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2.1) My Cards > 1.1 MTB Step 3 - Type 2 Diabetes Mellitus > Flashcards

1.1 MTB Step 3 - Type 2 Diabetes Mellitus Flashcards

Cards Complete:

1
Q

GENERAL

What are (4) Differences between Diabetes Type 1 & Diabetes Type 2?

A

DM Type 1:

  1. Onset = Juvenile
  2. Body Type = Thin
  3. DKA = Frequent
  4. Treatment = Insulin

DM Type 2:

  1. Onset = Adult
  2. Body Type = Obese
  3. DKA = Rare
  4. Treatment = Lifestyle changes, Oral agents, Insulin
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2
Q

GENERAL

DIAGNOSIS

What are the (4) ways to Diagnose Diabetes Mellitus?

A
  1. TWO Fasting Glucose > 125
  2. ONE Random Glucose > 199 + Symptoms (polyuria, polydipsia, polyphagia)
  3. Abnormal Glucose Tolerance Test (2hr GTT with 75g Glucose Load)
  4. HgA1c > 6.5%
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3
Q

GENERAL

SCREENING

What is the Strongest Indication for Screening for Diabetes?

A

HgA1c > 6.5%

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4
Q

TYPE 2 DM

TREATMENT

What are the (3) Best INITIAL Therapies for Type 2 DM?

A

Diet

Exercise

Weight Loss

Of patients with Type 2 DM, 25% can be controlled with exercise and weight loss alone.

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5
Q

TYPE 2 DM

TREATMENT

What is the Best INITIAL Medical Therapy for Type 2 DM?

A

METFORMIN

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6
Q

TYPE 2 DM

TREATMENT

  1. What is the Mechanism of Action (MOA) for Metformin?
  2. What are (2) Benefits of Metformin?
A
  1. MOA = Blocks Gluconeogenesis
  2. Benefits:
    • No risk of Hypoglycemia
    • No added weight gain because it doesn’t increase the release of endogenous insulin
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7
Q

TYPE 2 DM

TREATMENT

Metformin is Contraindicated for which (2) situations?

A
  1. Renal Insufficiency: Metformin may accumulate and increase the risk of Lactic Acidosis.
  2. Use of Contrast Agents: Contrast may lead to Acute Renal Failure (ARF) and, therefore, to the accumulation of Metformin.
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8
Q

TYPE 2 DM

TREATMENT

What are the names of (3) Sulfonylurea medications used for Type 2 DM?

A
  1. Glyburide
  2. Glimepiride
  3. Glipizide
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9
Q

TYPE 2 DM

TREATMENT

  1. What is the Mechanism of Action (MOA) for Sulfonylureas? (e.g., glyburide, glimepiride, glipizide)
  2. What are (2) Adverse Effects of Sulfonylureas?
A
  1. MOA = Increase Release of Insulin from the Pancreas.
  2. Adverse Effects:
    • Hypoglycemia
    • SIADH
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10
Q

TYPE 2 DM

TREATMENT

What are (4) Dipeptidyl Peptidase IV (DPP-IV) Inhibitors used to treat Type 2 DM?

A
  1. Sitagliptin
  2. Linagliptin
  3. Alogliptin
  4. Saxagliptin
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11
Q

TYPE 2 DM

TREATMENT

  1. When can you use Dipeptidyl Peptidase IV (DPP-IV) Inhibitors for treating Type 2 DM?
    • (Sitagliptin, Linagliptin, Alogliptin, Saxagliptin)
  2. What is the Mechanism of Action (MOA) for DPP-IV medications?
A
  1. DPP-IV Inhibitors can be added as a second agent to Metformin.
  2. MOA:
    • ​​Block metabolism of Incretins (e.g., GLP)
    • Increase Insulin Release (causes weight gain)
    • Block Glucagon
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12
Q

TYPE 2 DM

BASIC SCIENCE CORRELATE

  1. What are (2) Types of Incretins?
  2. What is the Mechanism for Incretins?
A
  1. Glucagon-Like Peptides (GLPs) & Glucose Insulinotrpic Peptides (GIPs)
  2. MOA:
    • Increase Insulin Release and Decrease Glucagon Secretion from the Pancreas.
    • DPP-IV metabolizes GLP & GIP.
    • Inhibiting DPP-IV maintains high levels of GLP & GIP.
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13
Q

TYPE 2 DM

TREATMENT

What are (2) Thiazolidinedione medications used to treat Type 2 DM?

A

Rosiglitazone

&

Pioglitazone

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14
Q

TYPE 2 DM

TREATMENT

  1. What is the Mechanism of Action (MOA) for Thiazolidinediones?
  2. When are Thiazolidinediones contraindicated?
A
  1. MOA = Increase peripheral Insulin sensitivity
  2. Congestive Heart Failure (CHF) - may worsen CHF
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15
Q

TYPE 2 DM

TREATMENT

What are (2) Alpha-Glucosidase Inhibitor medications used to treat Type 2 DM?

A

Acarbose

&

Miglitol

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16
Q

TYPE 2 DM

TREATMENT

  1. What is the Mechanism of Action (MOA) for Alpha-Glucosidase Inhibitors?
  2. What are (4) Adverse Effects of Alpha-Glucosidase Inhibitors?
A
  1. MOA = Block the absorption of Glucose at the Intestinal lining.
  2. Adverse Effects:
    • Diarrhea
    • Abdominal pain
    • Bloating
    • Flatulence
17
Q

TYPE 2 DM

BASIC SCIENCE CORRELATE

What is the Mechanism of Diarrhea with Alpha-Glucosidase Inhibitors?

A
  • When Acarbose and Miglitol block glucose absorption, the sugar remains in the bowel, available to bacteria.
  • When bacteria eat the glucose, they cast off gas and acid.
  • Using Alpha-Glucosidase Inhibitors is like making a person Lactose Intolerant.
18
Q

TYPE 2 DM

TREATMENT

What are (2) Insulin Secretagogue medications used to treat Type 2 DM?

A

Nateglinide

&

Repaglinide

19
Q

TYPE 2 DM

TREATMENT

  1. What is the Mechanism of Action (MOA) for Insulin Secretagogues?
  2. What is an Adverse Effect of Insulin Secretagogues?
A
  1. MOA = Increase Release of Insulin from the Pancreas.
  2. Hypoglycemia

**These are very similar to Sulfonylureas**

20
Q

TYPE 2 DM

TREATMENT

  1. What are (3) SGLT Inhibitor medications used to treat Type 2 DM?
  2. What are (2) Adverse Effects of SGLT Inhibitors?
A
  1. Canagliflozin, Dapagliflozin, Empagliflozin
  2. Urinary Tract Infections (UTIs) and Vulvovaginal Candidiasis
21
Q

TYPE 2 DM

TREATMENT

  1. What are (4) GLP Analog medications used to treat Type 2 DM?
  2. What is the Mechanism of Action (MOA) for GLP Analogs?
  3. How are GLP Analogs administered?
A
  1. Dulaglutide, Exenatide, Liraglutide, Lixisenatide
  2. MOA = slow Gastric Emptying, promote Weight Loss, and Lower Glucose
  3. GLP Analogs are INJECTED
22
Q

TYPE 2 DM

TREATMENT

If none of the Type 2 DM medications sufficiently control the level of Glucose, what should you switch to?

A

INSULIN

23
Q

TYPE 2 DM

TREATMENT

What are (4) Long-acting Insulins used to treat Type 2 DM?

A
  1. Insulin Glargine (Lantus):once a day injection with an extremely steady-state level of insulin, used in combination with a very short-acting insulin at mealtime.
  2. NPH: twice a day
  3. Degludec:extremely long half-life; less frequent hypoglycemic episodes
  4. Detemir
24
Q

TYPE 2 DM

TREATMENT

  1. What are (3) Short-acting Insulin medications used to treat Type 2 DM?
  2. When are they given during the day?
  3. How long do they last?
A
  1. Lispro, Aspart, Glulisine
  2. Mealtime
  3. ~ 2 hours
25
Q

TYPE 2 DM

TREATMENT

What should you do when Insulin Monotherapy is not effective in controlling Type 2 DM?

A

Add METFORMIN

“start again with Metformin”

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