B14-2 Diabetes

Question 1

Normal fasting blood glucose level?

Answer 1

70-100 mg/dl

Question 2

Pre-diabetic fasting blood glucose level?

Answer 2

101-125 mg/dl

Question 3

Diabetic fasting blood glucose level?

Answer 3

> 125 mg/dl

Question 4

Normal A1C?

Answer 4

5.7% or lower

Question 5

Pre-diabetic A1C?

Answer 5

5.7 - 6.4 %

Question 6

Diabetic A1C?

Answer 6

6.4% or higher

Question 7

What are the ADA guidlines goals for a diabetic?

Answer 7

< 6.5% A1C & fasting glucose under 130mg/dl

Question 8

Which type of diabetic is more prone to ketoacidosis?

Answer 8

Type 1

Question 9

How are Type 1 diabetics treated?

Answer 9

Insulin

Question 10

How are Type 2 diabetics treated?

Answer 10

Typically oral meds, reserving insuline for a “last resort” type of treatment

Question 11

Name the “meal time” insulin therapys along with their onset and durations

Answer 11

• Lispro is Rapid acting (15 minute onset) and Regular insulin is short acting (30 minutes), both work for 4-6 hours

Question 12

Name the “basal” insulin therapys along with their dosing schedule, onset, and duration

Answer 12

• NPH is “intermediate” so it’s dosed b.i.d with a 1.5 hour onset and 12 hour duration
• Glargine is “Long acting” so it’s dosed q.d with a 2 hour onset and 24 hour duration

Question 13

Name the DOC for diabetes. What type of drug is it? How does it work? What (primarily) makes it the DOC? Side effects and contraindications/precautions to be aware of?

Answer 13

• Metformin, a Biguanide
• activates “AMPK” which decreases hepatic glucose output while increasing peripheral glucose uptake
• Has no affect on insulin or pancrease, so NO RISK OF HYPOGLYCEMIA
• Diarrhea (very common) and lactic acidosis (rare), do NOT give in renal or liver failure and avoid with/after IV contast

Question 14

Name the insulin secretagogues. How do they work? Any side effects?

Answer 14

• Glipizide (Sulfonylurea) & Repaglinide (Meglitinide)
• MOA: works on B-cells to increase insulin secretion (by blocking ATP-sensitive K+ channels )
• Side Effects: Sever Hypoglycemia and weight gain

Question 15

What kind of drug is Acarbose? MOA? Side effects?

Answer 15

• Alpha-glucosidase inhibitor
• Inhibits alpha-glucosidase in the intestine to prevent digestion of complex-carbs & control post-pandial spikes
• GI issues

Question 16

What kind of drug is Exenatide? Side effects? Contraindications?

Answer 16

• GLP-1 Analog (aka incretin-mimetic)
• MOA: stimulates glucose-dependent insulin secretion
• SE: Weight-loss
• Contraindications: Hx of acute pancreatitis or thyroid tumors

Question 17

What kind of drug is Sitagliptin? MOA?

Answer 17

• DDP-4 inhibitor

- Slows inactivation of incretin hormones to increase glucose output and decrease glucagon

Question 18

What kind of drug is Canagliflozin? MOA? Side Effects?

Answer 18

• SGLT2 inhibitor
• Acts in the kidney (so renally adjust) to prevent glucose reabsorption
• UTI’s (excessive glucose in the urine)