Diabetes

Question 1

Criteria for diabetes
Fasting BG
75g oral glucose tolerance test BG
A1C
Random BG with symptoms

Answer 1

Fasting >126
OGTT >200
A1C >6.5
Random BG >200 with symptoms

Question 2

Diabetic BG goals (A1C, pre and postprandial)

Answer 2

A1C < 7
preprandial 80-130
postprandial <180 (measured 1-2 hours after beginning of meal)

Question 3

Type 1 vs Type 2 Diabetes

Answer 3

Type 1- Autoimmune beta cell destruction, absolute insulin deficiency, LATA
Type 2- Progressive loss of beta cell insulin secretion, insulin resistnce

Question 4

Gestational diabetes

Answer 4

occurs in 2nd or 3rd trimester

Question 5

Recommended treatment regimen for Type 1 Diabetes

Answer 5

Multiple daily injections of prandial and basal insulin
OR
continuous sq insulin infusion pump
Rapid acting analogs to prevent hypoglycemia
Match prandial doses to carb intake, premeal BG, and anticipated physical activity

Question 6

Recommended treatment regimen Type 2 diabetes

Answer 6

Metformin preferred
Cardiac/Renal disease –> GLP-1/SGL-2 drugs
GLP-1 preferred over insulin

Question 7

pancreatic cells (gamma, beta, alpha)

Answer 7

gamma- somatostatin
beta- insulin
alpha- glucagon

Question 8

Glucagon MOA, SE

Answer 8

made by alpha cells of pancreas
Bind to G protein receptors on liver stimulate gluconeogensis and glycogenolysis
causes n/v

Question 9

Glyburide (glibenclamide)

Answer 9

Sulfonylurea for type 2 diabetics
bind to sulfonylurea receptors on beta cell of pancreas and stimulate insulin secretion
cause weight gain, nausea, skin rash, itching
Do not give to type 1 diabetics, hepatic impairment, renal insufficiency
black box increased CVD mortality

Question 10

Glipizide (glydiazinamide

Answer 10

sulfonylurea, for type 2 diabetics
bind to sulfonylurea receptors of beta cells of pancreas to stimulate insulin secretion
cause weight gain, nausea, skinrash, itching
do not give to pt with renal insufficiency, hepatic impairment
black box for CVD

Question 11

Glumepiride (Amaryl)

Answer 11

Sulfonylurea
bind to sulfonylurea receptors on pancreas to stimulate insulin secretion
SE: weight gain, nausea, itching, skin rash
Do not give to pt with hepatic/renal impairment
black box warning CV disease

Question 12

Sulfonylureas

Answer 12

Glipizide, Glyburide, Glimepiride

Question 13

Meglitinide

Answer 13

replaglinide (Prandin)
Same MOA as sulfonylureas but more rapid onset
Type 2 diabetics only
Contraindicated in hepatic/renal impairment

Question 14

Meglitinide

Answer 14

replaglinide (Prandin)
Same MOA as sulfonylureas but more rapid onset
Type 2 diabetics only
Contraindicated in hepatic/renal impairment

Question 15

D-phenulaline Derivative

Answer 15

Nateglinide (Starlix)
MOA: short term glucose dependent insulin secretion after meals, rapid onset
SE: weight gain
Contra: hepatic impairment

Question 16

Biguanides

Answer 16

Metformin
MOA: cAMP activated protein kinase to decreases hepatic gluconeogenesis, decrease intestinal glucose aborption and increases insulin sensitivity
GFR cannot be below 30
causes lactic acidosis

Question 17

TZDs

Answer 17

pioglitazone (Actos), rosiglitazone (Avandia)
MOA: increase insulin sensitivity in muscle, adipose tissue, and liver
SE: weight gain
Black box for CHF

Question 18

Alpha Glucosidase Inhibitors (acarbose and miglitol)

Answer 18

Acarbose (Precose)
miglitol (Glyset)
SE: farting
Contraindicated in IBG

Question 19

Dopamine receptor agonist

Answer 19

Bromocriptine mesylate
MOA: inhibit sympathetic tone, decreasing postmeal plasma glucose
For type 2 only
interact with antipsychotic meds, headache, vomiting, somnulence

Question 20

Colesevelam HCL (Welchol)

Answer 20

Bile acid sequestrant
MOA: bind to bile acid in intestine, impeding reabsorption
cause unpleasant taste, flatulence, constipation, tale with liquid

Question 21

GLP-1 Receptor Agonists

Answer 21

exenatide, liraglutide, gulaglutide, albiglutide, semaglutide
DO NOT GIVE with hx of medullary thyroid cancer
MOA: stimulates insulin secretion, decreased glucagon, decreased gastric emptying
CAUSES WEIGHT LOSS

Question 22

Dupeptidyl Peptidase-4 Inhibitors

Answer 22

“gliptin” stigliptin (Januvia), saxagliptin (onglyza), etc
Inhibit enzyme respsonsible for breakdown of GLP-1 and GIP –>increased insulin secretion and decreased glucagon
Do not use in hx of pancreatitis

Question 23

Pramlintide

Answer 23

Can be used for Type 1 and 2
Promotes weight loss
causes gastroparesis

Question 24

SGLT-2 Inhibitors

Answer 24

“flozin” (canagliflozin, dapagliflozin, empagliflozin (Jardiance), etc)
MOA: reduce glucose absorption in kidneys
Genitourinary yeast infections, UTI

Question 25

Total Daily Dose calculation

Answer 25

body weight (kg) x 0.55

Question 26

Basal vs bolus insulin

Answer 26

Basal=long acting (Lantus)
30-50% of TDD
Bolus=short acting (HumaLog/lispro)
10-20% of TDD

Question 27

Aspart (novolog), Lispro (humalog), glulisine (Apidra)

Answer 27

rapid acting insulin

200 u/mL

Question 28

Humulin R Novolin R

Answer 28

Short acting insulin

500u/mL

Question 29

NPH Humulin N Novolin N

Answer 29

Intermediate acting insulin

Question 30

Glargine (lantus) detemir (levemir)

Answer 30

Long acting insulin (300 u/mL)

Question 31

Afrezza

Answer 31

Inhaled insulin
contraindicated in pt with pulm disease
perform spirometry and FEV1 before (need at least 80% to go on, if it decreases by 20% while on, consider d/c)

Question 32

Diabetes mesd adjustments prior to surgery

Answer 32

Sulfonylureas: NO EVENING DOSE
insulin pumps: redue basal rates by 20% at midnight
Short/rapid acting (Humalog): NO BEDTIME DOSE