Diabetes Management

Question 1

pre-diabetes ogtt

Answer 1

7.8-11.0 mmol/L

Question 2

pre-diabetes fpg

Answer 2

6.1-6.9 mmol/L

Question 3

target HbA1c

Answer 3

<7%
7-8.5 if vulnerable

Question 4

target FBG

Answer 4

4 to 7

Question 5

target PPG

Answer 5

<10

Question 6

nonpharma

Answer 6

1. quit smoking
2. weight reduction
3. exercise (150 min/week. at least 3d/wk of moderate intensity)
4. diet modification

Question 7

metformin moa

Answer 7

decrease hepatic glucose prod

Question 8

metformin dosage form

Answer 8

500mg, 850mg, 1g

Question 9

metformin AE

Answer 9

GI, anorexia, metallic taste (take with food), (rare) lactic acidosis

Question 10

metformin CI

Answer 10

crcl<30, hypoxia

Question 11

metformin ddi

Answer 11

etoh, cationic drugs, iodine contrast

Question 12

metformin benefits

Answer 12

negligible weight gain
negligible hypogly

Question 13

su moa

Answer 13

SU bind to SU receptor proteins and inhibits Katp channel mediated K+ efflux, triggering calcium dependent release of insulin from b cells

Question 14

su requirement

Answer 14

need functional beta cells to work (not for T1)

Question 15

su AE

Answer 15

hypogly, weight gain

Question 16

su ddi

Answer 16

BB, etOH, Cyp2c9

Question 17

tzd moa

Answer 17

peroxisome proliferator activated receptors agonist to promote glucose uptake into target cells

Question 18

tzd ae

Answer 18

hepatotoxicity (do not initiate if ALT > 3xUNL)
edema
fracture
weight gain

Question 19

tzd ci

Answer 19

active liver disease, HF class III or IV

Question 20

a glucosidase moa

Answer 20

delay glucose absorption and decrease PPG (inhibit brush border enzymes for breakdown of complex carbohydrates)

Question 21

a glucosidase inhibitor ae

Answer 21

flatulence, diarrhoea

Question 22

a glucosidase inhibitors ci

Answer 22

breast feeding, GI diseases

Question 23

a glucosidase ddi

Answer 23

yakult!

Question 24

glp 1 receptor agonist moa

Answer 24

binds to beta cells to
- delay gastric emptying
- increase insulin secretion
- decrease food intake

Question 25

glp 1 receptor ae

Answer 25

GI NVD, acute pancreatitis

Question 26

glp 1 receptor benefits

Answer 26

- weight loss - ascvd benefit - ckd minimal benefit

Question 27

dpp4i moa

Answer 27

prevents active glp1 from being converted to inactive glp 1

Question 28

dpp4i ae

Answer 28

very mild (sitagliptin) pancreatitis

Question 29

sglt2i moa

Answer 29

increased renal glucose excretion, decreased blood glucose

Question 30

sglt2i ae

Answer 30

uti, hypot, hypogly, fournier's gangrene

Question 31

sglt2i benefits

Answer 31

ascvd (cana, empa) , hf, ckd

Question 32

meds to take before meal

Answer 32

su

Question 33

meds to take with meal

Answer 33

alpha glu

Question 34

weight loss inducing meds

Answer 34

metformin, glp1, sglt2i

Question 35

weight gain inducing meds

Answer 35

su, tzd

Question 36

meds targeting PPG

Answer 36

SU, GLP1, TZD

Question 37

meds targeting FPG

Answer 37

metformin, SGLT2, TZD

Question 38

insulin moa glucose

Answer 38

increase glucose uptake, inhibits hepatic glucose output

Question 39

insulin moa fat

Answer 39

enhance fat storage, prevents lipolysis

Question 40

insulin moa protein

Answer 40

increase protein synthesis, inhibits proteolysis

Question 41

rapid acting insulin types

Answer 41

aspart lispro glulisine 15 min before meal

Question 42

short acting insulin types

Answer 42

regular / actrapid 30 min before meal

Question 43

long acting insulin types

Answer 43

detemir glargine

Question 44

intermediate acting types

Answer 44

nph

Question 45

when injectables started, tzd?

Answer 45

discontinue tzd / reduce by 50%

Question 46

when injectables started, su?

Answer 46

discontinue (esp if mealtime insulin initiated) / reduce by 50%

Question 47

when injectables started, dpp4i?

Answer 47

discontinue

Question 48

mixtard 30 components

Answer 48

70% nph, 30% regular

Question 49

conversion of mixtard to glargine

Answer 49

20% reduction of NPH

Question 50

target range for fpg

Answer 50

5 to 7

Question 51

hyperglycemic hyperosmolar state is which type of diabetes

Answer 51

type 2

Question 52

diabetic ketoacidosis happens in which type of diabetes

Answer 52

type 1

Question 53

dawn phenomenon

Answer 53

release of cortisol in waking hours

Question 54

somogyi effect

Answer 54

bg levels drop sharply at night, body releases glucagon, bg increases

Question 55

uses of aspirin in DM

Answer 55

those with diabetes and Hx of ASCVD