3 - Diabetes

Question 1

What are the diagnostic parameters for a diagnosis of DMII?

Answer 1

Fasting glucose > 126

Casual plasma > 200 AND s/s of diabetes

Hgb A1C of 6.5 or higher

Question 2

In regards to meals, when should lispro be taken?

When should regular insulin be taken?

Answer 2

Lispro: immediately before or after meals

Regular: 30-60 min before meals

Question 3

Which non-insulin diabetes medication is used in pregnant women?

Answer 3

Metformin is the ONLY ONE

Question 4

What is the MOA of metformin?

Answer 4

Inhibits glucose production in the liver

Sensitizes tissues to insulin

Question 5

Is hypoglycemia a concern with metformin?

Answer 5

NO

It does not actively lower blood glucose levels

Question 6

Metformin carries a black box warning for:

Answer 6

metabolic acidosis with accumulation

Patients with renal failure are particularly at risk

Question 7

Why has metformin historically been held pre-operatively?

Answer 7

Fear of hypoglycemia and lactic acidosis

Question 8

Should you continue metformin if a patient is admitted to the hospital?

Answer 8

No. Patients are going to undergo significant changes in medications, hemodynamics, and nephrotoxic drugs/events

Its not worth the risk inpatient

Question 9

If a patient with Type 1 diabetes has hypertension, what would be the first line drug?

Answer 9

ACE-I, or an ARB if unable to tolerate

Helps reduce the risk of CV incidents and nephropathy, even without HTN

Question 10

What are C-peptides, and how are they useful in diabetes management?

Answer 10

When the body produces insulin, the last step is cleaving the C peptide, converting proinsulin to insulin

Measuring C peptides allows us to analyze how much insulin is being made endogenously

Question 11

Activation of ______ adrenergic receptors promotes insulin release

Activation of __________ adrenergic receptors inhibits insulin release

Answer 11

Beta 2 promotes

Alpha 2 inhibits

Question 12

Activation of ______ adrenergic receptors promotes insulin release

Activation of __________ adrenergic receptors inhibits insulin release

Answer 12

Beta 2 promotes

Alpha 2 inhibits

Question 13

If the goal of beta 2 activation is to provide the body with glucose, why would it trigger insulin secretion?

Answer 13

Beta 2 activation also triggers glycogenolysis and increased glucose production, so the effect of the insulin isn’t meant to decrease blood glucose levels. It’s meant to facilitate movement of that released glucose into cells

Question 14

Insulin has two anabolic effects:

Answer 14

1. stimulates cellular uptake of glucose, AAs, nucleotides, and potassium
2. promotes synthesis of complex organic molecules

Question 15

Insulin deficiency causes a _______ state

Answer 15

catabolic

Question 16

Describe the catabolic effects of insulin deficiency:

Answer 16

Glycogen is converted into glucose (hyperglycemia)

Proteins are broken down into AAs (muscle wasting)

Fats are converted to glycerol and free fatty acids (hyperlipidemia)

Question 17

Only one long acting insulin is appropriate for mixing with short acting insulins:

Answer 17

NPH

Question 18

Why do we always draw clear to cloudy?

Answer 18

Because accidentally contaminating rapid insulin with long acting could be catastrophic, whereas the reverse would a small amount of rapid insulin in NPH is unlikely to cause damage

Question 19

BIGUANIDES

MOA & DRUG LIST

Answer 19

1. Inhibits glucose production in the liver
2. Reduces glucose absorption in the gut (slight)
3. Sensitizes insulin receptors in fat tissues and skeletal muscles increasing glucose uptake in response to insulin

METFORMIN

Question 20

What are the most common side effects of Metformin?

Answer 20

N/V/D

Decreased absorption of Vit B12, which may lead to worsened peripheral neuropathy

Question 21

Metformin carries a black box warning for:

Answer 21

Severe metabolic acidosis

Question 22

What are the therapeutic uses of Metformin?

Answer 22

1. Glycemic control
2. Prevention of DM2 in overweight persons
3. Gestational Diabetes
4. PCOS

Question 23

Which oral agent is usually initiated at diagnosis of Type II DM, before lifestyle changes are attempted?

Answer 23

Metformin

Question 24

Which classes of oral noninsulin drugs act by increasing insulin release from Beta cells?

Answer 24

The insulin secretagogues:

Sulfonylureas and Glinides

Question 25

Which classes of oral noninsulin drugs do not drive down blood glucose?

Answer 25

Biguanides

Alpha glucosidase inhibitors

SGLT-2 inhibitors

Question 26

SULFONYLUREAS

MOA & DRUG LIST

Answer 26

Glipizide, Glimepiride, Glyburide

Stimulate release of insulin from pancreatic islets by blocking ATP-sensitive K channels, resulting in depolarization and release of insulin

Question 27

What are the main side effects of Sulfonylureas?

Answer 27

Hypoglycemia and weight gain

Question 28

MEGLITINIDES

MOA & DRUG LIST

Answer 28

Repaglinide

Have the same MOA of sulfonylureas, but have a different duration

shorter acting and taken with each meal

Question 29

ALPHA GLUCOSIDASE INHIBITORS

MOA & DRUG LIST

Answer 29

Acarbose, Miglitol

Act in the intestines to delay absorption of carbohydrates

Alpha glucosidase is the enzyme in the intestines that breaks down carbs into monosaccharides

Question 30

What are the main side effects of Acarbose?

Answer 30

GI stuff! Makes sense!

Bacteria ferment all the unabsorbed carbs in the gut, leading to excessive flatulence, rumbling, cramps, diarrhea, and distention

Question 31

SGLT-2 INHIBITORS

MOA & DRUG LIST

Answer 31

-liflozin

SGLT-2 is a transporter in the kidney that performs about 90% of glucose reabsorption

Question 32

Which patients should not take SGLT-2 Inhibitors?

Answer 32

Patients with a history of frequent UTIs or bacteriuria

Question 33

GLIPTINS

MOA & DRUG LIST

Answer 33

Januvia

Reduces breakdown of incretin hormones, which stimulate insulin release and suppress postprandial release of glucagon