Final Exam- Diabetes Flashcards
(103 cards)
1
Q
Balance between hepatic glucose production and peripheral glucose uptake and utilization:
A
Glucose homeostasis
2
Q
Pancreatic islet hormones maintain:
A
glucose balance
3
Q
Pancreatic beta cells secrete:
A
insulin
4
Q
Pancreatic alpha cells secrete:
A
glucagon
5
Q
Released by cells in the small intestines after food ingestion , stimulate insulin secretion when the blood glucose is above the fasting level:
A
Incretin hormones
- Glucagon-like peptide 1 (GLP1)
- Glucose-dependent insulinotropic polypeptide
(GIP)
6
Q
Two wammies that individuals who are obese often struggle with:
A
- uncontrolled hyperglycemia
- insulin resistance
7
Q
Hyperglycemia is due to:
A
- Uncontrolled hepatic glucose output
- Reduced updates of glucose by skeletal muscle
- Reduced glycogen synthesis
8
Q
Absolute deficiency of insulin resulting from autoimmune destruction of pancreatic beta cells:
A
insulin deficiency
(Type 1 DM)
9
Q
What type of diabetics are prone to diabetic ketoacidosis (DKA)?
A
Type 1
10
Q
Type of drug that can cause transient hyperglycemia:
A
Glucocorticoids
11
Q
T/F: Majority of type 2 diabetics are asymptomatic and diagnosed by lab testing
A
True
12
Q
Type ____ DM is often associated with weight loss and keoacidosis
A
1
13
Q
Symptoms that are more common in type 1 DM versus Type 2, although they can occur in both:
A
- Lethargy
- Stupor
- Weight loss
- Kussmal breathing
- Smell of acetone (fruity breath)
- Nausea
- Vomitting
- Abdominal pain
14
Q
A1C basically measures:
A
sugar coated hemoglobin
15
Q
measures the average amount of glucose in a person’s blood over the last 3-4 months:
A
A1C
15
Q
List the A1C test ranges for the following:
Normal
Pre-Diabetic
Diabetic
A
Normal = below 5.7%
Pre-Diabetic= 5.7-6.4%
Diabetic= 6.5%+
16
Q
List the fasting glucose ranges for the following:
Normal
Pre-Diabetic
Diabetic
A
Normal = 99mg/dl or below
Pre-Diabetic =100-125mg/dl
Diabetic= 126mg/dl or above
17
Q
List the glucose tolerance ranges for the following:
Normal
Pre-Diabetic
Diabetic
A
Normal= 140mg/dl or below
Pre-Diabetic= 140-199mg/dl
Diabetic= 200mg/dl +
18
Q
Macrovascular complications of diabetes:
A
- brain
- heart
- extremities (peripheral vascular disease)
19
Q
Microvascular complications of diabetes include:
A
- Eyes
- Kidneys
- Nerves (peripheral & autonomic)
- Periodontal disease
20
Q
What category of conditions are the main type of death for patients with Type 2 DM?
A
cardiovascular
21
Q
A1C goal for both type 1 and type 2 diabetics:
A
Under 7.0
22
Q
MOA for all insulins:
A
mimic endogenous insulin
23
Q
What is a requirement for Type 1 diabetes (no other treatment, they have to have it)
A
Insulin therapy
24
How is human insulin made?
Recombinant DNA-rDNA technology
25
Modified amino acid sequences (_____) provided rapid/short acting and long acting/basal insulins
Insulin analogs
26
Categorize the following diabetic medication:
INSULIN LISPRO
- Humalog
- Amelog
- Lyumjev
INSULIN ASPART
-NovoLog
- Fiasp
INSULIN GLULISINE
- Apidra
Ultra-rapid/rapid acting insulin
27
Insulin that has an onset of 10-30 min:
Ultra-rapid/ rapid-acting insulin
28
Patients on short-acting (regular) insulins need to take their insulin:
30 minutes before meals (this allows it to get in the bloodstream in time)
29
Categorize the following diabetic medications:
HUMULIN R
NOVOLIN R
Short-acting (regular insulins)
30
What is the onset of short-acting (regular) insulins?
~30 min
31
Inhaled insulin (Afrezza) is considered a ____ insulin
Rapid acting
32
Rapid acting inhaled insulin:
Afrezza
33
Inhaled insulin is contraindicated in:
Chronic lung disease (asthma/COPD)
34
Intermediate-acting insulin is also known as:
NPH (Neutral Protamine Hagedorn)
35
What is the onset of intermediate-acting (NPH) insulin?
1-2 hours
36
Categorize the following diabetic medications:
HUMULIN N
NOVOLIN N
Intermediate-acting (NPH) insulin
37
_____ insulins CANNOT be mixed with other type of insulins (or taken with other types)
Long-acting
38
Categorize the following diabetic medications:
INSULIN GLARGINE
- lantus
-basaglar
- rezvoglar
-semglee
INSULIN GLARGINE
- toujeo
Long-acting insulin
39
What is the onset of long-acting insulin?
about 1 hour
40
What is the duration of long-acting insulin?
About 24 hours (basal insulin
41
Categorize the following diabetic medications:
INSULIN DEGLUDEC
- Tresiba
Ultra Long-acting insulin
42
What is the duration of ultra long-acting insulin?
42 hours
43
What is the onset of ultra long-acting insulin?
30-90 min
44
Why do we want patients to give themselves multiple insulin injections per day?
To match what pancreas does
45
Multiple daily injections =
basal-bolus regimen (usually 4 injections per day)
46
How many injection are typically given with a basal-bolus regimen?
4
47
Mimics physiologic insulin release:
basal-bolus regimen
48
For basal injections of insulin we use:
For bolus injections of insulin we use:
long-acting analog
ultra-rapid acting or rapid-acting analog
49
for patient that don't like injections but you can convince the to do two injections per day:
Rapid-acting/NPH
50
Continuous insulin infusion pump devises only use _____ as basal insulin with continuous delivery with bolus administration as needed
shor- or rapid-acting
51
Often require a lower dose of insulin because less issue with insulin resistance:
Type 1
52
Multiple daily injections of prandial insulin and basal insulin or continuous subcutaneous insulin infusion is recommended for:
Type 1
53
Often require higher doses of insulin due to insulin resistance:
Type 2
54
Often start with basal/long-acting insulin and coinnue certain oral anti-diabetic medications:
Type 2
55
About ____% of patients benefit from insulin if they have type 2 DM
33% (1/3)
56
Adverse effects of insulin:
1. Weight gain
2. Hypoglycemia
57
Highest risk of any type of diabetic medications:
Hypoglycemia
58
Does basal or bolus insulin have a higher risk for causing hypoglycemia?
bolus has higher risk
59
Glucose alert value for hypoglycemia =
Serious, clinically significant glucose value for hypoglycemia =
Less than 70 mg/dl
Less than 54 mg/dl
60
When is treatment for hypoglycemia indicated?
Glucose of less than 70mg/dl
61
Describe the rule of 15 for treating hypoglycemia:
1. Eat or drink 15g of carbs
2. Wait 15 min and check blood sugar
3. If still low eat another 15g of carbs
4. Check blood sugar after 15 min
62
If a patient has to skip a meal prior to their dental procedure, what should insulin regimen look like?
Skip short/rapid-acting insulin does but still take their basal
63
If a patient becomes unconscious/unresponsive or unable to speak due to hypoglycemia, what should you do?
1. Call 9-1-1 (or have someone call 9-1-1 after administering the 1st dose of glucagon)
2. Stimulate gluconeogenesis
64
What is the dosing for stimulating gluconeogenesis in a unresponsive hypoglycemic patient?
1mg of glucagon IV or IM in buttocks/thigh/arm and repeat at 15 min if no response
(Patient will need glucose after injection OR give 50ml of 50% dextrose IV)
65
Metformin is in what drug class?
Biguanide
66
Another name for metformin:
Glucophage
67
MOA:
- Decreases hepatic glucose production (Primary mechanism)
- Decreases insulin resistance (increases insulin sensitivity)
- Increase glucose utilization in muscle and adipose tissues
- Inhibits intestinal absorption of glucose
Metformin (Glucophage)
(Drug class: Biguanides)
68
What is the formulation of metformin (glucophage):
Oral
69
Medication often used for the first line/initial agent for type 2 DM:
Metformin
70
T/F: Metformin (glucopahge) can be used in pre-diabetes
True
71
Describe the risk of hypoglycemia with use of ONLY metformin (glucophage) in a pre-diabetic individual:
Low risk (with mono therapy)
72
What is a notable ADE associated with metformin (glucophage)?
Notable GI adverse effect
- diarrhea
- loose stools
- faltulence
- dyspepsia
-abdominal distension/pain
- nausea
- vomitting
73
All GLP1s end in:
"tide"
74
Biggest reason people can't tolerate GLP1s:
Abdominal side effects
75
-Albiglutide
-Dulaglutide
- Exenatide
- Liraglutide
- Lixisenatide
- Semaglutide
These drugs are all:
GLP-1
76
What is the mechanism of action for GLP-1 Receptor agonists?
1. Stimulates GLP-1 receptors in the pancreas to INCREASE INSULIN SECERTION in response to elevated glucose
2. Stimulation of GLP1 receptors in the GI tract and CNS DECREASE GLUCAGON SECRETION and SLOW GASTRIC EMPTYING
77
Benefits of GLP 1- Receptor agonists:
1. weightloss
2. CV benefits (ASCVD)
3. Kidney benefits (CKD)
78
ADE's for GLP-1 Receptor Agonist:
GI issues (nausea & diarrhea)
79
What is the risk for hypoglycemia for GLP -1 receptor agonists?
Low risk with monotherapy
80
Glucose-dependent insulinotropic polypeptide agonist + Glucagon-like peptide-1 agonist:
GIP/GLP-1 Receptor co-agonist
81
Trizepatide (Mounjaro) is classified as:
GIP/GLP-1 Receptor Co-agonist
82
Diabetes medication that provides the best weight loss:
Trizepatide (Mounjaru)
(GIP/GLP-1 Receptor Co-agonist)
83
Activates both the GLP-1 receptor and the GIP receptor.
increases insulin secretion in response to elevated glucose, decreases glucagon secretion, slows gastric emptying:
This is the MOA for:
GIP/GLP-1 Receptor Co-agonist (Tirzepatide/mounjaro)
84
ADEs for GIP/GLP-1 Receptor Co-agonist ("twincretin")
GI (diarrhea, nausea, vomiting)
85
Diabetic medication that functions by targeting the kidneys (proximal renal tubule):
Sodium glucose cotransporter-2 (SGLT2) inhibitors
86
SGLT2 inhibitors end in :
"flozin"
87
_____ is responsible for 90% of glucose reabsorption
SGLT2
88
- Bexagliflozin
- Canagliflozin
- Dapaglifozin
- Empaglifozin
- Ertugliflozin
These are types of:
SGLT2 inhibitors
89
MOA: Blocks glucose reabsorption in the proximal convoluted tubules of the kidney which increases excretion of glucose in the urine (also blocks sodium reabsorption):
SGLT2 inhibitors (Flozins)
90
ADEs for SLGT2 Inhibitors (Flozins):
1. Fungal/yeast infections
2. UTIs
91
What is the risk for hypoglycemia with SGLT2 inhibitors (Flozins):
Low risk as monotherapy
(may significantly reduce insulin needs)
92
What are the added benefits for SGLT2 Inhibitors (flozins):
1. CV benefits (ASCVD & HF)
2. Renal Benefits (CKD)
3. Weightloss (Less than GLP-1s)
93
What diabetic drugs show the most significant weight loss effects?
Twincretins (GLP-1 + GIP)
(But these don't have the added benefits such as the CV and Renal benefits)
94
MOA: DIRECTLY stimulate pancreas beta cells to release more insulin:
Sulfonylureas (SU)
(Secreteagogues)
95
- Glimepiride
- Glyburide
- Glipizide
(2nd gen)
These drugs are all considered:
Sulfonylureas (SU) (secretagogues)
96
- Nateglinide
- Repaglinide
These drugs are both:
Meglitinides
97
MOA: DIRECTLY increase insulin release from the pancreas in reposes to food, keeping blood glucose from rising too high after meals. (SHORTER ACTING):
Meglinitides
98
ADEs of both Meglinitides and Sulfonylureas (SU):
- HYPOGLYCEMIA!!!
- Weight gain
99
MOA:
-increases peripheral insulin sensitivity
- binds to nuclear receptor
- reduces glucose output
Thia-zolidine-diones
(Glitazones, TZDs)
100
What is the one drug that belongs to Thia-Zolidine-diones? (Glitaxones, TZDs)
Pioglitzone
101
What type of insulin do we see patients on with non-alcoholic fatty liver disease?
TZDs (Glitazones)
102
