DM

Question 1

Cells within islets of langerhans

Answer 1

alpha cells secrete glucagon, beta cells secrete insulin, delta cells secrete somatostatin, gamme cells secrete pancreatic polypeptide

Question 2

What is negative inhibitor for growth hormone?

Answer 2

somatostatin

Question 3

Insulin lowers blood glucose in 3 different ways:

Answer 3

inhibits glucagon secretion from alpha cells, increases glucose uptake by adipose tissue and skeletal muscle, and 3. decreases hepatic glucose production (liver produces less)

Question 4

populations most affected by DM

Answer 4

non-hispanic black men

Question 5

Age of onset in Type I DM

Answer 5

bimodal- 4 to 6, and 10-14. Majority diagnosed in childhood.

Question 6

risk factor ethnicity in DM Type I vs. II

Answer 6

Type I- non hispanic whites at risk. Type II- non hispanic blacks at risk

Question 7

Type IA vs. Type IB DM (idiopathic type I DM)

Answer 7

1a- autoimmune destruction of beta cells (MOST CASES)

ib- non-autoimmune beta cell destruction

Question 8

3 presentations in Type I DM

Answer 8

1. classic new onset: polyuria, polydipsia, weight loss. Ill, lethargy, visual disturbances. 2. Diabetic Ketoacidosis- polyuria, polydipsia, weight loss. Fruity smelling breath, drowsiness, lethargy. 3. Silent

Question 9

Most important modifiable risk factor for Type II DM

Answer 9

Obesity, sedentary lifestyle, highfat diet

Question 10

Ketonuria more indicative of type I or type II DM

Answer 10

type I

Question 11

what test to order if concerned about gestational diabetes in pregnant woman?

Answer 11

oral glucose tolerance test

Question 12

Hemoglobin A1c helpful in diagnosis of …

Answer 12

type 2 diabetes

Question 13

Patient with hemoglobin A1C of 6.5%. Next step?

Answer 13

Check for hyperglycemia by doing fasting blood glucose to confirm DM

Question 14

Impaired glucose TOLERANCE

Answer 14

140-199 mg/dl blood glucose at 120 minutes

Question 15

If want to check glucose levels in sickle cell anemic patient, which test would you order?

Answer 15

serum fructosamine- gives you good idea of recent blood glucose control over the last 1-2 weeks.

Question 16

C peptide and insulin levels in T1

Answer 16

Both decreased

Question 17

C peptide and insulin levels in T2

Answer 17

Both increased

Question 18

Type I DM controlled insulin and c peptide levels

Answer 18

C peptide decreased, insulin increased (because taking exogenous insulin)

Question 19

how does metformin work?

Answer 19

decreases hepatic gluconeogenesis and lipogenesis

Question 20

Metformin is contraindicated in…

Answer 20

patients with severe kidney or liver disease, and alcoholics

Question 21

Metformin associated with weight gain?

Answer 21

NO!

Question 22

Can hypoglycemia occur in patient taking metformin?

Answer 22

NO!

Question 23

MOA sulfonylureas

Answer 23

stimulate insulin release from pancreatic beta cells

Question 24

sulfonylureas contraindicated in

Answer 24

patients with chronic liver or kidney disease (like metformin)

Question 25

side effects of sulfonylureas

Answer 25

hypoglycemia, weight gain

Question 26

Purified insulin

Answer 26

proinsulin contamination less than 10 ppm

Question 27

concentration of insulin available

Answer 27

100 units/mL

Question 28

insulin dispension

Answer 28

10 ml vials or 3 ml pens

Question 29

regular insulin aka

Answer 29

short acting insulin

Question 30

Rapid vs short acting insulin onset of action, peak action, and duration

Answer 30

rapid acting- onset of action is 10 mins. peak action is 1 hr. lasts 4 hours. short acting is double this time.

Question 31

What insulin med. lasts 24 hours?

Answer 31

Glargine- long acting insulin therapy

Question 32

intermediate acting insulin therapy med

Answer 32

NPH

Question 33

Total insulin daily requirement

Answer 33

Half is long acting, half is short acting

Question 34

insulin dosing starts at

Answer 34

0.2 units/kg

Question 35

short acting insulin therapy med examples

Answer 35

lispro, aspart, glulisine

Question 36

Normal blood glucose levels preprandial and postprandial

Answer 36

preprandial- 90 to 130 mg/dL. 1 hour postprandial- less than or equal to 180 mg/dL. 2 hour postprandial- less than or equal to 150 mg/dL

Question 37

What do you do at F/U visit of DM patient?

Answer 37

F/U every 3 months during initial tx phase. routine height, weight, BMI measurements, smoking cessation counseling, routine screening for HTN

Question 38

Annual foot exams at what age of diabetes patien

Answer 38

10 or older

Question 39

Lab F/U with diabetes patient

Answer 39

HbA1c every 3-6 months, urine testing for microalbuminurea, serum creatinine testing, lipid profile annually, TSH every 1-2 years, celiac disease screening

Question 40

What must you be careful to monitor in honeymoon phase of type I DM?

Answer 40

hypoglycemia risk. exogenous insulin needed at this time decreases

Question 41

Morning hyperglycemia causes

Answer 41

dawn phenomenon, somogyi effect

Question 42

at what age should you begin screening patients for DM

Answer 42

45 or older, every 3 years