Diabetes

Question 1

dx for diabetes

Answer 1

fasting blood glucose > 126
HbA1c > 6.5%
non-fasting blood glucose > 200
postive oral glucose tolerance test > 200 at 2-3 hours after bolus of glucose

Question 2

c-peptide levels are used for…

Answer 2

can differentiate between type 1 and 2
to see how much insulin is being produced by pancreas in newly diagnosed diabetics
- low in type 1 and high in type 2

Question 3

what is c-peptide level in type II DM

Answer 3

it is high at the beginning of dz because pancreas is putting out a lot of insulin

Question 4

type 2 diabetes

Answer 4

insulin resistance
insulin deficiency and excess hepatic glucose production
anti-islet cell ab absent (present in type 1)

Question 5

tx for pregnant women with dm or gestational dm

Answer 5

insulin rather than oral meds

Question 6

Biguanides

Answer 6

metformin (glucophage): decreases hepatic glucose production and enhances insulin sensitivity in dkeletal muscle

Question 7

which meds can cause weight loss/weight gain

Answer 7

Metformin: weight loss
Sulfonylureas: weight gain

Question 8

SE of metformin

Answer 8

abdominal cramping and nausea, metallic taste, b-12 deficiency
*lactic acidosis

Question 9

metformin contraindicated in

Answer 9

renal insufficiency

Question 10

sulfonylureas

Answer 10

stimulate intact beta cells of pancreas to release more insulin
- block potassium release, which leads to prolonged ca and prolonged release of insulin

Question 11

types of sulfonylureas

Answer 11

1st generation: chlorpropamide/diabinese
Tolbutamide/orinase
2nd generation: Glipizide/glucotrol
glyburide/micronase
Glimeperide/ amaryl (2nd or 3rd)

Question 12

SE of sulfonylureas

Answer 12

hypoglycemia
weight gain
glybuide causes greater incidence of hypoglycemia

Question 13

sulfonylurea contraindications

Answer 13

ineffective in type 1 DM or where there is absolute deficiency of insulin production
avoid during pregnancy and sulfa allergy
become ineffective after 5-10 years of use

Question 14

Meglitinides

Answer 14

stimulate beta cells to release insulin
Nateglinide/starlix and Repaglinide/prandin (more effective)
before meals 3-4 times daily
no generic option, so expensive

Question 15

Thiazolidinediones/glitazones

Answer 15

improve insulin sensitivity in skeletal muscle, fat cells, liver cells and decrease hepatic glucose production
can tae up to 14 weeks to achieve max effects
- avandia and actos
*only ACTOS is approved for concurent use with insulin

Question 16

SE of thiazolidinediones/glitazones

Answer 16

increased risk of CHF
liver function test before start - check ALT
decreased bone density
weight gain

Question 17

alpha-glycosidase inhibitors

Answer 17

Acarbose/precose and Miglitol/glyset
decrease prosprandeal glucose by interfere with hydrolysis of carbs and delaying absorption of glucose
osmotic diarrhea
can cause hypoglycemia if given with other meds
poorly tolerated
take with meals
no generic, expensive

Question 18

Dipeptidyl peptidase-4 (DPP-4) inhibitors

Answer 18

stimulates pancreas to stim insulin release and decrease glucagon
sitagliptin/januvia - cannot be given with insulin
*associated with acute pancreatitis

Question 19

Pramlintide/symlin

Answer 19

injectible drug - synthetic amylin hormone
type 1 and 2
cannot be given at the same time as insulin, but decreases amount of insulin needed
weight loss