

Answer 63

3-5L

Question 64

MC form of DMN

Answer 64

Distal symmetric polyneuropathy

Question 65

DM with hyperhidrosis of UE, anhidrosis of LE, urinary retention, erectile dysfunction and orthostatic hypotension

Answer 65

Autonomic neuropathy

Question 66

Recommended for a patient with severe hypoglycemia who is unable to take oral glucose or IV therapy no practical

Answer 66

SC or IM glucagon