Diabetes

Question 1

What viruses are associated with increased development of type I DM?

Answer 1

rubella, coxsackie, and mumps

Question 2

What HLA types are most associated with type I DM?

Answer 2

HLA-DR3, HLA-DR4, HLA-DQ

Question 3

What is required for a diagnosis of DM?

Answer 3

One of the following:

1. A1C >6.5
2. Spot glucose >200 with sx
3. fasting glucose >126 on 2 occuasions
4. glucose challenge test: glucose >200 2 hrs after 75 g insulin load

Question 4

What is a general treatment approach to DM2?

Answer 4

• start with diet and weight loss
• Add metformin
• If A1C >7 after 2-3 months, add second oral agent (or insulin). usually sulfonylureas, thiazoladinidedione
• If A1C still bad or consistently >8.5, add insulin

Question 5

How does metformin work?

Answer 5

-decreased hepatic gluconeogenesis, increase insulin sensitivity, reduce LDL, raise HDL

Question 6

What are the adverse effects of metformin?

Answer 6

GI disturbance, rare lactic acidosis, may decrease vitamin B12 absorption
contraindicated in renal or hepatic failure

Question 7

What are the sulfonylureas and how do they work?

Answer 7

stimulate insulin release, reduce glucagon

glyburide, glimepiride, glipizide

Question 8

What are the thiazolidinediones and how do they work?

Answer 8

pioglitazone, rosiglitazone

-increase tissue uptake of glucose

Question 9

What are the adverse effects of the thiazolidinediones?

Answer 9

-weight gain, fluid retention (contraindicated in CHF), incr. LDL, rare liver toxicity, ?increased risk of MI with rosiglitazone?

Question 10

What are the DPP-IV inhibitors?

Answer 10

sitagliptin, saxagliptin, linagliptin. inhibit degredation of incretin hormones. can cause diarrhea, constipation, edema. adjuvant

Question 11

What are the incretin mimetics? How do they work

Answer 11

agonize GLP-1 receptors to increase insulin, decrease glucagon. names: exenatide, liraglutide

Question 12

What are the side effects of the incretin mimetics?

Answer 12

the have to be given via injection. Associated with wieght loss, nausea. slight risk of pancreatitis

Question 13

What is acarbose?

Answer 13

decr. GI absorption of starch, diasaccharide, but cause diarrhea and flatulance

Question 14

What are the meglitinides?

Answer 14

repaglinide, nateglinide- stimulate insulin release from beta cells, but much more $$$ than sulfonylurea w/o therapeutic advantage

Question 15

What places pts at risk for DKA?

Answer 15

not taking insulin, alcohol use, MI, stress, infection