Diabetes

Question 1

What is different in the two treatment methods between type 1 and type 2 diabetes?

Answer 1

Insulin is required for type 1
Type 2 patients will start with oral meds and may eventually need insulin

Question 2

How is diabetes monitored?

Answer 2

Fasting blood glucose levels
HbA1c
Continuous glucose monitoring

Question 3

What are the goal levels for an HbA1c?

Answer 3

Goal is <7% but <8% if hypos or limited life expectancy

Question 4

What is the goal for continous glucose monitoring?

Answer 4

Time in range (TIR) goal is <70%

Question 5

All insulins carry some form of?
Which ones carry a higher risk?

Answer 5

hypoglycemia
The short acting forms have a higher risk

Question 6

Insulin:
What are the onset, peak, and duration of insulin lispro?

Answer 6

Onset: 15-30 minutes
Peak: 0.5-2.5 hrs
Duration: 3-6hr

Question 7

Insulin:
What are the onset, peak, and duration of regular insulin?

Answer 7

Onset: 30-60min
Peak: 1-5hr
Duration: 6-10hr

Question 8

Insulin:
What are the onset, peak, and duration of NPH insulin?

Answer 8

Onset: 60-120 min
Peak: 6-14 hr
Duration: 16-24 hr

Question 9

Insulin:
What are the onset, peak, and duration of insulin glargine (100)?

Answer 9

Onset: 70 min
Peak: none
Duration: 18-24hr

Question 10

Insulin:
What are the onset, peak, and duration of insulin detemir?

Answer 10

Onset: 60-120 min
Peak: none
Duration: 12-24

Question 11

Insulin:
What are the onset, peak, and duration of insulin glargine (300)?

Answer 11

Onset: 360 min
Peak: none
Duration: >24hr

Question 12

Insulin:
What are the onset, peak, and duration of degludec?

Answer 12

Onset: 30-90 min
Peak: none
Duration: >24

Question 13

What concentrations is insulin lispro come in?

Answer 13

U-100 and U-300

Question 14

How is insulin lispro administered?

Answer 14

Only subQ, never IV

Question 15

What is the only insulin given IV?

Answer 15

Regular insulin U-100

Question 16

Regular insulin U-500 comes in only what form?

Answer 16

Only in pen form

Question 17

Which insulin has a cloudy suspension?

Answer 17

NPH

Question 18

When combining NPH with another insulin, what is the protocol?

Answer 18

Clear before cloudy

Question 19

How often is NPH given?

Answer 19

Twice per day

Question 20

What are the best insulins for basal control?

Answer 20

Insulin glargine 100
Insuline levimir

Question 21

What is the main difference between insulin glargine 300 and insulin degludec?

Answer 21

Glargine 300 U-300 comes in prefilled pens
Degludec comes in U-100 or U-200 prefilled pens

Question 22

Which site of administration is the fastest for insulin delivery?

Answer 22

Abdomen is fastest
Thigh is slowest

Question 23

What is the ‘magic’ number for glucose levels?

Answer 23

70

Question 24

A rapid fall in blood sugar would exhibit what symptoms?

Answer 24

Increased HR, Sweating, Shakiness

Question 25

A slow fall in blood sugar would exhibit what symptoms?

Answer 25

HA, confusion, fatigue, drowsniess

Question 26

What medication is the first line therapy for type 2 diabetes?

Answer 26

Biguanide (Metformin)

Question 27

What other illnesses is biguanide (metformin) also given for?

Answer 27

Pre-diabetes and PCOS

Question 28

What are the pharmacokinetics of biganide (Metformin)?

Answer 28

Inhibits glucose production in liver Increases insulin sensitivity in tissues Lowers blood glucose (but does NOT cause hypoglycemia)

Question 29

What are the adverse effects biganide (Metformin)?

Answer 29

GI effects (take with food) B12 deficiency (monitor level) Toxicity: Lactic acidosis so no alcohol Excreted by kidneys (so watch for renal impairment)

Question 30

What is the oldest class of oral anti-hypoglycemics?

Answer 30

Sulfonylurea: Glipizide

Question 31

What are the pharmacokinetics of Sulfonylurea: Glipizide

Answer 31

Stimulates insulin secretion in pancreas Increases insulin sensitivity

Question 32

What are the adverse effects of Sulfonylurea: Glipizide?

Answer 32

Hypoglycemia No alcohol Beta blockers

Question 33

What are the pharmacokinetics of Thiazolidiediones/Glitazones/TZDs: Pioglitazone?

Answer 33

Increases insulin sensitivity in tissues Inhibits glucose production Half life is 16-24 hrs Metabolized by CYP enzyme

Question 34

What are the adverse effects/contraindications for Thiazolidiediones/Glitazones/TZDs: Pioglitazone?

Answer 34

Fluid retention (don't use in heart failure patients) Drug interactions with CYP inducers/CYP inhibitors Risk of bladder cancer Risk of fractures in women Possibly hepatotoxic

Question 35

What are the pharmacokinetics of Alpha-glucosidase inhibitors: Arcarbose?

Answer 35

Delays carb absorption Eat with meals 3x per day

Question 36

What are the adverse effects/contraindications for Alpha-glucosidase inhibitors: Arcarbose?

Answer 36

Frequent GI distress Decreased iron absorption Possible liver dysfunction

Question 37

What are the pharmacokinetics of Dipeptidyl Peptidase-4 (DPP-4) inhibitors such as Sitagliptin?

Answer 37

Enhances incretin hormones Stimulates insulin secretion in pancreas

Question 38

What are the adverse effects of DPP-4s such as Sitagliptin?

Answer 38

Pancreatitis

Question 39

What are the pharmcokinetics of Sodium Co-Transporter 2 (SGLT-2) inhibitors like canagliflozin

Answer 39

Inhibits SGLT-2 in kidneys Decreases reabsorption of glucose Increases urinary glucose excretion Glucosuria->Caloric loss->Modest weight loss Half life of 12 hrs Shown to prevent cardiovascular events

Question 40

What are the adverse effects/contraindications of (SGLT-2) canaglifozin?

Answer 40

Increased urination can lead to dehydration UTI's/fungal infections/genital necrotizing infections

Question 41

What are the two different subtypes of Glucagon-like peptide 1 (GLP1)?

Answer 41

Short acting exenatide Byetta: 1-2x per day Long acting exenatide Bydureon: 1x per week

Question 42

Which drug is a non insulin injectable?

Answer 42

Glucagon-like peptide 1 (GLP1) also known as ozempic

Question 43

What are the pharmacokinetics of Glucagon-like peptide 1 (GLP1)?

Answer 43

Mimics incretin hormone: -stimulates insulin secretion -supresses post-prandial release of glucagon -slows gastric emptying -Supresses appetite

Question 44

What are the adverse effects of Glucagon-like peptide 1 (GLP1)?

Answer 44

GI Effects Hypoglycemia (when given with sulfaonylurea) Pancreatitis (rare) Renal impairment (rare)

Question 45

What is the treatment for Diabetic Ketoacidosis?

Answer 45

Replace fluids Slow adjustment of plasma glucose Fix Potassium issues Adminster sodium bicarb

Question 46

What is the treatment of hyperosmolar hyperglycemic (nonketotic state)

Answer 46

Replace fluids Slow Adjustment of plasma glucose Fix potassium issues (Difference is just not giving sodium bicarb)