Chapter 38: Diabetes Flashcards
What are the four long-term microvascular complications of diabetes?
- Nephropathy
- Retinopathy
- Peripheral neuropathy - increases risk for foot infections and amputations
- Autonomic neuropathy - ED, gastroparesis, loss of bladder control, UTIs
What are the three long-term microvascular complications of diabetes?
- CAD - MI, HF
- Cerebrovascular disease - TIA, stroke
- Peripheral artery disease
All of the following would qualify a patient with a diagnosis of pre-diabetes, EXCEPT: (Select all that apply)
A. HbgA1c 6.4% B. FPG 110 mg/dL C. 2-hr oral glucose tolerance test of 180 mg/dL D. HgbA1c 5.5% E. FPG 130 mg/dL
D and E are the exceptions
The criteria for diagnosis of pre diabetes is as follows:
FPG: 100-125mg/dL
A1c: 5.7-6.4%
2-hr OGTT: 140-199 mg/dL
Which of the following statements about diabetes is correct? (Select all that apply)
A. Classic Sx of DM are polyuria, polyphagia, and polydipsia
B. A1C ≥ 6.3% is diagnostic for DM
C. Type 1 DM is caused by autoimmune destruction of pancreatic beta cells
D. FPG goals for DM in pregnancy are more relaxed than in non-pregnant patients with DM
E. Fluoroquinolones can both increase and decrease blood glucose
A, C, and E are correct
Criteria for diagnosis of DM is as follows:
Classic Sx AND a random plasma glucose ≥ 200 mg/dL
FPG: ≥ 126 mg/dL
A1c: ≥ 6.5%
2-hr OGTT: ≥ 200 mg/dL
Must repeat test for true diagnosis for all criteria except if patient presents with classic Sx and random ≥ 200 mg/dL
Propranolol and octreotide are more examples of drugs that can both raise and lower blood glucose.
B and D are incorrect
As mentioned above, diagnosis of DM based on A1c must be ≥ 6.5%.
FPG goals for DM in pregnancy are actually MORE stringent than DM patients without DM. If patient develops DM during pregnancy (gestational DM) fasting goal is ≤ 95 mg/dL, 1 hr post-meal ≤ 140mg/dL, and a 2 hr post-meal ≤ 120 mg/dL. If patient develops DM prior to pregnancy (pre-gestational DM) fasting goal is 60-99 mg/dL, A1c 6-6.5%, and peak postprandial 100-129 mg/dL.
Which of the following drugs can raise blood glucose levels
A. Geodon® B. Atazanavir C. Linezolid D. Simvastatin E. Prograf®
A, B, D, and E are correct.
Atypical antipsychotics such as ziprasidone (Geodon®), olanzapine, clozapine, quetiapine, etc. can raise blood glucose levels along with protease inhibitors atazanavir (Reyataz®), statins, and tacrolimus (Prograf®)
C is incorrect
Linezolid can actually lower blood glucose
Which of the following is correct regarding DM?
A. DM patients have increased rates of hospitalizations and mortality from influenza and pneumococcal disease
B. Niacin, posaconazole, and HCTZ can raise blood glucose
C. First degree relative with DM is a risk factor for T2DM
D. Men and women with DM ≥ 50 y/o with one additional risk factor should receive ASA 81mg as primary prevention of CVD
E. Goal BP for patients with DM is
A, B, C, D are correct
ASA should be considered for primary prevention in patients with T1DM and T2DM who have 10-year CVD risk > 10% which includes men and women ≥ 50 y/o with DM and one additional risk factor (smoking, HTN, family hx of CVD, dyslipidemia, or albuminuria).
E is incorrect
Goal BP for DM patients is
Type 2 DM is much more common than type 1 DM and is associated with obesity, physical inactivity, and family history. Which of the following statements about T2DM is true? (Select all that apply)
A. Due to insulin resistance
B. Due to insulin deficiency
C. Due to autoimmune destruction of pancreatic beta cells
D. Characterized by gradual decline in insulin production
E. One of the leading causes of CKD
A, B, D, and E are correct
T1DM is characterized by autoimmune destruction of pancreatic beta cells
What alternative antiplatelet therapy is recommended for primary prevention of CVD in DM patients with a 10-year risk > 10% if the patient has an aspirin allergy?
Clopidogrel 75mg daily
Jorge, a 38 y/o male, presented to his PCP c/o of “peeing all the time and constantly being thirsty.” His PCP took a random plasma glucose and A1c and the results are as follows:
Random plasma glucose: 310 mg/dL
A1c: 10.2%
Jorge’s PCP diagnoses him with T2DM. Which of the following statements is correct? (Select all that apply)
A. Jorge should be counseled on lifestyle modifications such as DM education, exercise, weight loss, and healthy diet
B. Jorge should be started on metformin, long-acting basal insulin, and mealtime insulin
C. Jorge should be started on a two drug regimen such as metformin and sitagliptin
D. Jorge does not need medication at this time and should only be counseled on lifestyle modifications. If Jorge is not at A1c goal after 3 months, initiate medication therapy
E. Jorge should be banned from McDonalds
A, B, and E are correct
Given the patient’s significantly elevated random plasma glucose and A1c, this patient should be started both metformin and insulin. If the patient’s A1c was ≥9% (but less than 10%), the PCP could consider starting the patient on 2 oral DM medications instead of insulin. This patient should not be allowed to step foot in a McDonalds.
C and D are incorrect
All of the following drugs can lower blood glucose, EXCEPT? (Select all that apply)
A. Lasix® B. Pentamidine C. Belviq® D. Ciprofloxacin E. Itraconazole
A and E
Loop diuretics and azole antifungals can raise blood glucose, not lower it
Pentamidine, lorcaserin (Belviq®), and FQ’s can lower blood glucose. FQ’s can raise blood glucose as well.
Pentamidine (Pentam®) is an IM/IV antifungal agent indicated for the treatment of pneumocystis jirovecii pneumonia (PCP).
Jorge, a 38 y/o male, presented to his PCP c/o of “peeing all the time and constantly being thirsty.” His PCP took a random plasma glucose and A1c and the results are as follows:
Random plasma glucose: 310 mg/dL
A1c: 10.2%
Jorge’s PCP diagnoses him with T2DM. Which of the following vaccinations is indicated for Jorge assuming he received all of his childhood vaccinations, but hasn’t had any vaccine in 11 years? (Select all that apply)
A. Fluzone B. Havrix C. Recombivax D. Pneumovax E. Td
A, D, and E
Jorge is due for a Td booster shot since the question states he hasn’t received any vaccinations in the past 15 years. Since being diagnosed with T2DM, Jorge should receive influenza (Fluzone), pneumococcal (Pneumovax), and Hep B (Recombivax).
B and C are incorrect
Havrix is the vaccination for Hep A. Hep A vaccination is not indicated for patients with DM.
Recombivax is the vaccination for Hep B. UNVACCINATED adults with DM aged 19-59 should receive the Hep B vaccine. The question clearly states that this patient received ALL of his childhood vaccinations, which according to the CDC, includes the 3-dose series for Hep B.
Jorge, a 38 y/o male, presented to his PCP c/o of “peeing all the time and constantly being thirsty.” His PCP took a random plasma glucose and A1c and the results are as follows:
Random plasma glucose: 310 mg/dL
A1c: 10.2%
Based on Jorge’s A1c reading, what was his estimated average blood glucose over the past 2-3 months?
A. 180 B. 200 C. 205 D. 245 E. 300
D. 234
A1c Average Glucose 6 126 126/6 = 21 7 154 8 183 9 212 10 240 11 269 12 298 298/12 = 25
I estimated multiplying 10.2% by 24 to give me 245
Brand and drug class of canagliflozin?
canagliflozin (Invokana®) 100mg PO daily prior to first meal of the day
SGLT2-inhibitor
Sodium glucose co-transporter-2 is located in the proximal renal tubules and is responsible for the majority of filtered glucose reabsorption. Inhibiting this transporter increases urinary excretion of glucose.
Brand and drug class of dapagliflozin?
dapagliflozin (Farxiga®) 5mg PO daily in the AM
SGLT2-inhibitor
Sodium glucose co-transporter-2 is located in the proximal renal tubules and is responsible for the majority of filtered glucose reabsorption. Inhibiting this transporter increases urinary excretion of glucose.
Brand and drug class of empagliflozin?
empagliflozin (Jardiance®) 10mg PO daily in AM
SGLT2-inhibitor
Sodium glucose co-transporter-2 is located in the proximal renal tubules and is responsible for the majority of filtered glucose reabsorption. Inhibiting this transporter increases urinary excretion of glucose.
Which of the following are SE of SGLT2 inhibitors? (Select all that apply)
A. Hypoglycemia B. UTIs C. Weight gain D. Hepatotoxicity E. Genital mycotic infections
A, B, and E are correct
SGLT2-inhibitors have a low risk of hypoglycemia, serious UTIs, and genital mycotic infections (fungal infections). Increased urination and thirst, symptomatic hypotension (from volume depletion –> increased urinary glucose excretion –> water follows glucose out –> boom, volume depleted), and DKA have also been reported.
C and D are incorrect
SGLT2-inhibitors can actually cause weight LOSS, not gain. There is no risk of hepatotoxicity, however, all SGLT2-inhibitors are CI in severe renal impairment (CrCl
Which SGLT2-inhibitor should be avoided in a patient with hyperkalemia?
canagliflozin (Invokana®) can increase risk of hyperkalemia and should be avoided in patients with elevated K+
From Invokana® package insert:
INVOKANA® can lead to hyperkalemia. Patients with moderate renal impairment who are taking medications that interfere with potassium excretion or medications that interfere with the renin‐angiotensin‐aldosterone system are more likely to develop hyperkalemia. Monitor serum potassium levels periodically in patients with impaired renal function and in patients predisposed to hyperkalemia due to medications or other medical conditions.
