Diabetes Mellitus

Question 1

What are the 3 very high risk to progress to Diabetes Mellitus?

Answer 1

1. Age < 60 yo
2. BMI ≥ 35 kg/m2
3. History of Gestational DM

Question 2

What can be done to avoid exercise-related hyper or hypoglycemia in individuals with T1DM?

Answer 2

1. Monitor blood glucose levels before, during and after exercise
2. Delay exercise if blood glucose is > 14 mmol/L or 250 mg/dL and ketones are present
3. If the blood glucose is < 5.0 mmol/L. Or 90 mg/dL, ingest carbohydrate before exercising
4. Monitor glucose during exercise and ingest carbohydrate as needed to prevent hypoglycemia
5. Decrease insulin doses (based on previous experience) before and after exercise and inject insulin into a nonexercising area
6. Learn individual glucose responses to different types of exercise

Question 3

Basal insulin agent associated with a longer duration of action with less frequent and severe nocturnal hypoglycemia

Answer 3

Decludec

Question 4

MOA of DEGLUDEC

Answer 4

It forms multihexamers in subcutaneous tissues and binds albumin, brought about by modification and extension of the carbo-terminus of the B chain

Question 5

Duration of action of DEGLUDEC

Answer 5

> 42 hours

Question 6

What is reflected by elevated Hba1c and 2h after lunch blood sugar level amidst having an FBS within target?

Answer 6

POSTPRANDIAL HYPERGLYCEMIA

Question 7

Best choice for obese patient with t2dm

Answer 7

GLP-1 receptor agonist
Semaglutide, dulaglutide, liraglutide
Because these agents can also cause weight loss

Question 8

Give 2 OHA which may be associated with weight gain

Answer 8

1. Pioglitazone
2. Sulfonylurea

Question 9

What OHA is contraindicated in patients with Congestive Heart Failure III or IV? And why?

Answer 9

Thiazolidinediones. They are associated with WEIGHT GAIN and MILD INCREASE IN PLASMA VOLUME.
PERIPHERAL EDEMA and CONGESTIVE HEAR FAILURE are more common in individuals taking TZDs

Question 10

What is the goal for time-in-range for most nonpregnant adults with DM?

Answer 10

> 70%

Question 11

Postprandial CBG target for nonpregnant adults? For older / high-risk adults?

Answer 11

Nonpregnant adults: <180 mg/dL or < 10 mmol/L
Older / high risk adults: < 200 mg /dL OR 11.1 mmol/L

Question 12

Target time below 3.9mmol/L or 70mg/dL?

Answer 12

Non pregnant: <4%
High risk: < 1%

Question 13

Target Glucose variability

Answer 13

Non-pregnant: ≤ 36%
Older / high risk: < 33%

Question 14

Which class agents may be associated with Vitamin B12 deficiency ?

Answer 14

BIGUANIDES