DM II

Question 1

What percent of DM is DM II?

Answer 1

90-95%

Question 2

What two ethnicities have high rates of DM II?

Answer 2

Native Americans

African Americans

Question 3

What are the major microvascular complications of DM II?

Answer 3

Retinopathy
Neuropathy
Nephropathy

Question 4

What are the major macrovascular complications of DM II?

Answer 4

Cerebrovascular disease
PVD
CAD

Question 5

What is the fasting glucose level that indicates DM II? Random?

Answer 5

Fasting more than 126 mg/dL

Random more than 200 mg/dL and ssx

Question 6

What is the two hour postprandial BG (75 g of glucose) levels that indicated DM II?

Answer 6

more than 200 mg/dL

Question 7

What is the HbA1C level that indicates DM II?

Answer 7

More than 6.5%

Question 8

What is the prediabetes level of BG (fasting and random)?

Answer 8

Fasting = 100-126
Random = 140-200

Question 9

What are the three main targets of insulin?

Answer 9

Liver
Muscle
Fat

Question 10

How can the liver play a role in the development of hyperglycemia 2/2 DM II?

Answer 10

Increased glucose production

Question 11

What is the cascade of events that occurs in the development of DM II, starting with insulin resistance?

Answer 11

1. Insulin resistance
2. Hyperinsulinemia
3. Compensated insulin resistance
4. Impaired glucose tolerance
5. beta-cell failure

Question 12

How long does it take for DM II to develop?

Answer 12

Years–hyperinsulinemia years before the development of ssx

Question 13

Why is it that some DM II pts need exogenous insulin?

Answer 13

Beta cell burnout

Question 14

What is the timeframe that HbA1c measures?

Answer 14

3 months (life time of RBCs)

Question 15

HbA1C level of 5% correlates with what average BG level?

Answer 15

90

Question 16

HbA1C level of 6% correlates with what average BG level?

Answer 16

120

Question 17

HbA1C level of 7% correlates with what average BG level?

Answer 17

150

Question 18

HbA1C level of 8% correlates with what average BG level?

Answer 18

180

Question 19

What chronic disease can cause a falsely elevated HbA1C level?

Answer 19

Sickle cell anemia

Question 20

What can cause a falsely low HbA1C level?

Answer 20

Blood transfusion

Question 21

What is the suffix of the Na/glucose transporter inhibitors?

Answer 21

“-flozin”

Question 22

What are the two GLP-1 agonists? MOA?

Answer 22

Exenatide
Liraglutide

Increases insulin, decreases glucagon release

Question 23

What are the DPP-4 inhibitors? MOA?

Answer 23

“-gliptins”
inhibits the breakdown of GLP-1

Increases insulin release
Decreases glucagon release

Question 24

What percent of body weight was lost with the DPP lifestyle change group?

Answer 24

7%

Question 25

What is the MOA of acarbose?

Answer 25

alpha-glucosidase inhibitor

Question 26

What is the MOA of miglitol?

Answer 26

alpha-glucosidase inhibitor

Question 27

What are the two alpha-glucosidase inhibitors?

Answer 27

Miglitol | Acarbose

Question 28

What is the biguanide that is used in the treatment of DM II?

Answer 28

Metformin

Question 29

What type of drug is Metformin?

Answer 29

Biguanide

Question 30

What are the two first generation sulfonylureas?

Answer 30

Tolbutamide | Chlorpropamide

Question 31

What are the three second generation sulfonylureas?

Answer 31

Glyburide Glimepiride Glipizide

Question 32

What type of drug is pramlintide? MOA? Side effects?

Answer 32

- Amylin analog - Decreases gastric emptying - Decreases glucagon production

Question 33

What is incretin and what does it do? What drugs mimic this?

Answer 33

a group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins do so by causing an increase in the amount of insulin released from pancreatic beta cells of the islets of Langerhans after eating, before blood glucose levels become elevated GLP-1 analogs DPP-4 inhibitors

Question 34

What is amylin, and what does it do? What medication mimics this?

Answer 34

Peptide hormone that is secreted with insulin to slow gastric emptying DPP-4 inhibitor

Question 35

What type of drugs are the best option for pts who have a mild postprandial hyperglycemia?

Answer 35

alpha-glucosidase inhibitors

Question 36

What is the MOA of metformin? Side effect?

Answer 36

Decreases gluconeogenesis GI upset and lactic acidosis

Question 37

What what pts is metformin contraindicated?

Answer 37

CKD

Question 38

What is the MOA of thiazolidinediones? What is the major side effect seen with this drug?

Answer 38

PPAR-gamma agonists, which increases insulin sensitivity in peripheral tissues Weight gain/edema Hepatotoxic

Question 39

What are the two thiazolidinediones?

Answer 39

Pioglitazone | Rosiglitazone

Question 40

What is the suffix that denotes the thiazolidinediones?

Answer 40

"-azone"

Question 41

In whom are incretin mimetics (GLP-1 and DPP 4 inhibitors) contraindicated?

Answer 41

CKD

Question 42

What DM med aids with weight loss?

Answer 42

GLP-1 analogs

Question 43

What is the major contraindication to pramlintide?

Answer 43

Someone who already has gastroparesis

Question 44

What are the effects of TZDs on: - Weight - HDL - LDL - TGs

Answer 44

- Weight = increases - HDL = increases - LDL =increases - TGs = decreases

Question 45

What are the effects of biguanides on: - Weight - HDL - LDL - TGs

Answer 45

- Weight - decrease - HDL = increases - LDL = decreases - TGs = decreases

Question 46

What are the effects of secretagogues on: - Weight - HDL - LDL - TGs

Answer 46

- Weight = increases - HDL = none - LDL = none - TGs = none

Question 47

What are the effects of alpha-glucosidase inhibitors on: - Weight - HDL - LDL - TGs

Answer 47

- Weight = none - HDL = none - LDL = none - TGs = none

Question 48

What amount of HbA1C will two drugs drop?

Answer 48

1.2-1.8%

Question 49

What are the major indicators that DM II patients need to start insulin?

Answer 49

- no more effect of drug regimen - acute decompensation - surgery

Question 50

What are the three fast acting insulins?

Answer 50

Lispro Aspart G

Question 51

What are the two long acting insulins?

Answer 51

glargine | Detemir

Question 52

What does (70/30) insulin mean?

Answer 52

Mix of 70 long acting, and 30% short acting

Question 53

What is the major intermediate acting insulin?

Answer 53

NPH

Question 54

What is the onset for rapid, short, intermediate, and long acting insulin?

Answer 54

``` Rapid = 10 mins Short = 45 mins Intermediate = 2 h Long = 2 h ```

Question 55

What is the peak time for rapid, short, intermediate, and long acting insulin?

Answer 55

``` Rapid = 1 h Short = 2 h Intermediate = 4 h Long = no peak ```

Question 56

What is the duration of rapid, short, intermediate, and long acting insulin?

Answer 56

``` Rapid = 5 h Short = 6 h Intermediate = 12 h Long = 24 ```

Question 57

What should be done when adding insulin to a pts regimen when their meds are failing?

Answer 57

Add single NPH insulin at bedtime Target FBG of less than 100

Question 58

What is the usual units/kg dosage for new and experience pts?

Answer 58

0.2-0.5 units /kg

Question 59

What is the total cholesterol goal for pts with DM?

Answer 59

Less than 200

Question 60

What is the LDL goal for pts with DM?

Answer 60

Less than 100

Question 61

What is the HDL goal for pts with DM?

Answer 61

More than 45 or 55 for male/female respectively

Question 62

What is the TG goal for pts with DM?

Answer 62

Less than 150

Question 63

What is the BP goal for pts with DM?

Answer 63

Less than 130/80

Question 64

How many PCP visits should be had with DM II pts? How many HbA1C tests per year?

Answer 64

2 office visits and 4 tests per year

Question 65

What is the age at which screening for DM begins?

Answer 65

45

Question 66

What BMI is a risk factor for DM?

Answer 66

Over 25

Question 67

True or false: a h/o gestational DM is a risk factor for DM II

Answer 67

True

Question 68

True or false: Family h/o DM in a 1st degree relative is a risk factor for DM II

Answer 68

True

Question 69

What ovarian disease is a risk factor for DM II

Answer 69

PCOS