Diabetes

Question 1

what characterizes type 1 diabetes?

Answer 1

autoimmune destruction of the beta cells in the pancreas

patients are younger and thinner

insulin is required as treatment

Question 2

what charactherizes type 2 diabetes?

Answer 2

insulin resistance and insulin deficiency that progresses with time.

older, heavier patents

factors are genetics and physical inactivity

Question 3

what characterizes gestational diabetes ?

Answer 3

There are metabolic and endocrine changes in the mother that cause insulin resistance

The placenta secretes hormones. The mother develops more adipose tissue, exercises less and eats more food.

The pancreas of the mother is unable to overcome the insulin resistance by increasing her insulin production sufficiently

Question 4

what are HEDIS HgA1c goals?

Answer 4

HEDIS is a quality assurance program that allows us to measure the quality of the healthcare being provided by clinicians. It takes into account the A1c, blood pressure, LDL, eye exams, nephropathy screening to know whether clinicians are providing quality care. They measure how many people under the dr.s care falls under different a1cs.

A1c > 9% is considered poor controlled and patients <8% are controlled and so are pts <7 are controlled.

Question 5

what studies support the HEDIS hga1c goals?

Answer 5

x

Question 6

what are the differences between glipizide and glyburide?

Answer 6

Glyburide is cleared renally

Glipizide is cleared hepatically

Question 7

How do you manage the GI side effects of metformin?

Answer 7

Take with food

if its a big dose, can split doses during the day

Question 8

why is actos not a recommended therapy?

Answer 8

Studies have shown an increased risk of bladder cancer after 1 year of use

Can exacerbate CHF NYHA class III and class IV (BBW)

Can increase fracture risk

can cause edema

Question 9

onset of action

peak

duration of NPH

Answer 9

2-4 hours onset

4-8 Hours Peak

8-12 hour duration, up to 24 hours

Question 10

Onset of action

peak

duration of regular insulin

Answer 10

30min to 1 hour onset

2-3 hour peak

4-6 hour duration

Question 11

Onseta of action

peak

duration of lantus

Answer 11

1-2 hours onset of action

No peak

24 hour duration

Question 12

onset of action

peak

duration of Humalog

Answer 12

15 min onset

1-2 hours peak

3-5 hours

Question 13

what is the dawn phenomineon and what is somoygi?

Answer 13

The dawn phenomenon is a phenomenon that occurs in early morning before breakfast in which there is an increase in blood sugar. Overnight, the body produces growth hormone, cortisol etc that work against insulin and increase blood sugar. Usually, the body compensates by producing more insulin but some diabetics like type 1 diabetics may not be able to do so. Dawn phenomenon is more a regular physiological phenomenon (routinely elevated)

Somogyi is also hyperglycemia in the morning but it is in response to hypoglycemia that occurs at night. The hypoglycemia may be due to having too much insulin the night before, so the body reacts by increasing hormone production. This is more of a response to too much insulin rather than a regular thing. Also called rebound hypeglycemia

Question 14

what are the signs and symptoms of hypoglycemia?

Answer 14

hunger
shakinees
irritability
headache
sweaty
confusion
fast heartbeat

Question 15

how do you treat hypoglycemia?

Answer 15

15 grams of sugar, then check BG in 15 min

If still low take 15g again, check inf 15 min

If still low call 911

An unconcious patient can be injected with glucagon 1mg SC, IV, or IM

Question 16

discuss alpha glucosidas inhibitors

Answer 16

inhibits alpha glucosidase inhibitorswhic leads to delayed absorpiton of glucose

start at 25mg wti first bite of each meal. Increase by 25 mg every 1-2 months (max 300mg/day ) divided dose

must take with food and wit hfull glass of water

flatulence
diearrhea
abdominal pain
contraindicated in IBD , colonic ulceration or complete bowerl obstruction

must check LFTs with acarbose q 3m x 1 year

Question 17

discuss non-sulfonylural insulin secretogogues

Answer 17

Meglitinide increase insulin secretion

prandin is slightly more effective than starlix

hypoglycemia*
weight gain
URTI

a1c decrease 0.5-1.5%

Question 18

discuss prandin

Answer 18

metabolized in the liver and metabolites excreted in the feces

if A1c < 8% give 0.5mg TID

If A1C >= 8% 1-2mg TID, take 15-30 minutes before meals

Question 19

discuss byetta (exenetide)

Answer 19

Store at room temp and stable for 30 days

inject in abdomen SC x 5 seconds

patients are at a small risk of developing pancreatitis

*Nausea
V/D
hypoglycemia
weight loss

avoid if ClCr <30ml/min

twice daily QAM and QPM, 30-60 min before meals

Question 20

discuss symlin

Answer 20

synthetic analog of amylin. Amylin slows gastric emptying prevents glucagon increase after a meal, increases satiety

if co administered with insulin , can lead to severe hypoglycemia

inject in the abdomen prior to meals

hypoglycemia*
Nausea
anorexia

decrease the insulin dose by 50% of the rapid acting, short acting and mixed insulins

for type 1 diabetics and type 2 diabetics on insulin

usually for poorly controlled diabetics with post prandial high blood glucose

Question 21

discuss januvia (sitagliptin)

Answer 21

pregnancy category B
weight neutral

inhibits dPP4 enzymes which mormall break down increntin hormones. As a result, there are more incretin hormones and this leads to increase insulin secretion, decreases glucagon secretion, decrease hepatic glucose production

100mg po qam, if clcr <30ml/min use 25mg po qd

nasopharyngitis URTIs
peripheral edema
rash
hypoglycemia
rare acute pancreatitis