Diabetes

Question 1

Dawn phenomenon

Answer 1

Hyperglycemia at night then Hyperglycemia in the morning due to insulin resistance caused by growth hormone (4-8am). Hypoglycemia at 3am

Spilt NPH between dinner and before bedtime

Question 2

Micro albumin

Answer 2

At diagnosis and annually

Early indicator of renal issue in diabetes (elevated creative is a late indicator)

Intervention: BP, lipid and glycemic control

Question 3

BP

Answer 3

Less than 140/90

Ace 
Arb
Beta blockers 
Ca channel blockers
Alpha beta blockers (carvedilol)

Every 3 to 6 months

Question 4

Lipids

Answer 4

Annually

LDL 45 (men), > 55 (women)

Question 5

Eye exam/foot exam

Answer 5

Annually

Question 6

Exercise

Answer 6

At least 150mins a week
Moderate activity (walking for 30mins) at least 5x week with no more than 2 consecutive days without exercise
Resistance training at least 2x week

Question 7

Biguanides (metformin)

Answer 7

Increases insulin sensitivity and reduced hepatic glucose production

No hypoglycemia
Weight loss
GI upset (not as much with extended release)
Renal (cr) and LFTs
Lactic acidosis (on day and 48hrs pair in contrast, dehydration, renal insufficiency, elderly)

Question 8

Sulfonylureas (glipizide, glyburide)

Answer 8

Increases insulin secretion

Hypoglycemia
Renal and LFTs
Weight gain
Contraindicated in sulfonamide allergy
Less effective more than 5years after diagnosis

Question 9

TZDs (pioglitazone (actos) rosiglitazone (avandia)

Answer 9

Increases insulin sensitivity, decreases hepatic glucagon production
Increase water retention

Contraindicated in CHF and heart disease
Don't use with insulin
Don't use with nitrates 
Weight gain 
Bladder CA with more than 1 year use
LFTs

Question 10

DPP4 inhibitor (sitagliptin (januvia))

Answer 10

Increases insulin release, increases levels on incretin

No hypoglycemia
Can cause acute pancreatitis
Caution in renal

Question 11

Alpha glucosidase inhibitor (acarbose (precose))

Answer 11

Delays intestinal carbohydrate absorption

Taken with first bite of meal (posprandial hyperglycemia)
GI (flatulence, bloating)
Avoid in IBD, impaired renal function

Question 12

GLP 1 agonist

Exenatide (Byetta) or victoza

Answer 12

Increases insulin production
Slows gastric emptying

Injection
Weight loss
GI (N/V, contraindicated on gastroparesis or pancreatitis)
Caution in renal

Question 13

Meglitinide (prandin)

Answer 13

Increases insulin secretion

GI
Rapid acting (postprandial)

Question 14

Amylin analog (symlin)

Answer 14

Decrease gastric emptying

Weight loss

Question 15

Somogyi phenomenon

Answer 15

Insulin induced Hypoglycemia at night leads to excess glucagon and cortisol which results in Hyperglycemia in the morning

Lower dinner time NPH insulin

Type I

Question 16

Type 2 screening

Answer 16

Every 3 years for older than 45 individuals asymptomatic

Question 17

Type 2 diagnosis

Answer 17

A1c equal or greater than 6.5
FPG greater than 126 on 2 occasions
RPG of 200 or more + symptoms (pollution,polydipsia, polyphagia)
2hr post 75g OG of 200 or more