Diabetes

Question 1

39 year old white female is seen in clinic with a reoccurring vaginal infection. She also has complaints of skin irritation, blurring vision, and peripheral neropathy you suspect.

Answer 1

diabetes type 2

Question 2

39 year old white female is seen in clinic with a reoccurring vaginal infection. She also has complaints of skin irritation, blurring vision, and peripheral neropathy what laps should be done

Answer 2

random plasma glucose, ketonuremia, BUN/creatinine, oral glucose tolerance test, HbA1c.

Question 3

normal HbA1c

Answer 3

5.5 to 7 (for 2 to 3 months)

Question 4

normal serum fasting

Answer 4

blood sugar less than 126 after fasting at least 8 hours, at 2 occaisions

Question 5

Whtat is normal Glucose tolerance test

Answer 5

greater than or equal to 200 mg/dL 2 hours post prandial

Question 6

normals for impaired glucose tolerance

Answer 6

fasting blood glucose greater than 100 and less than 125

Question 7

what diet teaching for type 1 diabetics should be included when discussing carbohydrates, fats, fiber, and protein

Answer 7

carbohydrates should make up 55 to 60%of calories, should 20 to 30 % of calories, fiber 25g/1000 and protien 10 % to 20 %

Question 8

If patient presents with ketones then what should be initiated

Answer 8

inuslin therapy should be started, start with 0.5u/kg/day

Question 9

What therapy should be started when type 2 diabetes concerned

Answer 9

diet and exercise

Question 10

sulfonylureas work in what way, and what are examples

Answer 10

insulin secretigogs, inhibit potassium transporter, stimulate the pancreas B-cells to release insulin, examples glyburide (Diabeta, Micronase), Glipizide (glucotrol), glimepiride (amryl)

Question 11

Biguanides can be used for patients with

Answer 11

obesity

Question 12

example of biguanide medication, what is potential compication

Answer 12

metformin
lactic acid
gi upset and anorexia

Question 13

Medication considered standard of care for diagnosis of Diabetes type2

Answer 13

metformin

Question 14

Metformin works by

Answer 14

first line treatment, causes increase insulin sensitivity, increase glucose uptake, decrease glycogenolysis in liver. Stimulates glucose moving into cell in liver, and stimulate glucose to store as glycogen, also inhibits breakdown of glycogen to glucose

Question 15

Alpha glucosidase inhibitors work by

Answer 15

binding to disaccharidases more readily than sucrose, causing less glucose to be absorbed by the gut

Question 16

Gylset is an example of what diabetic medication class

Answer 16

alpha glucosidase inhibitors

Question 17

How do thiazolidnediones work

Answer 17

decrease gluconeogenesis and increase increase insulin sensitivity (which increases glucose into tissues) and decrease free fatty acid release from adipose tissue

Question 18

What patients should not used metformin

Answer 18

liver and renal disfunction patient

Question 19

mechanism of action of sulfonylureas on pancreatic b-cells

Answer 19

inhibition of potassium transport cells, prevent potassium efflux, leads to increase release of insulin

Question 20

side effects of sulfonylureas and insulin secretigogs

Answer 20

hypoglycemia and weight gain

Question 21

side effects of thiazolidinediones

Answer 21

anemia, CHF, peripheral edema, fracture

Question 22

Thiazolidinediones are contraindicated in patients with

Answer 22

chf and liver failures

Question 23

alpha glucosidase inhibitors contraindicated for people with

Answer 23

ibs

Question 24

alpha glucosidase inhibitors MOA

Answer 24

prevent the breakdown of carbohydrates to glucose that will be absorbed into cell

Question 25

Byetta mechanism of action

Answer 25

(Exenatide) acts like incretins to act on pancrease to increase insulin release and act on liver to decrease glucagon production

Question 26

Januvia mechanism of action

Answer 26

Sitagliptan acts as Dipeptidyl peptidase-4 inhbitor; prevents DD-4 from breaking down incretins

Question 27

GLP-1 agonists MOA

Answer 27

bind to GLP-1 receptors to Release GLP-1 from intestinal cells to increase insulin release from pancreas

Question 28

GLP-1 agonist contraindications

Answer 28

DKA, and type 1DM

Question 29

GLP-1 agonist SEs

Answer 29

HA, muscle weakness

Question 30

Nocturnal hypoglycemia develops stimulating a surge of counter regulatory hormones which raise blood sugar. how can this be corrected

Answer 30

Somogyi Effect per should decrease pm insulin dose

Question 31

Patient wakes up 7am every morning for past 2 weeks with higher than normal BS, how can the problem be identified

Answer 31

as patient to wake up around 3 and check blood sugar. if blood sugar low its Somogyi.

Question 32

This is the result of tissue desensitization to insulin nocturnally. Glucose becomes progressively higher throughout night. How should this be treated.

Answer 32

Dawn effect. Person should increase night time insulin dose.