Diabetes mellitus

Question 1

Name 6 risk factors for diabetic nephropathy.

Answer 1

1. poor glycemic control
2. HTN
3. hyperlipidemia
4. high protein intake
5. smoking
6. genetic predisposition

Question 2

Describe the timing/order of steps toward ESRD in diabetic nephropathy.

Answer 2

1. first glomerular injury
2. onset of albuminuria
3. onset of overt proteinuria
4. onset of azotemia (elevation of serum creatinine)
5. onset of ESRD

Question 3

If your patient has loss of foot sensation by monofilament testing, what are they at increased risk for?

Answer 3

foot ulcers

Question 4

What is this?

Answer 4

Charcot foot secondary to diabetic neuropathy.

Question 5

What is seen here?

Answer 5

Diabetic retinopathy, including cotton wool spots, blot hemorrhages, and hard exudates.

Question 6

What is the firstline therapy for treatment of hypertension in diabetes?

Answer 6

ACE Inhibitor or Angiotensin II Receptor Blocker (unless contraindication such as hyperkalemia)

Question 7

What is the blood pressure goal for a patient with diabetes?

Answer 7

140/90

Question 8

What is the LDL goal for patients with diabetes?

Answer 8

< 100

( <70 in those with CAD)

Question 9

What is the triglyceride goal for patients with diabetes?

Answer 9

< 150

Question 10

What is the HDL goal for patients with diabetes?

Answer 10

over 40 (men)
 over 50 (women)

Question 11

What is the firstline medication therapy for type 2 diabetes?

What is the MOA of this drug?

Answer 11

metformin

suppresses hepatic gluconeogenesis (greatly increased in type 2 diabetics)

Question 12

What is the MOA of thiazolidinediones?

Answer 12

Medications of this class of antihyperglycemic agents sensitize peripheral tissues to insulin.

Question 13

What is the MOA of sulfonylureas?

Answer 13

The primary mechanism of action of the sulfonylureas is to stimulate insulin release from pancreatic B cells.

Question 14

When is metformin contraindicated?

Answer 14

renal failure

Question 15

What is the difference between basal insulin and bolus insulin?

Answer 15

Basal Insulin
• Suppresses glucose production between meals and
overnight - - for times when not eating
• Nearly constant levels
• 50% of daily needs
Bolus Insulin (Mealtime or Prandial)
• Limits hyperglycemia after meals
• 10% to 20% of total daily insulin requirement at each meal
(total is about 50%)

Question 16

How is random plasma glucose used to diagnose DM?

Answer 16

over 200 mg/dL AND symptoms

=

DM

Question 17

How is fasting plasma glucose used to diagnose DM?

Answer 17

• Fasting Plasma Glucose

– Normal – 99

– Pre-diabetes (impaired fasting glucose) 100 – 125 (often go to DM w/i 10 yrs)

– Diabetes* – 126 and above

*Confirm- repeat test on a different day

Question 18

How is hemoglobin A1c used to diagnose DM?

Answer 18

• Fasting Plasma Glucose / Hemaglobin A1c

– Normal – 5.4% and below

– Pre-diabetes (impaired fasting glucose) – 5.5 – 6.6% (often go to DM w/i 10 yrs)

– Diabetes* – 6.5% and above

*Confirm- repeat test on a different day

Question 19

Untreated, Type 1 DM can lead to what? (within hours/short-term)

Answer 19

Diabetic ketoacidosis (fruity breath):

– hyperglycemia>250 mg/dL and pH<7.3

– anorexia, nausea, vomiting, dehydration, mental status changes and coma

Question 20

What is the typical distribution of diabetic neuropathy in the extremities?

Answer 20

glove and stocking distribution

Question 21

What is the MOA of alpha-glucosidase inhibitors?

Answer 21

Prevents absorption of carbohydrates in the digestive tract.

Question 22

What is the MOA of incretins?

(GLP-1 agonists, DPP-4 inhibitors)

Answer 22

enhance glucose-dependent insulin secretion

Question 23

Name two rapid acting insulins.

Answer 23

lispro (Humalog)

aspart (Novolog)

Question 24

Name two short acting insulins.

Answer 24

regular insulin (Humulin R, Novolin R)

Question 25

Name 2 intermediate acting insulins.

Answer 25

Humulin N, Novolin N