Diabetes Mellitus

Question 1

What is required for a diagnosis of Diabetes Mellitus (DM)?

Answer 1

Persistently high fasting glucose > 125 on 2 or more separate occasions

Question 2

What is T1DM?

Answer 2

Insulin deficiency

Question 3

What patient population does T1DM typically present?

Answer 3

Childhood patients, not related to obestity

Question 4

What is T2DM?

Answer 4

Insulin Resistance

Question 5

What patient population does T2DM typically present?

Answer 5

Adulthood, obesity

Question 6

What antibodies are present in T1DM?

Answer 6

Anti-glutamic acid dexarboxylase (Anti-GAD)

Question 7

What hemoglobinopathies can falesly decrease the HbA1C level?

Answer 7

Sickle cell Disease
G6PD
thalassemia

Question 8

What are the different ways you can diagnose Diabetes?

Answer 8

2 Fasting blood glucose >125

Single blood glucose >200 with symptoms

Increases glucose on oral glucose tolerance test

HbA1c>6.5%

Question 9

What is the best initial drug treatment for diabetes?

Answer 9

Metformin

Question 10

How does metformin work?

Answer 10

Blocks gluconeogenesis

Question 11

Does metformin cause weight gain?

Answer 11

no

Question 12

What patient population is metformin contraindicated in?

Answer 12

Renal Dysfunction: can accumulate and cause lactic acidosis

Question 13

What are common DDP-IV inhibitors?

Answer 13

Sitagliption, Saxagliptin, Linagliptin, Alogliptin

Question 14

What suffix is used by DPP-IV Inhibitors?

Answer 14

“-Gliptins”

Question 15

How do DPP-IV Inhibitors (-Gliptins) work?

Answer 15

block metabolism of incretins: GIP and GLP

Question 16

How do Incretins (GIP and GLP) work?

Answer 16

increase insulin release and decrease glucagon release from the pancreas

Question 17

What are Incretins (GIP and GLP) released?

Answer 17

When food enters the duodenum

Question 18

What is Semaglutide?

Answer 18

GLP agonist

Question 19

What are common SGLT-2 Inhibitors?

Answer 19

Empagliflozin, dapagliflozin, canagliflozin, ertugliflozin

Question 20

What suffix is used by SGLT-2 inhibitors?

Answer 20

“-Gliflozin”

Question 21

When are SGLT2 inhibitors added to therapy?

Answer 21

When there is CHF or chronic kidney disease

Question 22

How do SGLT inhibitors work?

Answer 22

Inhibit resorption of glucose in the PCT after it has been filtered leading to excretion in urine

Question 23

What are common side effects of SGLT2 inhibitors?

Answer 23

UTI and fungal Vaginitis

Question 24

What are common Incretin Mimetics?

Answer 24

Exanatide, liraglutide, albiglutide, dulaglutide

Question 25

What suffix is used for Incretin Mimetics?

Answer 25

"-tide"

Question 26

How do Incretin Mimetics work?

Answer 26

directly replace incretins and slow gastric motility to markedly decrease weight

Question 27

What population are Thiazolidindeiones (glitazones) contraindicated in?

Answer 27

CHF: they increase fluid overload

Question 28

How do Nateglinide and Repalinide work?

Answer 28

Stimulate insulin release

Question 29

What is the best drug to add to metformin in a patient with obesity?

Answer 29

GLP agonist

Question 30

What is the best drug to add to metformin in a patient with CHF?

Answer 30

SGLT-2 Inhibitor

Question 31

What is the best drug to add to metformin in a patient with Chronic Kidney Disease?

Answer 31

SGLT-2 Inhibitor

Question 32

What is the time to onset of Insulins: Lispro, Aspart, and Glulisine?

Answer 32

5-15 minutes

Question 33

What is the time to onset of Insulin: regular?

Answer 33

30-60 minutes

Question 34

What is the time to onset of Insulin: NPH?

Answer 34

2-4 hours

Question 35

What is the time to onset of Insulin: Glargine, Detemir?

Answer 35

1-2 hours

Question 36

What is the time to onset of Insulin: Gegludec?

Answer 36

2-4 hours

Question 37

What type of DM is most associated with DKA?

Answer 37

Type 1

Question 38

How do patients with DKA present?

Answer 38

Hyperventilation, AMS Increased AG metabolic acidosis Hyperkalemia in blood with decreased total body K Increased AG Serum (+) for ketones Nonspecific abdominal pain "Acetone" breath odor Polydipsia, Polyuria

Question 39

How do you treat DKA?

Answer 39

Large volume Saline and insulin replacement

Question 40

How does Hyperosmolar Hyperglycemic Syndrome (HHS) present?

Answer 40

Extremely elevated glucose without ketone formation: Normal anion gap

Question 41

How do you treat HHS?

Answer 41

Insulin + high volume fluids

Question 42

What health maintenance should all patients with DM receive?

Answer 42

Pneumococcal vaccine Yearly eye exam: proliferative retinopathy Statin if LDL >100 ACE-I or ARB if BP elevated ACE-I or ARB if urine has microalbuminuria Foot exam: neuropathy and ulcers

Question 43

What are common causes of Hypoglycemia?

Answer 43

Insulinoma Insulin Autoimmune Ab Sulfonylurea abuse Surreptitious use of insulin/suicide

Question 44

How do you treat Hypoglycemia?

Answer 44

Glucose and/or glucagon via IV or Inhalation

Question 45

What lab markers are seen with Insulinoma?

Answer 45

Low glucose + high insulin/C-peptide

Question 46

What lab markers are seen with Sulfonylurea abuse?

Answer 46

Urine metabolites of sulfonylureas are found + elevated C-peptide and proinsulin

Question 47

What lab markers are seen with Surreptitious use of insulin/suicide?

Answer 47

Low C-peptide, low pro-insulin