Diabetes

Question 1

Type 1 DM

Answer 1

absolute deficiency of insulin

3 P’s - polyuria, polydipsia, polyphagia

Question 2

Type 2 DM

Answer 2

90% of cases
impaired insulin secretion
reduced effect of gut incretins
insulin resistance
excess glucose secretion
SGLT-2 upregulation
RELATIVE INSULIN DEFICIENCY

Question 3

Management of Diabetes

Answer 3

1. glycemic control
2. treat associated conditions
3. Screen for/ manage complications

Question 4

Insulin

Answer 4

degraded in digestive tract
given subQ
regular insulin can be given IV infusion
NEVER GIVE intermediate or long acting IV

Question 5

Insulin AE

Answer 5

hypoglycemia, weight gain

injection site reaction, lipodystrophy

Question 6

Types of Insulin

Answer 6

rapid (Aspart, Lispro, Glusine)
short
intermediate (neutral protamine Hagedorn NPH)
long-acting (detemir, glargine, degludec)
combination
CONCENTRATED (U-500 is 5x more potent, extremely high risk)

Question 7

Basal bolus insulin regimen

Answer 7

long acting insulin to predict basal rate
cover glucose from a meal 
mimics what the body does naturally 
provides ideal coverage 
CONS- multiple shots, high cost

Question 8

Modified regimen

Answer 8

intermediate-acting - 70/30 fixed combo
less injections, lower cost
but more difficult to individualize doses

Question 9

Insulin technosphere

Answer 9

rapid-acting inhaled insulin
AE: black box- acute bronchospasm in pts w/ chronic lung disease
contraindicated in asthma and COPD

Question 10

Amylin

Answer 10

hormone cosecreted w/ insulin
delays gastric emptying decreases postprandial glucagon, improves satiety
can also be given as PRAMLINTIDE (synthetic)
given w/ mealtime insulin subQ

Question 11

Pramlintide AE

Answer 11

hypoglycemia, especially when combined with mealtime insulin
nausea, vomiting, anorexia
SHOULD BE AVOIDED in patients with diabetic gastroparesis

Question 12

Incretin Mimetics

Answer 12

higher release of insulin when given orally
incretin response responsible for 60-70% of prostaglandin insulin secretion
GLP-1
GIP

Question 13

GLP-1 analogs

Answer 13

MOA: GLP-1 receptor agonist
decrease in A1C, weight loss
-tide’s
exenatide, liraglutide, dulaglutide, semaglutide

Question 14

GLP-1 pharm and AE

Answer 14

SubQ
different durations of actions
AE: risk of pancreatitis (discontinue immediately)
nausea, vomiting, diarrhea
avoid in pts w/ diabetic gastroparesis

Question 15

Biguanides - Metformin

Answer 15

oral antidiabetic treatment
insulin sensitizer
MOA: increase glucose uptake of utilization by target tissues
improves uptake of sugars and slows intestinal absorption
low risk of hypoglycemia
can also treat polycystic ovary syndrome PCOS

Question 16

Biguanides - Metformin pharm and AE

Answer 16

PO BID
renally excreted 
AE: GI distress is common (25%)
dose-related, take w/ food
decreased vitamin B12 absorption w/ long term use

Question 17

Sulfonylureas

Answer 17

insulin secretagogues
promote insulin secretion from beta cells
blocks ATP - sensitive potassium channels

Question 18

Second Generation sulfonylureas

Answer 18

glyburide, glipizide, glimepride

Question 19

Sulfonylureas pharm and AE

Answer 19

PO, protein bound, metabolized in the liver, really excreted
AE: hypoglycemia, very high risk for elderly, taking other antibiotics, and renal function
weight gain

Question 20

Meglitinides - glinides

Answer 20

repaglinide
nateglinide
MOA: bind to a site closing the ATP - sensitive potassium channels resulting in insulin release
rapid onset and short duration of action

Question 21

Glinides AE

Answer 21

AE: similar to sulfonylureas
hypoglycemia
never use w/ sulfonylurea
weight gain
CYP interactions

Question 22

Thiazolidinediones

Answer 22

insulin sensitizers 
pioglitazone, rosiglitazone 
MOA: acts as agonist for PPAR-gamma
can change lipid levels
increase HDL, increase LDl, decrease TGs

Question 23

Thiazolidinediones pharm and AE

Answer 23

PO once daily
AE: weight gain, edema due to fluid retention, may worse HF
liver toxicity, increase risk of cancer

Question 24

Alpha -Glucoside inhibitors

Answer 24

Miglitol, acarbose
reversibly inhibit alpha-glucosidase inhibitors, don't break down carbs
PO at beginning of meal
AE: flatulence, diarrhea
MUST USE SIMPLE SUGARS
will prevent breakdown of complex carbs

Question 25

DPP-4 Inhibitors

Answer 25

-liptins
MOA: inhibit DPP-4 and lengthens GLP-1
WEIGHT NEUTRAL
PO once daily 
AE: nasopharyngitis, headache, pancreatitis

Question 26

Sodium-Glucose Cotransporter 2 (SGLT2) inhibitor

Answer 26

-gliflozins
MOA: block SGLT2 which is responsible for reabsorbing filtered glucose in the tubular lumen of the kidney
PO once day
AE: INCREASED RISK OF UTI
INCREASED MYCOTIC INFECTIONS
empagliflozin shows a CV benefit used in pts w/ diabetes and CV disease

Question 27

Hypoglycemia

Answer 27

oral glucose, IV dextrose, glucagon