DIABETES

Question 1

AUTOIMMUNE PROCESS INVOLVING BETA CELL DESTRUCTION CAUSING INSULIN DEFICIENCY

Answer 1

Type 1 diabetes

Question 2

INSULIN RESISTANCE WITH EVENTUAL INSULIN DEFICIENCY

Answer 2

type 2 diabetes

Question 3

Patient may complain of unexplained weight loss, ketonuria, and the polys (polydipsia, polyuria, polyphagia)

Answer 3

Type 1 diabetes mellitus

Question 4

When should you begin screening for diabetes?

Answer 4

45 years of age UNLESS risk factors are present

-if results return normal then testing should be repeated at LEAST 3 year intervals

Question 5

When do you use insulin in patients with type 1 diabetes?

Answer 5

Always
basal insulin with adjustments for meals via injections or pump
basal - long acting 50% total daily
bolus - rapid acting 50% total daily

Question 6

What type of insulin is humalog and what is the onset of action time?

Answer 6

short acting, 15 mins, peaks at 1 hr, lasts 4 h

Question 7

What type of insulin is humulin R, Novolin R and what is the onset of action?

Answer 7

short acting but NOT rapid
30 min onset
2-3h peak
3-6 hour duration

Question 8

What type of insulin is levemir and/ or lantus, onset of action?

Answer 8

Long acting
onset 1-2 hours
No peak
Lasts 24 h approximately 
preferred basal insulin form

Question 9

What type of insulin is Humulin N or Novolin N or NPH/regular insulin ?

Answer 9

intermediate acting 
regular = IV use 
onset is 1-2 h
Peak = 6-14h
Duration = 16-24h

Question 10

What is the step 1 pharmacotherapy recommended by the ADA in type 2 diabetes?

Answer 10

Metformin

especially if A1C is <9%

Question 11

A patient presents with velvety appearing, hyperpigmented-plaques, mostly in his axillary region, nape of neck, and has been present for some time.. what is the most likely diagnosis?

Answer 11

Acanthosis nigricans
What lab should you draw based on this diagnosis?
-Hemoglobin A1C
-secondary to high blood insulin levels
-could be steroid use, adrenal issue, or thyroid problem

Question 12

Describe motivational interviewing

Answer 12

support changes in a person that is consistent with their own values and concerns 
reflective listening 
roll with resistance
express empathy 
partner with patient 
explore negative side of ambivalence 
open-ended questions
affirming statements-recognize strengths

Question 13

Large waistline, hypercholesteremia, HTN, low HDL, - all describe what?

Answer 13

metabolic syndrome

Question 14

What are you at risk for if in metabolic syndrome?

Answer 14

increased risk of cardiac events

cerebral vascular disease

Question 15

Metformin is what type of drug

Answer 15

Biguanide

improves insulin mediate glucose uptake and metabolic parameters such as fibrinolysis

usually reduces Ha1c about 1-2%

Question 16

Adverse effects of Biguanide or metformin

Answer 16

Most common = GI upset and diarrhea

early use in metabolic syndrome can help delay onset of T2dm

Question 17

What is a concern with the use of Metformin

Answer 17

rare development of lactic acidosis

person with renal impairment is more likely to have lactic acid cleared effectively

any disease causing decreased perfusion increases risk

Question 18

Describe and list medications in the Sulfonylureas drug class

Answer 18

Ex: glipizide, glyburide, glimepriride

MOA: act as insulin secretagogue, resulting in release of insulin for pancreatic beta cells

renally excreted = adjust dose in renal impairment

require functioning pancreatic beta cells to be effective

less effective during hyperglycemic episodes like acute illness

Question 18

Describe and list medications in the Sulfonylureas drug class

Answer 18

Ex: glipizide, glyburide, glimepriride

MOA: act as insulin secretagogue, resulting in release of insulin for pancreatic beta cells

renally excreted = adjust dose in renal impairment

require functioning pancreatic beta cells to be effective

less effective during hyperglycemic episodes like acute illness

Question 19

GLP-1 agonists or incretin mimetics

Answer 19

stimulates insulin production in response to plasma glucose
slows gastric emptying

exenatide BYETTA
Liraglutide VICTOZA
Injection only

promptly discontinue if pancreatitis symptoms are seen