Diabetes and Hyperlipidemia

Question 1

Anion Gap

Answer 1

Measured cations minus measured anions

Question 2

Total Daily Insulin Dose =

Answer 2

1/2 Basal insulin dose +

1/2 Meal insulin dose

Question 3

Causes of relative Insulin deficiency (DKA)

Answer 3

Acute Stress:
Infection
Inflammation
Infarction

(4-I’s)

Question 4

Metformin mechanism

Answer 4

decreases gluconeogenesis in liver, raises blood levels of lactate

Question 5

Lab Findings in T1DM

Answer 5

High glucose
Ketones present
Low bicarbonate
High Anion Gap
Electrolyte (K) loss
Increased BUN, creatinine --> fluid depletion

Question 6

12 hour half life insulin

Answer 6

Detamir, NPH

Question 7

Regions most at risk for mircovascular injury

Answer 7

eyes, kidneys, small nerves

Question 8

Metformin side effects

Answer 8

Nausea, abd pain, bloat, diarrhea

lactic acidosis (?)

Question 9

24 hour half life insulin

Answer 9

Glargine

Question 10

What drug should every Type 2 diabetic patient receive?

Answer 10

metformin

Question 11

Untreated T2DM can result in

Answer 11

HHS - hyperosmolar hyperglycemic states

Question 12

Symptoms of HHS

Answer 12

• Thirst/polyuria: glycosyria/dehydration
• Fatigue: hyperglycemia/dehydration/electrolyte disturbance
• Muscle cramps: electrolyte disturbance, dehydration
• Neurologic symtoms: dehydration

Question 13

Short acting Insulins

Answer 13

Aspart, Lispro, Glulisine, Regular

Question 14

Acarbose (Alpha glucosidase inhibitor)

Answer 14

–> inhibits upper GI enzymes that convert complete polysaccharide carbs into mono –> slow absorption of glucose

Question 15

Every non-insulin agent drops HbA1c by approximately

Answer 15

1%

Question 16

Pioglitazone (Thiazolidinediones) mechanism

Answer 16

lower blood glucose by enhancing glucose effects, enhance fat storage

Question 17

Signs of HHS

Answer 17

• Dehydration
• Tachycardia
• Hypotension
• Impaired consciousness/coma

Question 18

If HbA1c is greater than _____% then begin insulin

Answer 18

10%

Question 19

Only drugs with proven CHD morbidity/mortality benefits

Answer 19

Statins

Question 20

Causes of HHS

Answer 20

New diagnosis
Therapy Stopped
Acute stress (4-I’s)

Question 21

Sulfonylureas (Glipizide, glimmepiride, glyburide) mechanism

Answer 21

depolarlize the cell –> calcium influx –> insulin release (irrespective of glucose presence)

Question 22

GLP-1 agonists (exenatide, liraglutide, -tide) mechanism

Answer 22

enhance insulin secretion but reliant on glucose to initiate insulin secretion

Question 23

Type 1 diabetes can be treated with oral drugs or insulin therapy.

Answer 23

False - T1DM is only treated with insulin.

Question 24

Classes of drugs to treat peripheral neuropathy

Answer 24

Anticonvulsants (gabapentin, pregabalin)

Antidepressants (TCA, duloxetine)

Question 25

Statin Benefit Group

Answer 25

``` ALL diabetics (40-75, LDL >70) atherosclerotic CVD LDL >190 age 40-75 w LDL >70 + DM age 40-65 w LDL >70 - DM - CVD + 10yatheroCVD>7.5% ```

Question 26

DPP-IV inhibitors (-liptin) mechanism

Answer 26

make endogenous GLP-1 last longer

Question 27

At what levels should triglycerides be lowered and why?

Answer 27

over 500-1000, in order to prevent pancreatitis Therapy: fibrates, niacin, fish oil

Question 28

most common form of primary hypercholesterolemia

Answer 28

polygenic hypercholestorolemia

Question 29

moderate intensity statins

Answer 29

decrease LDL by 30-50%

Question 30

Acarbose (Alpha glucosidase inhibitor) side effects

Answer 30

flatulence, diarrhea

Question 31

Mechanism of the PCSK9

Answer 31

LDL receptors with PCSK9 attached get broken down, cannot take in and clear LDL --> high LDLemia

Question 32

Sulfonylureas/meglitinizes mechanism

Answer 32

depolarlize the cell --> calcium influx --> insulin release (irrespective of glucose presence)

Question 33

Causes of monogenic hypercholesterolemia

Answer 33

LDL receptor mutation affecting LDL clearance Familial defective apolipoprotein PCSK9 or apoB100 mutation

Question 34

high intensity statins

Answer 34

Decrease LDL by >50%

Question 35

Types of secondary hypercholesterolemia

Answer 35

Hypothyroidism | Aromatase inhibitor therapy

Question 36

SE of statins

Answer 36

myopathy, rarely rhabdomyolysis

Question 37

Biguanide (metformin) action

Answer 37

insulin sensitizer | acts on liver to decrease gluconeogenesis

Question 38

GLP-1 agonists (exenatide, liraglutide)

Answer 38

insulin secretagogues | --> glucose dependent

Question 39

thiazolidinediones

Answer 39

insulin sensitizer | PPAR Y agonist in muscle and adipose tissue

Question 40

Sulfonylureas (glipizide, glyburide, glimerpiride)

Answer 40

insulin secretagogues (acts on SUR on beta cell membrane) --> glucose independent

Question 41

DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin)

Answer 41

Insulin secretagogues (inhibit DPP-IV, make endogenous GLP-1 last) --> glucose dependent

Question 42

Which drug has concerns for coronary artery disease?

Answer 42

Pioglitazone (thiazolidinediones) --> not used much anymore

Question 43

Meglitinides (repaglinide, nateglinide) mechanism

Answer 43

insulin secretagogues

Question 44

This drug has side effects including flatulence and diarrhea

Answer 44

Acarbose (Alpha glucosidase inhibitor)

Question 45

SGLT2 inhibitor (canagliflozin)

Answer 45

increase urinary glucose excretion

Question 46

These drugs help with weight loss

Answer 46

``` GLP-1 agonists (exenatide, liraglutide) SGLT2 inhibitors (canagliflozin) ```

Question 47

Which drugs can cause hypoglycemia?

Answer 47

sulfonylureas (glipizide, glyburide, glimerpiride) | meglitinides (repaglinide, nateglinide)

Question 48

How do you treat both DKA and HHS?

Answer 48

fluids insulin electrolyte (potassium) replacement

Question 49

Do not use these drugs in patients with a history of pancreatitis

Answer 49

GLP-1 agonists (exenatide, liraglutide) | DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin)