DM tx

Question 1

Insulin secretagogues do?

Drug classes?

Answer 1

stim insulin secretion

sulfonylureas
meglitinides

Question 2

Sulfonylureas action?

S/E?

Answer 2

bind β-cell receptors -> ↑ sensitivity to glu -> ↑ insulin release

QD dosing

hypogly
weight gain

Question 3

Meglitinides action?

Answer 3

bind K+ receptors -> ↑ insulin

rapid/short

Question 4

Insulin sensitizers do?

Drug classes?

Answer 4

↑ sensitivity of liver/mm to insluin,
↓ glu and insulin levels

biguanides
thiazolidinediones

Question 5

Biguanides action?

S/E?

Answer 5

↓ gluconeogenesis, ↑ glu uptake

QD dosing

GI
Lactic acidosis

Question 6

Thiazolidinediones action?

S/E?

Answer 6

↑ membrane response to insulin -> ↓ amount of insulin needed

Long lead time (wks)

hepatotoxic

Question 7

α-glucosidase inhibitors action?

S/E?

Answer 7

delay CHO absorp

before meals

GAS

Question 8

Pathogennesis of DM?

Answer 8

↑ insulin resistance ->
↓ insulin secretion ->
↑↑ glucagon secretion ->
impaired incretin effect

Question 9

Incretin hormones include?

Answer 9

GLP1 (glucagon-like peptide),

GIP (glucose-dependent insulinotropic peptide)

Question 10

GLP1 and GIP do what?

Answer 10

Looks like glucagon but ACTS LIKE INSULIN

respond to food -> bind β-cells -> stim insulin secretion

Question 11

Incretin mimetic drugs action?

Answer 11

synthetic GLP1:
insulin release in response to food,
↓ gluconeogenesis,
satiety,
slow emptying
(P) also ↑ β-cell mass

Question 12

Incretin mimetics used when?

S/E?

Answer 12

DM2 failure on other txs
preprandial

acute pancreatitis

Question 13

Synthetic Amylin drug actions?

Used when?

Answer 13

similar to incretin mimetics

DM1 or 2 adjunct to other txs
preprandial

Question 14

DPP4 inhibitors action?

Answer 14

stop DPP4 from degrading GLP1 ->

↑ action of incretins

Question 15

Meds for pancreatic failure?

Answer 15

sulfonylureas

incretin mimetics

Question 16

Meds for high hepatic glucose prdxn?

Answer 16

biguanides (Metformin)

DPP4 inhib

Question 17

Meds for over eating (high postP glucose)?

Answer 17

incretin mimetics
α-glucosidase inhibitors
DPP4 inhib

Question 18

Meds for insulin resistance?

Answer 18

biguanides (Metformin)

thiazolidinediones

Question 19

DOC for DM2?

Combine w/ what if needed?

Answer 19

metformin

sulfonylurea, incretin mimetic

Question 20

DM2 tx Stage A?

Answer 20

lifestyle ∆

Question 21

DM2 tx Stage B?

Answer 21

lifestyle ∆

+ oral

Question 22

DM2 tx Stage C?

Answer 22

lifestyle ∆
+ oral
+ bedtime med/long acting insulin

Question 23

DM2 tx Stage D?

Answer 23

lifestyle ∆
+ QD long insulin + premeal rapid insulin

Or

+ BID interm insulin + premeal rapid/short insulin

Question 24

Start insulin in DM2 at what HbA1c level?

Answer 24

~8% regardless of optimal oral tx

Question 25

Rapid insulin: Onset Peak Duration

Answer 25

Onset < 15 min Peak 1 hr Duration 2-4 hrs

Question 26

Short/Regular insulin: Onset Peak Duration

Answer 26

Onset 0.5-1 hr Peak 2-3 hrs Duration 3-6 hrs

Question 27

Intermediate insulin: Onset Peak Duration

Answer 27

Onset 2-4 hrs Peak 6-12 hrs Duration 10-16 hrs

Question 28

Long insulin: Onset Peak Duration

Answer 28

Onset 1-2 hrs Peak NONE Duration 20-24 hrs

Question 29

Dosing regimen?

Answer 29

peakless (long) as base + rapid premeal

Question 30

Insulin requirement DM1? Dosing?

Answer 30

1/2 unit/kg split daily total in 1/2s: 1/2 as long 1/2 as bolus in 1/3s premeal

Question 31

Microvascular complication of DM? (3)

Answer 31

retinopathy nephropathy neuropathy

Question 32

Macrovascular complications of DM? (3)

Answer 32

CAD peripheral vascular dz cerebrovascular dz

Question 33

Other complications of DM? (2)

Answer 33

hypoglycemia | hyperglycemia (DKA)

Question 34

Ocular complications of DM?(3)

Answer 34

cataracts retina proliferation exudates

Question 35

Nephropathy may lead to? Tx?

Answer 35

proteinuria HTN ↓ GFR -> renal fail ACE

Question 36

Neuropathy effects on peripheral?

Answer 36

Affects long axons: numb/tingling/cramps in feet, hyper- hyposensitivity to touch, loss of balance/coord

Question 37

Neuropathy effects on autonomics?

Answer 37

urinary incontinence, lost sex arousal, gastric stasis ortho hypoTN

Question 38

Peripheral vascular dz leads to?

Answer 38

ulcers gangrene necrosis amputation

Question 39

Hypo or hyperglycemia develops rapidly?

Answer 39

hypogly -> death in minutes hyper -> not as critical but still emergent

Question 40

Hypoglycemia sxs: adrenergic?

Answer 40

(from ↑↑ epi release) ``` sweat tachy weak hunger tremor anxiety ```

Question 41

Hypoglycemia sxs: neuroglycopenic?

Answer 41

(from ↓↓ CNS glucose) ``` HA dizzy clouded vision confusion seizure coma ```

Question 42

Hypoglycemia tx?

Answer 42

``` STAT blood sugar Glucose ASAP (carbs) ```

Question 43

Morning Hyperglycemia from waning insulin? Tx?

Answer 43

p.m. dose worn off ↑ dose or ∆ timing

Question 44

Morning Hyperglycemia from Dawn Phenom? Tx?

Answer 44

↑ GH secretion b/w 3-7 a.m. ↑ dose or ∆ timing

Question 45

Morning Hyperglycemia from Somogyi? Tx?

Answer 45

rebound hypergly from p.m. hypo followed by secretion of cortisol, glucagon, GH ↓ dinner/bedtime dose or snack at bedtime

Question 46

Brittle DM is?

Answer 46

DM w/ high/low glucose extremes Hugh response to small insulin adjustments

Question 47

Diabetic Ketoacidosis caused by?

Answer 47

(U) Type 1 insuff insulin infection major stressors (MI, pregnancy)

Question 48

DKA signs/sxs?

Answer 48

``` N/V/Abd pain hypervent hypoTN dehydration acidosis w/ > anion gap high glucose serum ketones ```

Question 49

DKA lab findings?

Answer 49

High blood/urine glucose Low CO2 + urine ketones + serum ketones

Question 50

DKA tx?

Answer 50

Goals: 1) Restore fluid vol (iso saline) 2) Correct e- imbal (K+, PO4, Na+) 3) Reverse acidosis (bicarb) 4) Stop ketogenesis (insulin) 5) Clear ketones Tx till normal pH and no ketonemia

Question 51

NKHS caused by?

Answer 51

(U) Type 2 2º to severe stress w/ ↓ renal excr of glu

Question 52

NKHS signs/sxs?

Answer 52

severe hypergly (glu > 500) dehydration (plasma osmo > 320) NO ketonemia

Question 53

NKHS tx?

Answer 53

Fluid/e- replacement | Insulin