IC12-13 DM

Question 1

Monitoring for DM

Answer 1

HbA1c
Macrovascular: BP, Lipids
Microvascular: Eye exam, foot exam, kidney function

Question 2

MOA of metformin

Answer 2

Decrease hepatic glucose production, increase muscle glucose uptake and utilisation

Question 3

Max dose of metformin

Answer 3

IR: 2550MG (3 x 850)
XR: 20000MG

Question 4

What are the special populations for metformin

Answer 4

Children older than 10 years and pregnant women

Question 5

ADR of metformin

Answer 5

GI disturbances, metallic taste, decreased serum vit B12 in long term use, rarely lactic acidosis

Question 6

Contraindications of metformin

Answer 6

GFR < 30ml/min
Hypoxic states
HF, liver impairment, respiratory failure
Alcoholism

Question 7

Metformin % decrease in Hba1c

Answer 7

1.5%

Question 8

Metformin effects on weight and hypoglycemia

Answer 8

Negligible effects on weight and hypoglycemia

Question 9

MOA of sulfonylureas

Answer 9

Stimulate insulin secretion by beta cells, need functional beta cells and decrease hepatic insulin output and increase insulin uptake by muscles

Question 10

Sulfonylurea effects on weight and hypoglycemia

Answer 10

Weight gain and risk of hypoglycemia

Question 11

DDI of sulfonylureas

Answer 11

Beta blockers: mask hypoglycemia
Alcohol: disulfiram like reaction
CYP2C9 inhibitors: amiodarone, fluoxetine

Question 12

Sulfonylureas % Hba1c by?

Answer 12

1.5%

Question 13

MOA of DPP4 inhibitors

Answer 13

Inhibit DPP4 enzyme, increase conc of incretins, decrease gastric emptying, decrease food intake

Question 14

Example of DPP4i

Answer 14

Sitagliptin, Linagliptin, Vildagliptin

Question 15

ADR of DPP4 inhibitors

Answer 15

Severe joint pain
Acute pancreatitis
Skin rash, bullous pemphigold

Question 16

Contraindications of DPP4i

Answer 16

Hx of acute pancreatitis

Question 17

DPP4i % Hba1c reduction

Answer 17

0.5-0.8

Question 18

DPP4i effect on weight

Answer 18

Weight neutral

Question 19

MOA of SGLT2i

Answer 19

Increase glucose excretion renally

Question 20

Renal considerations for SGLT2i

Answer 20

Do not initiate when
Canagliflozin: < 30 ml/min
Empagliflozin: < 45ml/min
Dapagliflozin: < 45ml/min

Question 21

ADR of SGLT2i

Answer 21

Hypotension, genital mycotic infections, UTI, Fournier’s gangrene, euglycemic DKA

Question 22

SGLT2i % Hba1c reduction

Answer 22

0.8-1.0%

Question 23

SGLT2i effects on weight and hypoglycemia

Answer 23

Slight weight loss, no hypoglycemia

Question 24

MOA of acabose

Answer 24

Inhibits alpha glucosidase enzyme from breaking down complex carbohydrates to simple carbohydrates for absorption through bursh border

Question 25

Indications for acabose

Answer 25

Not as monotherapy, as add on if PPG is not at control

Question 26

Max dose of acarbose

Answer 26

Weight based dosing 60kg: 300mg per day

Question 27

ADR of acarbose

Answer 27

Flatulence, increase in LFT

Question 28

Contraindications for acarbose

Answer 28

GI diseases Liver cirrhosis CrCl < 25ml/min

Question 29

Acarbose % Hba1c reduction

Answer 29

0.5-0.8%

Question 30

Insulin % Hba1c reduction

Answer 30

2.5%

Question 31

Indications for insulin

Answer 31

Pregnancy Symptomatic for hyperglycemia: 3Ps Hba1c > 10% Blood glucose > 16.7 mmol/L

Question 32

Steroid induced hyperglycemia

Answer 32

Steroid increases production of glucose, use NPH

Question 33

MOA of GLP1 agonists

Answer 33

Increase active GLP1 (incretin), decrease gastric emptying, decrease food intake

Question 34

Examples of GLP1 agonists

Answer 34

Liraglutide (SC OD), semaglutide (PO ODor SC weekly), dulaglutide (SC weekly)

Question 35

Contraindication of GLP1 agonists

Answer 35

Family hx of thyroid cancer Hx of pancreatitis

Question 36

PO semaglutide dosing instructions

Answer 36

Dosed on empty stomach, 30 mins before first meal of the day + no more than 120ml of water

Question 37

GLP1 agonist % Hba1c reduction

Answer 37

1-2%

Question 38

GLP1 agonist effect on weight and hypoglycemia

Answer 38

Weight loss, no risk of hypoglycemia