Diabetes meds

Question 1

T1DM

Answer 1

> Positive HLA-DR4, HLA-DR3 association.
weak familial predisposition
Autoimmune response that triggers the destruction of insulin producing B cells
leukocyte infiltration of islets

Question 2

DKA

Answer 2

Primarily seen in pts with T1DM.
Insufficient insulin levels often secondary to an acute infection

Manifests as hyperglycemia 300 -600mg/dl, polyuria, polydispsia, nausea, vomiting, volume depletion ( dry oral mucosa), mental status changes and coma

Ketones, Sweet smelling breathe, mentation change, acidosis.

Question 3

T2DM

Answer 3

> Has a strong genetic component
NO HLA association
There is insulin resistance and or impaired secretion due to B cell dysfunction.
Amyloid polypeptide deposits in islets (IAPP)

Question 4

Screening of T2DM

Answer 4

HbA1c

Question 5

Diabetic microvascular complications

Answer 5

Diabetic Nephropathy
Diabetic Retinopathy
Diabetic Neuropathy

Question 6

Diabetic Macrovascular Complications

Answer 6

CAD
Stroke
PAD
Monkeberg arteriosclerosis (medial calcific sclerosis)

Question 7

Management includes

Answer 7

antihyperglycemics
statins (lipid lowering)
ACE inhibitors
ARB
aspirin (ant-platelet)

Question 8

Sulfonylureas
DDP-4 inhibitors
SGLT-2 inhibitors
thiazolidinediones

Answer 8

NOT Licensed to be used in management of Diabetes in Children

Question 9

Type 1 Classifications

Answer 9

Type 1A = Insulin dependent
LADA = Latent autoimmune diabetes in adults (late onset of type 1 diabetes in adults) often mistaken for T2DM
Type 1B = idiopathic (strong hereditary component, no auto antibodies detected)

Question 10

GDM

Answer 10

A1GDM = no medication required
A2GDM = REQUIRE Insulin immediately

Question 11

MODY

Answer 11

Maturity onset of Diabetes of the Young
early onset <25 years of age
non-insulin dependent DM
Autosomal Dominant

Question 12

MODY II

Answer 12

Single mutation leads to impaired insulin secretion due to altered Glucokinase function.

Can be managed by diet alone

Question 13

Glucokinase

Answer 13

Glucose sensor of the B Cell

Question 14

Bronze Diabetes

Answer 14

Due to increased iron in the body which destroy the pancreatic islets
Hemochromatosis. > Most frequent genetic dz in the white population

Question 15

Cystic Fibrosis related diabetes

Answer 15

Pancreatic insufficiency

Question 16

Cushing Disease

Answer 16

Glucose intolerance

Question 17

Drug induced diabetes can be caused by

Answer 17

use of Corticosteroids

Question 18

cleavage of Proinsulin which is a precursor of Insulin produces

Answer 18

C-Peptide

Question 19

Congenital rubella infection
(congenital TORCH infections)

Answer 19

causes Hepatosplenomegaly

Question 20

Insulin

Answer 20

Stimulates intracellular Potassium accumulation

Stimulates protein synthesis and uptake of AA
Inhibits Proteolysis

Question 21

T1DM Antibodies

Answer 21

anti- GAD (anti-glutamic acid decarboxylase antibody)
anti-ICA (anti-islet cell cytoplasmic antibody)

Question 22

T2DM Treatment

Answer 22

Biguanides - Metformin is the first line initial treatment
increase peripheral glucose uptake by tissues and muscle.

s/e diarrhea and Abd. discomfort,
Vit B12 def. > diabetic neuropathy worsens

Question 23

Contraindications to Metformin

Answer 23

> eGFR<30mL/minute/1.73m2
acute of chronic metabolic acidosis
hypersensitivity to Metformin or its components

Question 24

GLP-1 Receptor Agonists (Incretin system mimetics)

Answer 24

Recommended for pts with eGFR<30ml/min), clinical ASCVD, or high risk of ASCVD
>Semaglutide (oral or injectable)
>Liraglutide (daily SQ )
>Dulaglutide (weekly SQ)

> Exenatide
Albiglutide
Lixisenatide
(((Tirzepatide))(look up latest studies)

Question 25

Dipeptidyl peptidase -4 inhibitors (DPP-4 i)

Answer 25

>Sitagliptin >Saxagliptin (avoid in pts with HF) >Linagliptin (DPP-4 degrades GLP1, therefore DPP4 inhibitors prolong the effects of GLP1 and GIP)

Question 26

GLP secreted upon ingestion of food (incretin system) (half-life 2 - 4 mins)

Answer 26

Promotes satiety and reduces appetite Suppresses glucagon activity and increases glucose dependent insulin secretion

Question 27

in T2DM

Answer 27

Meal induced GLP-1 release is reduced

Question 28

SGLT-2 Inhibitors >Empagliflozin >Dapagliflozin reduce insulin resistance

Answer 28

>Recommended for CKD and eGFR 15-29mL/min / 1.73m2, >Congestive heart failure clinical ASCVD or high risk for ASCVD >Beneficial for pts who want to Lose weight or maintain their weight

Question 29

Sulphonyl-ureas >Glimepiride >Gliclazide >Glyburide

Answer 29

>They inhibit ATP-sensitive potassium channels in the beta cell membrane, leading to depolarization and increased insulin release. >c/I in pts with eGFR <30mL/min) >associated with weight gain

Question 30

Glinides ( sulfonyl-ureas analogue) >Nateglinide >Repaglinide

Answer 30

>Short and Rapid action >used to correct Post-prandial Hyperglycemia >Increase insulin secretion >Associated with Weight gain and renal failure

Question 31

Thiazo-lidinedione (TZD) >Pioglitazone >Rosiglitazone

Answer 31

>Decrease insulin resistance and increase muscle and adipose tissue sensitivity to insulin. >Avoid in Pts with CHF, Liver pathology, and MI events > risks of # in women, >maximal clinical effect expected in a few weeks time. >associated with Weight gain, and increase LDL >Not to prescribe if risk for Bladder cancer.

Question 32

a-Glucosidase inhibitors >Acarbose >Miglitol >Voglibose

Answer 32

inhibits the enzyme that degrades oligosaccharides and disaccharides in the small intestines. associated with abd discomfort and flatulence

Question 33

Oral monotherapy lowers HbA1c levels by around 1%

Answer 33

every non-insulin added to metformin lowers HbA1c by an additional 0.7 -1.0%

Question 34

Do not combine Sulfonyl-ureas and Metformin

Answer 34

risk of Hypoglycemia

Question 35

if Diabetic pt undergoing surgery

Answer 35

avoid oral antidiabetic meds and instead insulin therapy may be initiated

Question 36

Insulin therapy in newly diagnosed patients

Answer 36

if HbA1c is >10% or >300mg/dl

Question 37

Basal insulin regimen

Answer 37

A type of treatment for type 2 diabetes mellitus that involves the injection of long-acting insulin (e.g., glargine) or intermediate-acting insulin combined with an antidiabetic drug. Indicated for patients with persistently elevated HbA1c levels despite noninsulin antidiabetic therapy.

Question 38

Albumin-to-creatinine ratio Abbreviation: ACR, UACR

Answer 38

The ratio of urine albumin concentration to urine creatinine concentration. (proteinuria) An ACR < 30 mg/g is considered normal to mildly increased; an ACR 30-300 mg/g for more than 3 months indicates likely chronic kidney disease. An ACR > 300 mg/g is severely increased.

Question 38

GLP-1 receptor agonists

Answer 38

Should be part of the treatment strategy prior to starting insulin therapy in patients with T2DM, unless they are not appropriate.

Question 39

Screening for microvascular complications of Diabetes

Answer 39

>Kidney = Albumin to creatinine ration >Retinopathy >Peripheral neuropathy with focused examination of sensation (pinprick, monofilament, vibration, temperature) >autonomic neuropathy

Question 40

Glucose handling in non-diabetic Pt

Answer 40

90% absorbed in the S1 section of Proximal tubule. Facilitated by SGLT-2 S3 segment (initial part of descending loop) 10% via SGLT1

Question 40

DPP-4 inhibitor Linagliptin

Answer 40

Elimination via Biliary system >70% safe to use in pts reduced GFR

Question 40

GLP-1 agonists

Answer 40

Proved CV safety risk of acute pancreatitis

Question 41

SGLT-2 inhibitors

Answer 41

>Block glucose reabsorption therefore more is excreted in urine. (glucosuria) >potential for BP control via Na+ elimination and h2o. >CV safety >reduces risk of HF and progression to CKD >increased risks for lower UTI

Question 42

for T2DM patients with established ASCVD or HF

Answer 42

GLP-1A or SGLT-2i are recommended have proved CV safety and benefit

Question 43

for T2DM patients without ASCVD but with HFrEF or CKD

Answer 43

SGLT2-inhibitors are recommended