Diabetes

Question 1

HbA1c and sickle cell trait

Answer 1

Lower HbA1c with sickle cell trait. Probably cells die early so less time for glycation

Question 2

Canagliflozin and Cardiovascular disease

Answer 2

2 fold increase in amputation in pts having or at risk of CVS d/s

Don’t start in patients at risk of amputation

Question 3

SGLT2 inhibitor with no bone related side effects

Answer 3

Empagliflozin

Question 4

Starting insulin dose - general rule

Answer 4

1/3 rd body weight.

If 60 kg -20 units

Question 5

Liraglutide (Victoza)is contraindicated in

Answer 5

Family history of Thyroid cancer or MEN 2. Potential risk of thyroid tumor

Question 6

GLP 1 receptor agonist with Cardiac protection

Answer 6

Liraglutide

Question 7

GLP1 agonists should not be combined with

Answer 7

DPP4 inhibitors. No added benefit

Question 8

Similarities in action of DPP4 inhibitors and GLP 1analogues

Answer 8

GLP is an Incretin

They increase insulin secretion

So obviously GLP 1 agonist useful in DM

DPP4 inhibits degradation of GLP 1

So mechanism of action are same By increasing INCRETIN effect

Question 9

Januvia dose to be reduced if Creatinine

Answer 9

<50 ml/mt ie roughly

Males >1.7
Females>1.5

Question 10

Dialysis is usually started when eGFR is

Answer 10

<5 ml/MR/1.73 m2

Question 11

eGFR best equation at GFR> 60

Answer 11

CKD-EPI

Question 12

Gliptin which doesn’t need dose adjustment in Renal failure

Answer 12

Linagliptin/ Trajenta

Question 13

Metformin And Renal Failure

Answer 13

eGFR<30 ml—Contraindication

<45- dose reductions if already on:: Dont initiate.

Question 14

Role of Aspirin after mechanical valve replacement

Answer 14

50-100 mg Aspirin

Question 15

Acarbose should be taken with

Answer 15

First bite of the meal

Question 16

Metformin And GFR

Answer 16

30-45:: Don’t start. Reduce to 50% or 50% max dose. Monitor RFT every 3 months

<30- contraindicated

Question 17

DPP4 which doesn’t need any dose adjustment with Liver or Renal impairment

Answer 17

Linagliptin

Question 18

Metformin use in Heart Failure

Answer 18

Small risk of lactic acidosis

In stable patients risk unlikely if Creatinine <1.5
ESC HF guideline-first line in overweight diabetic with GFR >30

Question 19

Difference in administration of Meglitines and Glucosidase inhibitors

Answer 19

Meglitinides 30 mts before meal

Glucosidase inhibitors with first bite of the meal

Question 20

Aspirin in DM

Uptodate 10/2018

Answer 20

If risk > 10% ( 10 yr CVD risk)

Question 21

Statins inDM aged less than 40

Answer 21

In those with multiple CVD risk factors

Above 40 yrs -add statins regardless of cholesterol levels