DIABETES

Question 0

T1DM - DOC

Answer 0

Insulin

Question 1

Starting dose insulin - T1DM or T2DM failing oral therapy (A1C >9.5 or FBG >260)

Answer 1

.3-.5 u/kg/day

2/3 intermed and 1/3 short

Question 2

Glyburide, glipizide - class?

Answer 2

Sulfonylureas

Question 3

Repaglinide (prandin) & nateglinide (starlix) - class?

Answer 3

Meglitinides

Question 4

Repaglinide - DDI

Answer 4

Gemfibrozil

Itraconazole

Question 5

Metformin - dosing

Answer 5

Start 500mg qd –> bid with food
Titrate
Max effective dose = 2000mg/d

Question 6

T2DM - DOC

Answer 6

Metformin

Question 7

Metformin vs SUs

Answer 7

Metformin has weight loss
No hypoglycemia
As good as SUs
Caution renal/hepatic

Question 8

Choosing an agent - baseline FBG>210 or A1C >9

Answer 8

Consider combo therapy (2 different classes)

+/- exenatide or pramlintide if failing oral

Question 9

If monotherapy for hyperglycemia fails –>

Answer 9

Add second oral agent or exenatide or pramlintide

Consider insulin

Question 10

If dual oral combo therapy fails –>

Answer 10

Add third agent or exenatide or pramlintide

Consider insulin

Question 11

Apidra (glulisine), novolog (aspart) and humalog (lispro) - class?

Answer 11

Rapid acting insulin

Question 12

Regular insulin - class?

Answer 12

Short acting insulin

Question 13

NPH insulin - class?

Answer 13

Intermediate acting insulin

Question 14

Lantus (glargine) and levemir (detemir) - class?

Answer 14

Long acting (basal insulin)

Question 15

Starting dose insulin - T2DM failing oral therapy (A1C >9, FBG<210)

Answer 15

0.1-.25 u/kg

2/3 intermediate, 1/3 short

Question 16

Early am hypoglycemia (3-5am)
Rebound to normal or high
Excessive release of cortisol or growth hormones

Answer 16

Somigyi phenomenon

Question 17

No early am hypoglycemia
Hyperglycemia in am
Relative resistence to effect of early am insulin

Answer 17

Dawn phenomenon