Diabetes

Question 1

A1c in children under 13 should be _____. Why?

Answer 1

under 7.5
- we are worried about being too aggressive with children because we do not want them to be hypoglycaemic- this is associated with cognitive or learning disabilities later on in life

Question 2

What is the fasting blood glucose levels for a 10 year old?

Answer 2

• 4-10

Question 3

What are the bad complications of diabetes that we want to try to avoid?

Answer 3

• nephropathy
• neuropathy
• retinopathy

Question 4

What is diabetic gastroporesis?

Answer 4

• slowing down of the G tract that can affect the digestion food and drugs (can also cause esophageal reflux). can also cause erectile dysfunction

Question 5

____ is the main cause of ESRD in canada

Answer 5

Diabetes

Question 6

What do you do to an insulin pump during exercise?

Answer 6

• turn it off!

Question 7

When taking 15 g of glucose, we should expect that blood sugar will go up by _____

Answer 7

2.5

Question 8

When is short acting/ rapid acting glucose given in relation to meals?

Answer 8

• short acting glucose: give 30 minutes before a meal

- rapid acting insulin: give right before or even at the same time as a meal

Question 9

What are some other problems that can be associated with elevated glucose levels in the morning?

Answer 9

• could be snacking at bedtime
• did the person change their insulin
• any problems to insulin storage
• is he using the pen right
• can you see the numbers on the pen when you are using

Question 10

What is the issue with insulin production in type 2 diabetics?

Answer 10

NOTHING
- people with type 2 diabetes make normal amounts of insulin, the issue with them is that they are not able to meet the needs of their body and their tissues are not as sensitive to it

Question 11

What is the usual starting dose for insulin in diabetics?

Answer 11

-10 units of NPH insulin a day, increasing by 1 unit a day until the persons between 4-7 mmol/L in the morning

Question 12

What is the major disadvantage associated with premixed insulins?

Answer 12

• less controlled because you cannot give exactly what you need when you need it
• can’t just change one part of the insulin dose- this is the bad part of premixed insulins
• when you draw up less units of the premixed insulins then you are affecting both of the doses
• the premixed insulins are in the body and will work whether you like it or not- you have to have good meal planning if you are using the premixed insulins- you cannot be caught in a situation where you are unable to eat your lunch because then you will be in trouble

Question 13

What should the starting dose of metformin be?

Answer 13

• LOW - 500 mg bid

Question 14

What should you always assess before starting someone off on metformin?

Answer 14

• always ask about kidney function!
• any frothing of the urine
• any family history of CKD, if anyone has asked them if they have any issues with their kidneys or kidney injuries
• if a person develops lactic acidosis on metformin they have a 50% chance of survival;

Question 15

What are the pros of metformin?

Answer 15

• more weight neutral, can help with a little bit of weight loss
• less risk of hypoglycaemia comparatively

Question 16

What is the action of acarbose?

Answer 16

• blocks alfa-glucosidases in the GI tract - delays carb digestion

Question 17

How long does acarbose take to have max effect?

Answer 17

• takes about 8 weeks

Question 18

How much does acarbose decrease A1c?

Answer 18

• decreases it by approx 0.5-0.8%

Question 19

Will someone gain weight on acarbose?

Answer 19

• no! it is weight neutral or can help with weight loss

Question 20

____ risk of hypoglycaemia with acarbose

Answer 20

low

Question 21

What are the GI SE associated with acarbose?

Answer 21

• flatulence >40%. diarrhea approx 30%, monitor liver function tests (AST, ALT)

Question 22

What is the timeframe for effect of pioglitazone?

Answer 22

• delayed onset of 4 weeks, max effect in 8-16 weeks

Question 23

What is pioglitazone’s effect on weight?

Answer 23

• causes weight gain of around 4 kg

Question 24

____ hypoglycemia with pioglitazone

Answer 24

no

Question 25

What are the adverse effects associated with pioglitazone?

Answer 25

• edema, mild anemia, increased incidence of fractures, requires monitoring of AST and ALT
• associated rarely with bladder cancer: monitor for blood in during, dysuria

Question 26

Who would be a candidate for using pioglitazone (part 3 EDS)

Answer 26

• for use in patients who are not optimally controlled on max doses of metformin and either a sulfonylurea, or regained or with CI to any of these agents
• type 2 diabetics that are on high doses of insulin and on max tolerate metformin who are not achieving optimal control

Question 27

What are the DPP-4 inhibitors?

Answer 27

• sitagliptan
• saxagliptin
• linagliptin, etc

Question 28

What is the onset of action of DPP-4 enhancers?

Answer 28

• onset in under 4 weeks, max effect in about 18 weeks

Question 29

How much do DPP-4 inhibitors decrease A1C?

Answer 29

• by 0.7%

Question 30

Whats the effect of DPP-4 inhibitors on weight? Hypoglycaemia?

Answer 30

• weight neutral or has slight weight loss

- no hypoglycemia when used alone

Question 31

What is the action of DPP-4 inhibitors?

Answer 31

• incretin enhancers

Question 32

What are the AE associated with DPP-4 inhibitors?

Answer 32

• avoid in heart failure
• reports of urticaria, angioedema, arthralgia and joint pain
• reports of pancreatitis
• increased incidence of sore throat, headache, nausea and diarrhea