Diabetes Mellitus

Question 1

Which type of diabetes is more prevalent?

Answer 1

Type 2 (90%)

Question 2

What is HbA1C?
what are the normal and diabetic ranges of this?
What’s the A1C treatment goal for diabetic patients?

Answer 2

Measure of glycated hemoglobin in blood
normal 4 to 5.9%
diabetic > 6.5%
treatment goal 7%

Question 3

What determines the acting duration of different insulins?

Answer 3

Pharmacokinetics - the speed with which they move away from the site of injection

Question 4

Insulins
Onset, Peak, Duration, name one for each:

Rapid
Short
Intermediate
Long

Answer 4

Rapid 15-30 min, 1-2, 3-5, lispro (meals)
remain as single molecules, disperse rapidly

Short 30-60 min, 2-3, 6-7, regular

Intermediate 1-2, 5-8, up to 18, NPH (cloudy, basal therapy)
insulin is bound to NPH, takes longer to break away

Long 90 min, no peak, up to 24, glargine (basal therapy)

Question 5

early signs of hypoglycemia (think of a very hungry person)

Answer 5

irritable, headache, sweating, shaky and tremors, pale

Question 6

Interactions: What drugs increase hypoglycemic effect (lower blood glucose levels)?

Answer 6

B-blockers (eg propranolol)
- they reduce the conversion of glycogen to glucose (glycogenolysis)
alcohol - do not drink alcohol when taking insulin!

Question 7

Interactions: What drugs reduce the effect of insulin (increase blood glucose levels)?

Answer 7

Glucocorticoids

- they decrease the effect of some hypoglycemic medications

Question 8

Type 2 Diabetes drugs - target pancreas
what do (3 things)
name one class and an example of a drug in that class
when take?

Answer 8

Insulin secretagogues

1. increase insulin production in Type 2 DM by acting on beta cells of pancreas
2. also improves tissue sensitivity to insulin in muscles, liver, fat cells
3. decreases rate of insulin metabolism (breakdown) in the liver

class: sulphonylureas
- e.g., glyburide

take with breakfast

Question 9

Oral drugs
name one
what do
when take?

Answer 9

metformin (in the class “biguanides”)

• decrease hepatic production of glucose (gluconeogenesis)
• increase tissue sensitivity to insulin so cells take up more glucose

when: take with meals to reduce GI upset

it does NOT stimulate the pancreas to produce more insulin

Question 10

Which one can cause hypoglycemia?

Glyburide or metformin?

Answer 10

Glyburide can

metformin cannot cause hypoglycemia

Question 11

Thiazolidinediones (abbreviated to TZD)
name one
what do
AEs

Answer 11

rosiglitazone

what: decrease insulin resistance (make cells more sensitive to insulin)

AEs: Boxed warning that they increase the risk of angina, MI, and HF

Question 12

What is the polar opposite of insulin?

Answer 12

Glucagon

- so we want to inhibit its production in diabetics

Question 13

Describe the relationship between incretin and the DDP-4 enzyme

Answer 13

Incretin (which stimulates insulin release and inhibits glucagon release [which are both good things and what we want them]) is inhibited by the DDP-4 enzyme.

Question 14

Incretin pathway drugs
name two
how does each work (briefly)

Answer 14

exenatide (in the class “incretin mimetic”)

• imitates incretin to cause secretion of insulin
• administered SC
• fun fact, it’s a synthetic form of a protein that comes from the Gila monster, which you should definitely Google

sitagliptin (in the class “gliptins”)

• DDP-4 enzyme inhibitor
• administered orally once daily

Question 15

Na-Glucose Transporter Inhibitors
name one
what do
AEs

Answer 15

Canagliflozin

what: inhibits a glucose transporter in nephron, which is the primary way that we reabsorb glucose into the body from the urine
- the Sodium-GLucose Transporter subtype 2 (SGLT2)
- causes loss of glucose in urine

AEs: increased urination and UTIs

Question 16

What is the hypoglycemic protocol?

Answer 16

• Give glucagon
• Give clear fruit juice (apple), glucose tablets
• Eat a full meal after the juice with carbs and proteins