Diabetes

Question 1

Def. diabetes

Answer 1

1. “Casual” plasma glucose ≥11.1 mmol/l and symptoms of diabetes
   2.OR a fasting plasma glucose ≥7.0 mmol/l;
2. OR a plasma glucose value in the 2 hour sample of the oral glucose tolerance test (75 g oral
   load of glucose) ≥11.1 mmol/l.
3. HbA1c ≥ 6.5%

Question 2

4 DM types

Answer 2

 Type 1 diabetes (beta cell destruction, immune mediated or idiopathic, usually leading to
absolute insulin deficiency).
 Type 2 diabetes (may range from predominantly insulin resistance with relative insulin
deficiency to a predominantly secretory defect with insulin resistance).
 Gestational diabetes mellitus (onset or recognition of glucose intolerance in pregnancy).
 Other specific types:
- Genetic defects of beta cell function or in insulin action;
- Diseases of the (exocrine) pancreas;
- Infections (rubella, coxsackievirus B, CMV, adenovirus, and mumps);
- Drug or chemical induced;
- Endocrinopathies (acromegaly, Cushing’s, glucagonoma, hyperthyroidism, etc);
- Uncommon forms of immune-mediated diabetes;
- Other genetic syndromes sometimes associated with diabetes

Question 3

screening guidelines

Answer 3

hemoglobin A1c every 3 years for
everyone over the age of 40
- more often for high risk groups

Question 4

7 drugs for DM2 and what they do

Answer 4

1. Biguanides (metformin) - sensetizer
2. Sulfonylureas (glyburide, glibizide)- secretagogue
3. DPP-4 inhibitors (sitagliptin, saxagliptin) - GPP4 inhibitor - enhance satiety and delay gastric emptying
4. SGLT-2 Inhibitors (canaglafozin) - enhance urine excretion of glucose
5. Alpha-glucosidase inhibitors - inhibit enzymes
6. Thiazolidinediones (i.e, pioglitazone) - rarely used
7. Meglitinides/nonsulfonylurea insulin secretagogues (i.e. repaglinide and nateglinide):

Question 5

goals of therapy

Answer 5

A1C less than 7 and if possible, less than 6.5

Question 6

3 main insulin regimens

Answer 6

1) Basal (glargine, detemir, NPH):
- frequently added to oral hypoglycemic regimens
- goal is to achieve target fasting glucose 4.0-7.0
- usual starting dose is 10 units qhs
- can be increased by 1 unit/day until targets reached
2) Basal-bolus (Multiple daily injection)
- calculate total daily dose 0.3-0.5 units/kg body weight
- distribute 40 % as basal (glargine, detemir, NPH)
- 20 % given TID with each meal (aspart, lispro, glulisine)
3) Premixed insulin (also called biphasic - injections ac breakfast and supper)
- mix of short or rapid acting with intermediate or long-acting insulin
- examples include
Humulin 30/70 - 30% regular, 70% NPH
Novolin 30/70 – 30% regular, 70% NPH
Humalog Mix 25 – 25% lispro, 75% lispro protamine (intermediate acting)
Humalog Mix 50 – 50% lispro, 50 % lispro protamine (intermediate acting)
NovoMix 30 – 30% aspart, 70% aspart protamine (intermediate acting)