Diabetes part 1.5

Question 1

Age of Type 1 vs type 2

Answer 1

30 (unless children)

Question 2

Onset of Type 1 vs type 2

Answer 2

Abrupt; Gradual

Question 3

Body of Type 1 vs type 2

Answer 3

Lean; Obese

Question 4

Insulin resistance type 1

Answer 4

Absent

Question 5

Autoantibodies type 1

Answer 5

Often present

Question 6

Weight loss at diagnosis type 1 vs. type 2

Answer 6

Common vs. uncommon

Question 7

Ketones at diagnosis type 1 or type 2?

Answer 7

Type 1 present

Question 8

Need for insulin therapy type 1 or type 2?

Answer 8

Type 1 needed immediate; type 2 years later

Question 9

Acute complications of type 1

Answer 9

diabetic ketoacidosis

Question 10

acute complications of type 2

Answer 10

hyperosmolar hyperglycemic syndrome

Question 11

Microvascular complications at diagnosis?

Answer 11

Type 2

Question 12

Macrovascular complications?

Answer 12

Type 1 rare; type 2 common

Question 13

Symptoms of type 1

Answer 13

polyuria, nocturia, polydipsia, polyphagia, weight loss

Question 14

Symptoms of type 2

Answer 14

uncommon; lethargy, polyuria, nocturia, and polydipsia

Question 15

Screening normal adults

Answer 15

45 y.o. every 3 yrs.

Question 16

Screening adults BMI>25 or >23 Asian Americans with risk factors

Answer 16

Repeat at least every 3 years

Question 17

Pediatric >10

Answer 17

BMI>85th percentile age and weight
Weight for height>85th percentile
weight>120% of IBW

Repeat every 3 years

Question 18

Risk factors of DM in adult populations

Answer 18

BMI>25 (>23 AsianAm)
Physical inactivity
First degree relative with DM
Member of high risk ethnic pop
Women delivered baby >9 lb or diagnosed with GDM
Hypertension BP>140/90
HDL250
Women with polycystic ovarian syndrome (PCOS)
Acanthosis nigricans
History CVD
a1c>5.7%, impaired glucose tolerance, impaired fasting

Question 19

Risk factors for pediatric

Answer 19

Family history of type 2 first/second degree relative
Member of high risk ethnic pop
Signs of insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS, small for gestational age birth weight
Maternal history of DM/ Gestational DM

Question 20

Fasting glucose to diagnose Type 2

Answer 20

BG>/= 126 mg/dL

Question 21

Increased risk of DM a1c range

Answer 21

5.7-6.4%

Question 22

Goals of therapy

Answer 22

Reduce risk of micro/macro complications
Improve symptoms, quality of life, reduce mortality
Hemoglobin a1c <6

Question 23

Lifestyle changes

Answer 23

Medical Nutrition therapy (MNT)
Physical activity (150/week mod intensity 30 min x2)
Lose 5%-10% of weight
Bariatric surgery (BMI >35)
Limit alcohol intake 1 drink/day FM and 2/day M
Smoking cessation

Question 24

Biguanides

Answer 24

Metformin (Glucophage)

Question 25

Acetohexamide

Answer 25

First Gen. Sulfonylureas

Question 26

Chlorpropamide

Answer 26

First Gen. Sulfonylureas

Question 27

Glimepiride

Answer 27

Second Gen

Question 28

Glyburide

Answer 28

Second Gen

Question 29

Tolazamide

Answer 29

First Gen

Question 30

Glipizide

Answer 30

Second Gen

Question 31

Tolbutamide

Answer 31

First Gen

Question 32

mealtime bolus

Answer 32

fast onset, shorter duration

Question 33

maintenance basal

Answer 33

slower onset, longer duration; provides appropriate levels b/t meals and during sleep inhibiting gluconeogenesis

Question 34

premixed insulins

Answer 34

combine mealtime and maintenance both types of coverage in single product

Question 35

Drug delivery by SC injection

Answer 35

Fatty layer between dermis and muscle. Relatively low blood flow - absorbed more slowly than IM

Question 36

Typical volumes of SC

Answer 36

2 mL or less

Question 37

Insulin absorption rates vary depending on site

Answer 37

Ab>arm>hip>thigh>buttock

Question 38

Insulin pumps awesome

Answer 38

Rapid absorption; constantly monitor and correct patients glucose or insulin levels

Question 39

formulation metaformin

Answer 39

IR, ER tabs and oral solution. ER use matrix-diffusion mechanism to slow rate of release

Question 40

absorption metaformin

Answer 40

absorbed rapidly oral bio - 50-60% Take immediately after meal to prevent GI upset