diabetes 2

Question 1

Diagnoses of DM from fasting

Answer 1

fasting glucose over 126mg/dl

Question 2

diagnosis non fasting glucose

Answer 2

non fasting over 200mg/dl

Question 3

diagnosis with glucose tolerance test

Answer 3

glucose tolerance over 200 at 2-3 hours after bolus

Question 4

Onset of type !

Answer 4

less than 20 years

Question 5

cause of DM I

Answer 5

autoimmunity against pancreatic beta cells and to insulin , familial

Question 6

cause of DM II

Answer 6

Insulin resistance, then insulin deficiency and excess hepatic glucose production

Question 7

diffenrence in body habitis of DM I and DM II

Answer 7

DM I often underweight onset prior to 20, DM II overweight and onset often after 30

Question 8

is DM II familial

Answer 8

yes, 90-100 percent in twins, in DM I is 50% with twins

Question 9

what is LADA

Answer 9

Latent onset adult diabets 1.5

Question 10

when should you look for DM 1.5

Answer 10

in all non obease adults who present with apparent type 2 DM or those with DM II who have rapid detoriation of glucose control

Question 11

what are the two secreatogues

Answer 11

Sulfonylureas and meglitinides (non sulpher)

Question 12

what aret he type 2 DM drug types

Answer 12

biguanides, sulfonylureas, meglitinides, A-glucosidase inhibitors, thiazolidinediones TZD glitazones, dipeptidyl peptidase-4 (DPP-4)

Question 13

with which of the type 2 DM drug classes can you also give insulin

Answer 13

most of them: buguanides, sulfonylureas, meglitinides, a glucosidase inhibitors, glitazones, Don’t give insulin to DPP-4 inhibitors.

Question 14

what type of drug is metformine

Answer 14

Biguanides

Question 15

how does MOA of biguanides

Answer 15

inhibit glucose production by liver and decrease insulin resistance

Question 16

how do the secreatogue work,

Answer 16

sulfonylureas and meglitinides increase secretion of insulin

Question 17

how do the alpha glucosidase inhibitors work

Answer 17

delay absorption of glucose by intestines.

Question 18

how to the glitazones, work

Answer 18

decrease insuline resistance

Question 19

how do the DPP-4 work

Answer 19

promote release of insulin after eating meal

Question 20

what meds delay absorption of glucose by intestines

Answer 20

alpha glucosidate inhibitors

Question 21

what drugs decrease insuline resistance

Answer 21

biguanides and the glitazones

Question 22

what drugs promote release on insulin after eating

Answer 22

DPP-4

Question 23

what drug inhibit glucose production by liver

Answer 23

biguanides

Question 24

what is the concern with oral diabetic medications and illness

Answer 24

may need to switch to insulin during acuted infection because they potentially will have wose glucose control. Also prior to inpatient surgery

Question 25

when would type II diabetics be given insulin rather than oral right off

Answer 25

if they become pregnant or develop gestation diabetes to maintain tighter glucose control.

Question 26

what has been associated wit horal diabetic medications and pregnancy

Answer 26

macrosomia

Question 27

what oral diabetic drug dose not cause hypoglycemia when used alone

Answer 27

biguanide -metformin/ alpha glucosidase inhibitors - acarbose

Question 28

what 2 oral drugs can cause hypoglycemia

Answer 28

secreatagogues: sulfonylureas and meglitinides

Question 29

would metformin or a sulfonylurea cause weight loss

Answer 29

metformin about 4-7 lbs

Question 30

what is the vitain B12 deficiency offten associated with

Answer 30

metformin

Question 31

what drug has severe sideefect lactic acidosis

Answer 31

metformin a biguanide

Question 32

who should not be on metformin

Answer 32

those with impaired renal function

Question 33

how does sulfonylurease cause insulin release

Answer 33

partial blocking of potassium channels increasing Ca release stage that signals insulin release

Question 34

what generation of sulfonylureases are most often used

Answer 34

2nd generation Glipizide

Question 35

most concerning about sulfonylureas

Answer 35

hypoglycemia and then there is often weight gain and lose effectiveness withing 5-10 years

Question 36

which sulfonylureas is most likely to cause hypoglycemia

Answer 36

gyburide

Question 37

how often dose metformin

Answer 37

twice daily

Question 38

how often dose glipizide

Answer 38

one morning dose

Question 39

what are the two meglitinides secretagogues

Answer 39

nateglinide and repaglinide which is more effective

Question 40

what drug class would you not want to mix meglitinides with

Answer 40

sulfonylureas because it would increase risk of hypoglycemia

Question 41

how often are meglitinies taken

Answer 41

3-4 times a day unlike sulfonylureas which are once in the morning

Question 42

how often are the glitazones dosed

Answer 42

1-2 times each

Question 43

what are the two glitazones

Answer 43

glitazones: avandia and actos

Question 44

which of the glitazones may be used with insulin

Answer 44

ACTOS only

Question 45

what is concerning about glitazones

Answer 45

they increase risk of CHF and possibly MI, increased ALT and wt tain

Question 46

what diabetic drug must you test liver function

Answer 46

glitazones: avandia and actos

Question 47

what are the two a glucosidase inhibitors

Answer 47

a-glucosidase inhibitors: Acarbose and miglitol

Question 48

when are the a-glucosidase inhibitors taken

Answer 48

with each meal,

Question 49

when would acarbose and miglitol cause hypoglycemia

Answer 49

only if combined with sulfonylurea or insulin, never if given alone

Question 50

side effects of A glucosidase inhibitors

Answer 50

flatulance abd pain, diarrhea because it works at GI brush border

Question 51

what drug has a rare fatal hepatic failure

Answer 51

Acarbose: aglucosidase inhibitor

Question 52

what is unique about hypoglycemia of those on a glucosidase inhibitos

Answer 52

The antadote is Glucose and can not be sucrose.

Question 53

who can not take acarbose or miglitor:aglucosidase inhibitor

Answer 53

those with chronic intestinal diseases or obstruction

Question 54

what does preservation o GLP and GIPdo

Answer 54

DDP-4:drive blood glucose to normal to lower insulin release and glucagon supression reducing risk o hypoglyemia

Question 55

what is a DPP inhibitor

Answer 55

Sitagliptin/januvia: potientiate insulin effects so it is never used with insulin

Question 56

what of the oral diabetic drugs are never used with insulin

Answer 56

Sitagliptin/januvia: DPP-4 inhibitors

Question 57

what drugs can cause increase of pancreantitis

Answer 57

DPP-4 inhibitrs: Sitagliptin/januvia and janumet

Question 58

what is the good first choice drug

Answer 58

Metformin: Biguanides, then ad sulfonylurea if that diesn't work.

Question 59

what are the two injectable DM type II drugs

Answer 59

Pramlintide and exenatide

Question 60

Pramlintide/symlin: injectable

Answer 60

Synthetic amylin - produced with insulin by beta cells, so can used less insulin while stil lowering average blood sugar

Question 61

Exenatide : injectable

Answer 61

syntehtic extendin -4 - gila monster saliva

Question 62

can pramlintide be used with insulin?

Answer 62

Yes but they can not be injected inside the same vial or syringe.

Question 63

why is pramlintide notable

Answer 63

first approved to lower blood sugar in diabetics since discovery of insulin

Question 64

why is pramalintide injected

Answer 64

at meals times, without causing wt gain or hypoglycemia although nausea is a side effect.

Question 65

incretin mimetics

Answer 65

Incretin mimetics: exenatide/byetta, lowers blood blucose by increasing insulin secretion

Question 66

what is unique about exenatides ability to lower blood glucose levels

Answer 66

it only lowers blood blucose in presence of high bloodglucose, so hypoglycemia is not a risk.