DM

Question 1

4 ways to Dx DM?

Answer 1

• Fasting glucose > 126
• OGTT (2 hour with 75 g oral glucose tolerance) > 200
• Sx + random glucose > 200
• A1c > 6.5

Question 2

4 ways to Dx Pre-DM

Answer 2

• Fasting glucose 100-125
• OGTT (2 hour with 75 g): 140-199
• A1c 5.7-6.4

Question 3

Recall: cut-off for Dx using a1c

Answer 3

• DM: 6.5

- IFG/pre-DM: 5.7-6.4

Question 4

Recall: cut-off for Dx using OGTT

Answer 4

• DM: > 200

- IFG/pre-DM: 140-199

Question 5

Recall: cut-off for Dx using fasting glucose

Answer 5

• DM: > 126

- IFG/pre-DM: 100-125

Question 6

If no risk factors, when start screening for DM?

Answer 6

Both genders: > 45 yo

Question 7

What are risk factors of DM?

Answer 7

• physical inactivity
• Fam hx
• Race (non-white)
• Women who has baby > 9lb or Hx of GDM
• HTN or on anti-HTN therapy
• HDL 250
• PCOS
• a1c > 5.7 in previous testing
• acanthosis nigricans
• CVD

Question 8

What start screening a$ patient for DM?

Answer 8

BMI > 25 + one risk factor

Question 9

If screening test is normal, repeat in ___ years?

Answer 9

3

Question 10

What is following up schedule for well-controlled patient?

Answer 10

Biannually - 2 times a year

Question 11

schedule for poorly-controlled patient with changing target?

Answer 11

Quarterly

Question 12

What’s the DM sx in the elderly?

Answer 12

Confusion and Dehydration

Question 13

T of F: renal threshold for glucose increases with advanced age

Answer 13

T

Question 14

T of F: with elderly, decreased thirst will suppress presentation of polydipsia

Answer 14

T

Question 15

T of F; elderly has diminished glucagon, epinephrine, growth hormone response to low glucose

Answer 15

T

Question 16

What is the DM treatment goal for healthy elderly adult with life expectancy greater than 10 years?

Question 17

What is the DM treatment goal for frail olderly adult with comorbidities and life expectancy less than 10 years

Answer 17

7-8

Question 18

For patient with CKD, treatment goal is

Question 19

Elderly complications of DM

Answer 19

• mononeuropathy: isolated CN 3 nerve palsy common

- Hypoglycemic increases risk of dementia and worsens cognitive impairment

Question 20

T of F: avoid metformin in anorexia, renal impariment, and CHF pateints

Answer 20

T

Question 21

T of F: avoid thiazolidinediones in CHF patients

Answer 21

T

Question 22

What are the drugs used in two-drug combo for DM Rx?

Answer 22

• sulfonylurea
• thiazolidinedione
• DPP-4
• GLP-1 receptor agonist
• Insulin

Question 23

What are major ADR of sulfonylurea

Answer 23

• mod risk of hypoglycemia

- weight gain

Question 24

What are major ADR of thiazolidinedione

Answer 24

• low risk of hypoglycemia
• weight gain
• Edema, HF, Fx

Question 25

What are major ADR of DPP-4 inhibitor

Answer 25

- low risk of hypoglycemia - weight neural! - rare side effect - pricey $$$

Question 26

What are major ADR of GLP-1 agonist?

Answer 26

- low risk of hypoglycemia - weight loss!!! - GI side effect - pricey $$$

Question 27

Can do up to three-drug combo, then what?

Answer 27

insulin

Question 28

Which drug is weight neural?

Answer 28

DPP-4 inhibitor

Question 29

What are examples of DPP-4 inhibitor?

Answer 29

Sitagliptin (Januvia) | Saxagliptin, Alogliptin,

Question 30

Which drug actually helps to lose weight?

Answer 30

GLP-1 receptor agonist

Question 31

What are examples of GLP--1 receptor agonist?

Answer 31

Exenatide, Albiglutide

Question 32

Which drug is known for causing edema, HF, Fx?

Answer 32

Thiazolidinedione

Question 33

Examplse of thiazolidinedione

Answer 33

‎Pioglitazone · ‎Rosiglitazone

Question 34

Which drug has higher dose of causing hypoglycemia than others?

Answer 34

- Most is insulin | - Then sulfonylurea

Question 35

What are examples of sulfonylurea?

Answer 35

‎Gliclazide · ‎Glimepiride · ‎Glipizide

Question 36

Which drug acts by increased insulin release from pancreas beta cell?

Answer 36

Sulfonylurea

Question 37

How does Thiazolidinedione work?

Answer 37

Activating PPAR gamma - peroxisome proliferator activated receptors - nuclear receptor for gene transcription -> increase storage of fatty acids in adipocytes