Diabetes

Question 1

Type 1A v. Type 1B diabetes

Answer 1

Both beta cell destruction

1A- autoimmune

1B -not autoimmune

Question 2

Risk factors for type 2 diabetes

Answer 2

Obesity
Family hx
Hispanic, African American, Pacific Islanders 
Htn
Hypld 
Delivery of >9lb infant

Question 3

Classic diabetes symptoms

Answer 3

Polyuria
Polydipsia
Polyphagia
Weight loss

Question 4

Describe the types of diabetic retinopathy

Answer 4

Nonproliferative: dot or flame shaped hemorrhages and cotton wool spots

Proliferative: neovascularization

Maculopathy: macular edema, blurred vision and central vision loss

Question 5

MC cause of end stage kidney disease

Answer 5

Diabetes

Question 6

First sign of diabetic nephropathy

Answer 6

Microalbuminuria

Question 7

What is expected on biopsy of the diabetic kidney?

Answer 7

Kimmelstiel-Wilson: modular glomerulosclerosis w/ pink hyaline material

Question 8

Macrovascular complications of DM

Answer 8

CAD
PAD
CVA

Question 9

Presentation of hypoglycemia

Answer 9

Sweating, tremors, palpitations, nervousness, tachycardia, HA, lightness, confusion, slurred speech, and dizziness

Sx when BS<60 and brain dysfunction when BS <50

Question 10

Lab values that indicate diabetes

Answer 10

Fasting glucose >126

2GGT >200

A1c >6.5%

Question 11

When should you screen for diabetes?

Answer 11

ADA: adults over 45 every 3yr and adults with BMI >25 with addition risk factor

USPSTF: 40-70yo if overweight or obese

Question 12

A1c monitoring

Answer 12

Every 3mo if uncontrolled

Twice a year if controlled

Question 13

A1c goals

Answer 13

<7.0% for most pts

7-8% if multiple comorbidities or older than 70

Question 14

Metformin MOA

Answer 14

Decreases hepatic glucose production and increases peripheral glucose utilization

Question 15

Metformin SE/cautions

Answer 15

Lactic acidosis
GI issues
Metallic taste
Macrocytic anemia due to decreased B12 absorption

Question 16

2nd generation sulfonylureas

Answer 16

Glipizide
Glyburide
Glimepride

Question 17

Sulfonylureas MOA

Answer 17

Stimulates pancreatic insulin release

Question 18

Sulfonylureas SE/caution

Answer 18

Hypoglycemia
GI upset
Disulfiram reaction
Weight gain

Question 19

A glucosidase inhibitors

Answer 19

Acarbose

Miglitol

Question 20

A glucosidase inhibitors MOA

Answer 20

Delays intestinal glucose absorption

Question 21

A glucosidase inhibitors SE/caution

Answer 21

Hepatitis

GI issues

Question 22

Thiazolidinediones

Answer 22

Pioglitazone (Actos)

Rosiglitazone (Avandia)

Question 23

TZD MOA

Answer 23

Increased peripheral insulin sensitivity

Question 24

TZD SE/cautions

Answer 24

Fluid retention/edema

Avandia-cardiotoxic

Question 25

GP1 agonists

Answer 25

Exenatide (Byetta) Liraglutide (Victoza)

Question 26

GLP1 agonist MOA

Answer 26

Mimics incretin increasing insulin secretion and delaying gastric emptying

Question 27

GLP1 agonist C/I

Answer 27

Hx of gastroparesis

Question 28

DPP4 inhibitors

Answer 28

Sitagliptin (Januvia) | Linagliptin (Tradjenta)

Question 29

DPP4 inhibitor MOA

Answer 29

Prevents breakdown of GLP1 and intecrin

Question 30

DPP4 SE/caution

Answer 30

Pancreatitis Renal failure GI symptoms

Question 31

SGLT2 inhibitor

Answer 31

Empagliflozin Canagliflozin Dapagliflozin

Question 32

SGLT2 inhibitor MOA

Answer 32

Increased urinary excretion of glucose and Na

Question 33

SGLT2 inhibitor SE/cautions

Answer 33

Thirst Nausea Abd pain UTI/fungal infection

Question 34

Dawn phenomenon

Answer 34

Rise in glucose between 2-8am

Question 35

Somogyi effect

Answer 35

Nocturnal hypoglycemia followed by rebound hyperglycemia due to surge in growth hormone

Question 36

Plasma glucose in DKA

Answer 36

Usually >250

Question 37

Plasma glucose in hyperosmolar hyperglycemic syndrome

Answer 37

>600

Question 38

Impaired fasting glucose (IFG)

Answer 38

Fasting level of 100-125 mg/dL

Question 39

Impaired glucose tolerance (IGT)

Answer 39

Levels of 140-199mg/dL 2 hr after 75g glucose load

Question 40

Rank antidiabetic meds by A1c lowering

Answer 40

1-2: metformin and sulfonylureas 0. 5-1.4: TZDs 0. 5-1:nonsulfonylureas,SGLT2 inhibitors, GLP1 agonists 0. 5-0.8: a-glucosidase inhibitors, DPP4 inhibitors