Diabetes

Question 1

Definition of type 1 DM

Answer 1

insulin deficiency
desrudion of insulin-producing pancreatic beta cells
5-10% in all cases
autoimmune predisposition
DKA

Question 2

Diabetes type II

Answer 2

decreased sensitvity
decrease of insulin produced
90-95% of cases
combination of insulin resistance and beta cell dysfunction
HHS

Question 3

A1C < 7.5

Answer 3

Metformin
monotherapy
treat for 2-3 months. If not at goal, move to dual therapy DDP4 or GLP1
2-3 months of triple therapy
not at goal, add insulin with med adjustments

Question 4

A1C > 7.5-9

Answer 4

dual therapy
metformin and
GLP1, PPD4, GLP1,SGL2 or meglitione

Question 5

Biguanide

Answer 5

Metformin(Glucophage)
First, Line agents- (Decreases hepatic glucose production and intestinal absorption)
can impair renal function. hold contrast 3 days post-study
can cause a risk of B12 deficiency

Question 6

Thiazolidinedione

Answer 6

Pioglitazone, Rosiglitazone
increase insulin sensitivity
cause fluid retention , HF weight gain, bone fx , CV risk

Question 7

Sulfonylurea

Answer 7

Glipizide,Glyburide, Glimepiride
stimulate pancreatic beta cell release
weight gain, hypoglycemia

Question 8

Meglintinides

Answer 8

Repalinide, Nateglinide
Stimulate beta insulin cell release
weight gain , TID dosing , Hypoglycemia

Question 9

Dipeptidyl peptidase-4 inhibitor (DPP-4 inhibitor)

Answer 9

Sitagliptin( Januvia) Saxagliptin (Onglyza) Linagliptin ( transient)
increase insulin from beta
pancreatic cells and decrease glucagon from alfa cells
monitor for the development of pancreatitis

Question 10

GLP 1 receptor agonist

Answer 10

Exenatide ( Budureon)
Liraglutide (Victozo)
increase insulin release, delays gastric emptying
weekly injections
can cause acute pancreatitis

Question 11

Sodium Glucose Cotransportor -2 (SGL2)

Answer 11

Canagliflozin (Inokana)
Dapaglifozin (Farxiaga)
Empaglifoxin ( Jaridance)
Lowers BG levels and excretes in urine
AKA , DKA , vulvovaginal candidiasis
DKA on SGL2 can be acidodic but BS will not be as elevated

Question 12

Alpha-Glucosidase Inhibitors

Answer 12

Acarbose ( Precose)
Miglitol ( Glyset)
delays glucose and carb absorption
Ileus, hepatitis and flatulence

Question 13

Somogyi Effect

Answer 13

hypoglycemia occurs late evening
glucose drop low at 2:00
adjust timing of insulin , lower dose before bed, eating an evening snack
Sleep= low , down

Question 14

Dawn Phenomenon

Answer 14

early morning hyperglycemia
avoid carbs at HS
adjust the dose of insulin
exercise HS
wake up is = elevated