Diabetes 1

Question 1

What cells in the pancreas secrete insulin?

Answer 1

B cells

Question 2

What cells in the pancreas secrete glucagon

Answer 2

Alpha cells

Question 3

released in the small
intestines after food ingestion,
stimulate insulin secretion when
the blood glucose is above the
fasting level

Answer 3

Incretins (glucagon-like peptide
1= GLP1)

Question 4

How does insulin affect glucose levels?

Answer 4

Stimulates glucose to be formed into glycogen which decreases glucose

Question 5

How does glucagon affect glucose levels?

Answer 5

Stumiulates glycogen breakdown into glucose which increases glucose

Question 6

—
◦ Absolute deficiency of insulin resulting from autoimmune destruction of pancreatic B
cells = insulin deficiency
◦ Commonly occurs in childhood and adolescence.
◦ Without insulin treatment patients will ultimately die of diabetic ketoacidosis

Answer 6

Type 1 (T1DM)

Question 7

Is insulin necessary for T1DM?

Answer 7

Yes

Question 8

◦ Hyperglycemia due to insulin resistance (proceeds overt disease) + progressive loss of
insulin secretion
◦ May have normal, increased (hyperinsulinemia) or decreased insulin levels due to
abnormal beta cell function
◦ Most commonly presents in adulthood and in obese patients
◦ Managed with diet, oral/subcutaneous (SC) antidiabetic agents and insulin SC
◦ Accounts for ~ 95% of individuals with diabetes > 30 years
◦ Alarming increases T2DM in obese children and adolescents
◦ Can be delayed or prevented with lifestyle modifications – diet, physical activity and
weight control
— Other forms (e.g. gestational diabetes, medications - glucocorticoids)

Answer 8

Type 2 (T2DM)

Question 9

What is the njmber cause of death in diabetes pts?

Answer 9

Heart disease

Question 10

is
a simple lab test that
shows the average
amount of glucose in a
person’s blood over the
last 3-4 months.

Answer 10

A1C

Question 11

What is a normal A1C?

Answer 11

5.6 or below

Question 12

What is prediabetic A1C?

Answer 12

5.7-6.4

Question 13

What is diabetic A1C?

Answer 13

6.5 or more

Question 14

What is the ideal A1C to get a diabetic pt to? (goal)

Answer 14

<7%

Question 15

What is the fasting glucose goal for a diabetic?

Answer 15

80-130

Question 16

What is the postprandial glucose goal for a diabetic?

Answer 16

180

Question 17

What type of insulin are insulin lispro, insulin aspart, and insulin glulisine?

Answer 17

Rapid acting insulin

Question 18

What type of insulin are humilin R and Novolin R?

Answer 18

Short acting insulin

Question 19

— Rapid acting insulin – given with meals
— Oral inhalation
— Amount of insulin delivered to lungs
depends on individual factors
— Dosing conversion from injected
insulin
— Contraindicated in chronic lung
disease (asthma/COPD)
— Not recommended in smokers
— Risk of bronchospasms and cough
— EXPENSIVE!

Answer 19

Inhaled insulin (Afrezza)

Question 20

What type of insulin is NPH : Novalin N and Humalin N?

Answer 20

INtermediate (NPH) acting insulin

Question 21

WHat type of insulin is insulin glargine, insulin detemir, and insulin glargine?

Answer 21

Long acting insulin

Question 22

What type of insulin is insulin degludec?

Answer 22

Ultra long acting insulin

Question 23

Is long acting insulin used as bolus or basal dose?

Answer 23

Basal dose

Question 24

Is short acting insulin used as bolus or basal dose?

Answer 24

Bolus dose

Question 25

— Growing use - primarily in T1DM — Deliver exogenous insulin that more closely approximates the normal biologic function and performance of the pancreas ◦ devices only use short- or rapid-acting acting insulin as basal insulin with continuous delivery with bolus administration as needed — Programed external pump - worn continuously ◦ Delivers insulin through a cannula inserted just beneath the surface of the skin ◦ One injection site for 72 hrs — Advantages ◦ Improved glycemic control ◦ Decreased A1c ◦ Decreased risk of hypoglycemia — Many pumps have Continuous Glucose Monitoring (CGM) system integrated within the pump or they can be used separately

Answer 25

Continuous insulin infusion pumps

Question 26

◦ Compact medical systems that continuously monitor glucose in almost real time – Readings generally at 5-minute intervals – Small sensor with with a cannula is inserted into arm or abdomen – replaces every 10-14 days (secured with adhesive) – Reusable transmitter sends readings wirelessly, usually to phone, computer or other monitoring device – Alerts can be sent to notify of low or high glucose (or customized) and can share device data with providers, parents, etc. – Used by patients with either T1DM or T2 DM – Insurance coverage varies with T2DM

Answer 26

Continuous glucose monitoring (CGM)

Question 27

Do T1DM require lower or higher doses of insulin?

Answer 27

Lower doses

Question 28

◦ Highest risk of any diabetes medication ◦ Tighter control (of glucose) = é risk of hypoglycemia ◦ Symptoms: shaky/tremors, confusion, nervous, sweating, clamminess, light headed/dizziness, fatigue, sleepiness, agitation, anxiety, hunger, nausea tingling or numbness (especially of lips and tongue), vision changes, headache, anger/stubbornness, sadness, tachycardia ◦ Severe may result in seizures or loss of consciousness

Answer 28

Hypoglycemia

Question 29

What is the blood glucose that is a serious clinical event?

Answer 29

Less than 54 mg/dL

Question 30

What is the blood glucose that is a glucose alert value?

Answer 30

Less than 70 mg/dL

Question 31

— MOA ◦ Keeps the liver from releasing too much glucose ◦ ̄ Hepatic glucose production (gluconeogenesis – markedly increased in Type 2) – PRIMARY MECHANISM ◦ Decreases insulin resistance (increases insulin sensitivity)- glucose utilization in muscle and adipose tissues ◦ Inhibits intestinal absorption of glucose — Often a drug of choice in Type 2 (especially in obese patients) ◦ Lower cost ◦ Effective A1C lowering for oral agent — Use in pre-diabetes (decreases risk of progression to DM) — Weight neutral/ameliorates insulin-associated weight gain — Low risk of hypoglycemia with monotherapy — Notable GI adverse drug effects (ADEs) such as diarrhea/loose stools, flatulence, dyspepsia, abdominal distension/pain, nausea/vomiting ◦ Titrating the dose up slowly can help patients tolerate and taking with food can help minimize ◦ Some patients can’t tolerate and must discontinue therapy – XL formulation may cause less GI side effects — Risk of B12 deficiency (should be checked annually) — Rare risk of causing lactic acidosis ◦ watch with dehydration ◦ contraindicated in chronic kidney disease (GFR < 30 ml/min), caution with GFR between 30-45 ml/min)

Answer 31

Metformin

Question 32

— MOA (Secretagogues) ◦ Help the pancreas release more insulin which lowers glucose ◦ Stimulate beta cells causing insulin secretion — Lower fasting and post-prandial glucose

Answer 32

Sulfonylureas (SU) — Glimepiride, glyburide and glipizide (2nd generation)

Question 33

Glimepiride, glyburide and glipizide are what class of drug?

Answer 33

Sulfonylureas

Question 34

— Similar to sulfonylureas but shorter acting – taken with meals ◦ hold dose if skipping meals — MOA (Secretagogues) ◦ Increase insulin release in response to food, keeping blood glucose from rising too high after meals — Lower post-prandial glucose

Answer 34

Meglitinides — Nateglinide, repaglinide

Question 35

What class of drugs are — Nateglinide, repaglinide?

Answer 35

Meglitinides

Question 36

— MOA ◦ Increase glucose uptake into muscles by enhancing the effectiveness of endogenous insulin ◦ bind to nuclear receptor – peroxisome proliferator-activated receptor γ (gamma) - (PPARγ) in adipose, muscle and liver ◦ Reduce glucose output — Low risk of hypoglycemia when used as monotherapy

Answer 36

Thia-zolidine-diones (glitazones, TZDs) — Pioglitazone and rosiglitazone

Question 37

What are the following drugs classified as Pioglitazone and rosiglitazone?

Answer 37

Thia-zolidine-diones (glitazones, TZDs) —

Question 38

— MOA ◦ Inhibit glucagon release which results in insulin secretion, decreased gastric emptying and decreased blood glucose levels — Hypoglycemia with monotherapy – low risk

Answer 38

Dipeptidyl-Peptidase-4 Inhibitors (DPP-4 inhibitors, “gliptins”) — Alogliptin, Linagliptin, Saxagliptin Sitagliptin

Question 39

What are the following drugs classified as? Alogliptin, Linagliptin, Saxagliptin Sitagliptin

Answer 39

Dipeptidyl-Peptidase-4 Inhibitors (DPP-4 inhibitors, “gliptins”) —

Question 40

- MOA — Located in the S1 segment of the proximal renal tubule — SGLT2 -responsible for 90% of glucose reabsorption — MOA - Blocks glucose reabsorption in the kidney, increases urinary excretion of glucose ◦ Block sodium reabsorption — Results in increased urinary excretion of glucose

Answer 40

Sodium glucose cotransporter-2 (SGLT2) inhibitors

Question 41

What type of drug are the flozins Canagliflozin, dapagliflozin, empagliflozin, ertugliflozin?

Answer 41

Sodium glucose cotransporter-2 (SGLT2) inhibitors

Question 42

— Most options available as injections (sc) only — Semaglutide available sc and po — Dosing frequency varies – BID, daily and weekly depending on medication and formulation — MOA: increases insulin secretion in response to elevated glucose, decreases glucagon secretion, slows gastric emptying

Answer 42

Glucagon Like Peptide-1 Receptor Agonists (GLP 1-RA, “incretin mimetics” - Glutides) — Albiglutide, Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide

Question 43

—What type of drugs are these? Albiglutide, Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide

Answer 43

Glucagon Like Peptide-1 Receptor Agonists (GLP 1-RA, “incretin mimetics” - Glutides)