Diabetes

Question 1

What are the diagnosing criteria for diabetes?

Answer 1

FBG > 100
GTT > 200
Random glucose: > 200
Hemoglobin A1C > 7.5%

Question 2

Why do we use hemoglobin A1C in monitoring for diabetic patients?

Answer 2

It gives a reading of the blood sugar averages over the past 3 months

Question 3

How do we treat T1DM?

Answer 3

Insulin therapy
Diet
Exercise

Question 4

How do we treat T2DM?

Answer 4

Diet
Exercise
Drug therapy (PO or insulin therapy)

Question 5

Rapid Acting Insulin

Answer 5

Used before meals
Onset: 5-15 minutes
Peak: 30-90 minutes
Duration: up to 5 hours

Question 6

Short Acting Insulin

Answer 6

Can also be used before meals
Onset: 30-60 minutes
Peak: 2-3 hours
Duration: 5-8 hours

Question 7

Intermediate Acting Insulin

Answer 7

Used between meals to help maintain blood sugar
Onset: 2-4 hours
Peak: 4-10 hours
Duration: 10-14 hours

Question 8

Long Acting Insulin

Answer 8

Used to maintain blood sugar over a 24 hours period
Onset: 2-8 hours
No peak
Duration: up to 24 hours

Question 9

What is the first line drug choice to T2DM?

Answer 9

Biguinides (metformin)

Question 10

What is the mechanism of action of biguinides?

Answer 10

Inhibits glucose production and output from the liver

Can also sensitize insulin receptors and reduce glucose absorption in the gut

Question 11

What are common side effects of biguinides?

Answer 11

GI symptoms (N/V/D, loss of appetite), Vitamin B12 deficiency

Question 12

What is a severe adverse effect of biguinides?

Answer 12

lactic acidosis (most common with AKI/CKD)

Question 13

When are biguinides contraindicated?

Answer 13

Renal impairment and heart failure due to the increased risk for lactic acidosis

Question 14

How much do biguinides lower A1C?

Answer 14

1-2%

Question 15

What is the mechanism of action of sulfonylureas?

Answer 15

Promote insulin release by stimulating the pancreatic beta cells

Question 16

What are common side effects of sulfonylureas?

Answer 16

hypoglycemia and weight gain

Question 17

What medication class should be avoided with sulfonylureas and why?

Answer 17

Beta blockers due to the fact that they can reduce the effectiveness by decreasing insulin release

Question 18

What at the sulfonylurea drug names?

Answer 18

Glipizide, Glimepiride, and Glyburide

Question 19

How much do sulfonylureas lower A1C?

Answer 19

1-2%

Question 20

What is the mechanism of action of the glinides?

Answer 20

Stimulate the pancreas to release insulin, primarily used prior to meals

Question 21

What is the mechanism of action of the SGLT-2 inhibitors?

Answer 21

They block the reabsorption of glucose in the kidneys (promote increased glucose excretion)

Question 22

What is a common side effect from SGLT-2 inhibitors

Answer 22

Elevated glucose levels in the urine which can cause UTI’s, yeast infections, and dehydration
hypotension is also a common side effect

Question 23

Should SGLT-2 inhibitors be given to a patient with renal impairment?

Answer 23

No as glucose can further damage the kidneys

Question 24

How much do SGLT-2 inhibitors lower A1C?

Answer 24

0.7-1.2%

Question 25

What are things to monitor for patients on SGLT-2's?

Answer 25

Kidney functions, BP, urine glucose levels

Question 26

What is a piece of education for patients on SGLT-2's?

Answer 26

Promote hydration as the increase in glucose excretion can increase dehydration levels

Question 27

What is a benefit to the SGLT-2's?

Answer 27

cardiovascular protection, possible weight loss, no hypoglycemia

Question 28

What is the SGLT-2 inhibitor endings?

Answer 28

-gliflozin

Question 29

What is the mechanism of action of the TZDs?

Answer 29

decrease blood glucose by decreasing insulin resistance, increases insulin sensitivity

Question 30

What are common side effects of TZDs?

Answer 30

Weight gain, URI, headaches, sinusitis, myalgia, hyperlipidemia

Question 31

What is a strong adverse effect of TZDs?

Answer 31

fluid retention

Question 32

What a contraindication for TZD use?

Answer 32

CHF as it can increase fluid volume and promote fluid retention and edema, thus worsening heart failure

Question 33

How much to TZDs lower A1C?

Answer 33

0.5-1%

Question 34

What is the only TZD on the market at present time?

Answer 34

Pioglitazone

Question 35

What is the mechanism of action of the DPP-4 inhibitors?

Answer 35

Enhance incretin hormones that stimulate glucose-dependent release of insulin and suppress post-prandial release of glucagon by inhibiting the DPP-4 enzyme

Question 36

What are common side effects of DPP-4's?

Answer 36

URI, headache, inflammation of nasal passage

Question 37

What is a severe adverse effect of the DPP-4's?

Answer 37

pancreatitis

Question 38

What is the ending of the DPP-4 inhibitors?

Answer 38

-gliptins

Question 39

What is the advantage of DPP-4 inhibitors over GLP-1 receptor agonists?

Answer 39

DPP-4's are an oral formulation whereas GLP-1's are an injection

Question 40

What is the mechanism of action of the GLP-1 receptor agonists?

Answer 40

Activate the GLP-1 receptors which slow gastric emptying, stimulate glucose-dependent release of insulin, inhibit postprandial release of glucagon, and suppresses appetite

Question 41

What is a benefit of the GLP-1's?

Answer 41

Weight loss

Question 42

What are some adverse effects of GLP-1's?

Answer 42

N/V/D, injection site soreness, puritis pancreatitis, renal impairment, tertatogenic effects, hypoglycemia when combined with sulfonylureas

Question 43

When are GLP-1's contrainidacted?

Answer 43

Patients with ESRD as they are excreted in the urine, unchanged

Question 44

What is the black box warning for the GLP-1's?

Answer 44

Thyroid cancer, history of thyroid cancer, or family history of medullary thyroid cancer

Question 45

What do the GLP-1 receptor agonists end in?

Answer 45

-glutide (except exantide)