Diabetes

Question 1

Diagnostic criteria:

Answer 1

HbA1C>6.5
FBG >126
OGTT >200

Question 2

Goals of therapy:

Answer 2

HbA1C <7
Preprandial: 80-130
Postprandial <180
BP <140/90 ( 125/75 with proteinuria)

Question 3

What meds cause hyperglycemia:

Answer 3

Hyperthyroidism, corticosteroids, estrogens, lithium, morphine, niacin, thiazides, thyroid hormones

Question 4

Meds that cause hypoglycemia:

Answer 4

Alcohol, beta-blockers, sulfonamides, tetracyclines, hypothyroidism

Question 5

What increase absorption?

Answer 5

Heat, decreases fat

Question 6

Rapid acting insulin is:

Answer 6

Humalog (Lispro)

Novolog (aspart)

Question 7

Onset of rapid acting:

Answer 7

5-30 minutes

Question 8

Peak of rapid acting:

Answer 8

0.5-3 hours

Question 9

Duration of rapid acting:

Answer 9

3-4 hours

Question 10

Short acting insulin is _ and is used to _.

Answer 10

Regular (Humulin R)

Bring down very high blood glucose

Question 11

Short acting onset, peak, and duration:

Answer 11

Onset: 30-60 minutes
Peak: 2-4 hours
Duration: 3-7 hours

Question 12

Intermediate acting is:

Answer 12

Isophane(NPH, Humulin N)

Question 13

Intermediate acting onset, peak, and duration:

Answer 13

Onset: 1-2 hours
Peak: 4-10 hours
Duration: 10-16 hours

Question 14

Long acting is:

Answer 14

Lantas (glargine)

Question 15

Long acting onset, peak, duration:

Answer 15

Onset: 1-2 hours
Peak: none
Duration: 20–24 hours

Question 16

Biguanides are:

Answer 16

Metformin and first line therapy

Question 17

Metformin MOA:

Answer 17

Inhibits hepatic glucose production and moderately improves peripheral sensitivity to insulin. Glycemic control is achieved without stimulating insulin secretion, so hypoglycemia does not occur.

Question 18

Metformin reduces:

Answer 18

Fasting and postprandial glucose

Question 19

Metformin is contraindicated in:

Answer 19

Males with serum creatinine greater than 1.5 and females greater than 1.4, and heart failure

Question 20

Thiazolidinediones are:

Answer 20

Actos and avandia

Question 21

Thiazolidinediones MOA:

Answer 21

Increase insulin sensitivity in skeletal muscle and fat. They decrease peripheral insulin resistance.

Question 22

Thiazolidinediones are ideal for:

Answer 22

Type 2 diabetics with significant insulin resistance.

Question 23

Thiazolidinediones not recommended in:

Answer 23

Heart failure due to potential increase in plasma volume.

Question 24

Sulfonylurea MOA:

Answer 24

Stimulate the release of insulin

Question 25

Sulfonylurea can decrease:

Answer 25

HbA1C by 1.5%

Question 26

Side effects of Sulfonylurea:

Answer 26

Hypoglycemia

Question 27

Meglitinides MOA:

Answer 27

Stimulate the release of insulin in response to a meal.

Question 28

Take Meglitinides with:

Answer 28

Meals

Question 29

Alpha glucosidase inhibitors or starch blockers MOA:

Answer 29

Slow the absorption of carbs from the intestines.

Question 30

DPP-4 inhibitors MOA:

Answer 30

Blocks the effect against GLP-1 and increase the amount of native circulating incretins with the end result being a decreased glucose level.

Question 31

DPP-4 inhibitors are indicated for:

Answer 31

Patients with an elevated pre and postprandial glucose. Will have a reduction in both pre and post prandial glucose as well as HbA1C

Question 32

Contraindications for DPP-4 inhibitors:

Answer 32

Renal impairment/ watch function

Pancreatitis

Question 33

SGLT2 inhibitors MOA:

Answer 33

Induces glycosuria through the kidneys independent of insulin secretion. SGLT2 inhibitors will cause approximately 60% excretion of glucose in urine.

Question 34

SGLT2 inhibitors are:

Answer 34

Invokana and Jardiance

Question 35

Noninsulin injectables:

Answer 35

Incretins or GLP-1 agonists

Byetta and victoza

Question 36

Noninsulin injectables MOA:

Answer 36

Stimulate glucose-dependent secretion of insulin while suppressing the inappropriate release of glucagon. It slows gastric emptying and increases satiety.

Question 37

Noninsulin injectables are given:

Answer 37

Subq bid

Question 38

Avoid noninsulin injectables with:

Answer 38

Gastroparesis and family history of medullary thyroid cancer

Question 39

The alpha glucosidase inhibitors are most effective in patients with:

Answer 39

Postprandial hyperglycemia but only mildly elevated FBG

Question 40

Biguanides are drugs of choice in patients with:

Answer 40

Metabolic syndrome and when blood glucose is greater than 250.

Question 41

First line for type 2:

Answer 41

Biguanide, GLP-1, DPP4-I, and AG-I