7-13 Diabetes Mellitus

Question 1

Definition of DM:
HgbA1c:
Fasting glucose:
OGTT 2h glucose:
Single random glucose:

Answer 1

HgbA1c ≥ 6.5
Fasting glucose ≥ 126
OGTT 2h glucose ≥ 200
(HgbA1c, fasting glucose, OGTT 2h glucose: all of these need be done TWICE to meet definition requirements)
Single random glucose ≥ 200 with symptoms of hyperglycemia

Question 2

Definition of “pre diabetes”
HgbA1c:
Fasting glucose:
2h prandial glucose:

Answer 2

HgbA1c: 5.7-6.4%
Fasting glucose: 100-125
2h prandial glucose: 140-199

Question 3

3 autoantibodies that are positive in Type 1 diabetes:

Answer 3

anti-GAD
anti-islet cell
anti-insulin

Question 4

What is Flatbush diabetes?

Answer 4

“Type 2 DM presenting with DKA”

Question 5

What is the other name for “Type 2 DM presenting with DKA”

Answer 5

Flatbush diabetes or ketosis-prone type 2 diabetes

Question 6

Which population is Flatbush diabetes more often seen in?

Answer 6

Non-white

Anti-GAD antibodies can be positive or negative

Question 7

What is MODY?

Answer 7

Mature Onset Diabetes of the Young

Autosomal dominate forms of DM due to defects in insulin secretion genes

Question 8

6 secondary causes of diabetes

Answer 8

Exogenous glucocorticoids
Glucagonoma (DM, DVT, diarrhea)
Pancreatic (pancreatitis, hemochromatosis, cystic fibrosis, pancreatic resection)
Endocrinopathies (Cushing’s disease, acromegaly)
Gestational
Drugs (protease inhibitors, atypical antipsychotics)

Question 9

The 3 D’s of glucagonoma

Answer 9

DM, DVT, diarrhea

Question 10

Clinical manifestations of diabetes mellitus

Answer 10

Polyuria, polydipsia, polyphasic with unexplained weight loss (can also be asymptomatic)

Question 11

Metformin
Class:
Mechanism of action:
Decrease in HgbA1c:
Side effects:
Contraindications:

Answer 11

Biguanide
Decreases hepatic gluconeogenesis
1.5%
Weight neutral, nausea/vomiting/diarrhea, rare lactic acidosis
Contraindicated in renal failure (creatinine >1.5, GFR <45/30), liver failure

Question 12

Sulfonylureas
MOA:
Decrease in HgbA1c:
Side effects:

Answer 12

Increases insulin secretion (blocks potassium channels)
1.5%
Hypoglycemia, weight gain

Question 13

Thiazolidinediones
MOA:
Decrease in HgbA1c:
Side effects:
Contraindications:

Answer 13

PPAR-gamma agonists; increases insulin sensitivity in adipose and muscle
1%
Weight gain, hepatotoxicity, fluid retention and CHF, bone fractures, questionable increase in MI with rosiglitazone (not pioglitazone)
Contraindicated in liver disease and NYHA III-IV, monitor LFTs

Question 14

GLP-1 agonists
MOA:
Decrease in HgbA1c:
Side effects:

Answer 14

Increases glucose-dependent insulin secretion
0.5%
Decreases CV events, weight loss, N/V/D

Question 15

DPP-4 inhibitors
MOA:
Decrease in HgbA1c:
Side effects:

Answer 15

Blocks degradation of GLP-1 and GIP to increase insulin
0.5%
Questionable increased risk of CHF with some

Question 16

SGLT-2 inhibitors
MOA:
Decrease in HgbA1c:
Side effects:

Answer 16

Sodium-glucose co-transporter-2 inhibitors

Blocks renal tubular glucose uptake