DM

Question 1

Risk factors for Diabetes

Answer 1

Obesity
Old age
African American
Native American
Hispanics
Family history (1st degree)
CVD
HTN
High Cholesterol
Physical inactivity

Question 2

Long-term complications of Diabetes

Answer 2

Eye damage
Kidney damage
Amputations
Heart attack
Stroke

Question 3

Criteria for diagnosing Diabetes

Answer 3

A1C >6.5%
or Fasting Glucose >120
or 2-hour Glucose >200
or Random Glucose >200

Question 4

What is the definition of fasting (in regards to glucose testing)

Answer 4

No caloric intake for at least 8 hours

Question 5

Blood (glucose/A1C/antibodies) should be used to screen for Type 1 Diabetes

Answer 5

A1C

Question 6

Type 1 Diabetes Mellitus is common in (children/adults)

Answer 6

Children (autoimmune)

Question 7

Diabetic Ketoacidosis is more commonly seen in Type (1/2) Diabetes

Answer 7

Type 1 (usually due to missed Insulin doses)

Question 8

Diabetic Ketoacidosis in Type 1 Diabetics is usually due to…

Answer 8

missed insulin doses (or increased stress)

Question 9

What autoimmune diseases are common in conjunction with Type 1 Diabetes

Answer 9

Grave’s disease
Celiac’s (gluten)
Pernicious Anemia (Intrinsic Factor)

Question 10

3 main antibodies found with Type 1 Diabetes

Answer 10

Glutamic Acid Decarboxylase Antibody (GAD)
Islet Cell Antibody (ICA)
Insulin Autoantibody (IAA)

Question 11

Factors that play into Type 2 Diabetes

Answer 11

Dec. glucose uptake
Dec. insulin and incretin (suppressed by fats)
Inc. glucagon
Inc. lipolysis

Question 12

In Type 2 Diabetes, hyperglycemia leads to elevated _______________ _________ levels

Answer 12

fatty acid*

*suppressing insulin and it’s action

Question 13

Type (1/2) Diabetes has a stronger genetic contribution

Answer 13

Type 2

Question 14

Type (1/2) Diabetes is more common in adults

Answer 14

Type 2

Question 15

C-peptide levels can be high-normal in Type 2 Diabetes (True or False)

Answer 15

True, but only in EARLY stages (will decline with time)

Question 16

Best preventatives for Type 2 Diabetes

Answer 16

Diet
Exercise

*drugs are not used for prevention, only treatment

Question 17

Suggested Lifestyle changes to PREVENT Diabetes

Answer 17

> 7% weight loss

>150 min/week of exercise

Question 18

Blood sugar peaks around ___________ after eating

Answer 18

1 hour

Question 19

Patients with diabetes are discouraged from drinking alcohol (True or False)

Answer 19

False, but must moderate within daily sugar intake

Question 20

How is physical activity beneficial for diabetics or pre-diabetics (besides the weight loss of course)

Answer 20

Inc. insulin sensitivity (helps prevent progression)

Question 21

What are the goals for Diabetics, in regards to glucose levels with treatment

Answer 21

Premeal glucose: 80-130
2-h post-meal: <180
HbA1c: <7%

Question 22

Which drug is considered the FIRST LINE agent for Diabetes and why?

Answer 22

Metformin

Has cardiovascular protection, lowers TG and LDL and doesn’t bottom out sugar levels

Question 23

MOA of Sulfonylureas and Meglitinides for Diabetes treament

Answer 23

Inc. Insulin release

Question 24

MOA of Metformin and Glitazones for Diabetes treatment

Answer 24

Inc. Insulin sensitivity (Metformin via AMPK) (Glitazones via PPARy)

Question 25

What liver enzyme does Metformin activate to increase Insulin sensitivity

Answer 25

AMP Kinase

Question 26

What enzyme do Glitazones activate in Adipose cells to inc. Insulin sensitivity

Answer 26

PPARy (inc. uptake of fatty acids to store)

Question 27

Disadvantages of Glitazones (as opposed to Meformin)

Answer 27

Weight gain Fluid retention--> CHF Inc. LDL

Question 28

MOA of Acarbose for Diabetes treatment

Answer 28

Delay sugar absorption (from gut) via a-Glocosidase inhibition

Question 29

Why is Acarbose not used too much for Diabetes

Answer 29

Poor patient adherence (makes them toot)

Question 30

Examples of most common drugs for Diabetes

Answer 30

Sulfonylureas (inc. insulin) | Metformin (inc. sensitivity)

Question 31

Examples of Insulin Secretagogues (2 total)

Answer 31

Sulfonylureas | Meglitinides

Question 32

Limitations and RISK for Sulfonylureas and Meglitinides (Insulin Secretagogues)

Answer 32

Requires functional Beta cells | Can cause HYPOglycemia

Question 33

Possible risk of Metformin (Inc. Insulin sensitivity)

Answer 33

Lactic acidosis (VERY RARE)

Question 34

Physiologic functions of the Incretins and Amylin

Answer 34

Promotes satiety Stimulate Insulin release* Inhibit Glucagon release Slow gastric emptying *Incretins only

Question 35

(IV/Oral) glucose has a much higher effect on Insulin secretion

Answer 35

Oral (due to Incretin effect in gut) *Diabetics have stunted Incretin effect

Question 36

Examples of SGLT-2 Inhibitors (promote renal excretion) (3 total)

Answer 36

Canagliflozin Dapagliflozin Empagliflozin

Question 37

Benefit of Insulin Analogues vs. Human insulins

Answer 37

Analogues have limited self-aggregation, so stay as monomers in solution and act quicker

Question 38

Examples of Insulin Analogues (5 total)

Answer 38

``` Aspart Glulisine Lispro Glargine* Degludec* ``` *long acting

Question 39

Benefit of the Insulin Analogues Glargine and Degludec specifically

Answer 39

Actually a LONG acting formulations, slowly dissolving from hexamer to dimer to monomer

Question 40

Examples of LONG acting Insulin Analogues (2 total)

Answer 40

Glargine | Degludec (Tresiba)

Question 41

ALL patients with Type (1/2) Diabetes require insulin therapy

Answer 41

Type 1 (autoimmune attack, so no insulin production)

Question 42

When would you use Insulin for a Type 2 Diabetic?

Answer 42

When disease is not well controlled on oral meds

Question 43

What are some barriers to using Insulin

Answer 43

Fear of injections Complex regimens Lack of time/resources Perceived significance of needing Insulin

Question 44

Immune-mediated loss of fat at the site of Insulin injections

Answer 44

Lipoatrophy

Question 45

Non-immune mediated gain of fat tissue at the site of repeated insulin injection

Answer 45

Lipohypertrophy