Diabetes Mellitus

Question 1

What are the two main functions of the pancreas, and what hormones does it produce?

Answer 1

Produces hormones (insulin and glucagon) and produces pancreatic digestive enzymes.

Question 2

Alpha cells release ______ while beta cells of the pancreas release _______.

Answer 2

Alpha cells: glucagon. Beta cells: Insulin

Question 3

HbA1c allows us to determine the average blood sugar control over a 6-12 week period. How is this possible?

Answer 3

HbA1c is formed in a non-enzymatic glycation pathway by hemoglobin’s exposure to plasma glucose. As plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way, reflecting the average level of glucose to which the RBC has been exposed to during its life cycle. (which is 100-120 days).

Question 4

Duration of glycemic burden should be measured how often and what does it tell us?

Answer 4

Every 3 months, it is a strong predictor of adverse outcomes

Question 5

To diagnose diabetes mellitus: HbA1c has to be greater than or equal to _____, fasting plasma glucose has to be _______, and two hour glucose during an OGTT (75 g glucose in water) has to be _______. With symptoms of hyperglycemia with a random glucose of ______.

Answer 5

HbA1c: > 6.5%
Fasting sugar: 126 mg/dL
2-hr glucose during OGTT: >200
Random glucose: >200

Question 6

Glycemic targets: HbA1C

Answer 6

<7%

Question 7

Glycemic Targets: Preprandial plasma glucose

Answer 7

70-130

Question 8

Glycemic targets: postprandial plasma glucose

Answer 8

<180

Question 9

Polyuria, polydipsia, polyphagia, glucosuria, weight loss, and fatigue are clinical manifestations of what?

Answer 9

Type 1 DM

Question 10

Body breaks down fatty acids for fuel if it can’t utilize insulin.

Answer 10

Diabetic ketoacidosis

Question 11

Primary treatment for Type 1 DM

Answer 11

Insulin

Question 12

Onset 15 min, peak 1-3 hrs, duration 3-5 hours. Dose according to how many carbs are ingested, give 15 minutes before or immediately after a meal.

Answer 12

Rapid acting insulin

Question 13

Onset 30-60 minutes, peak 2.5-5 hours, duration 4-12 hours. Give 30-60 minutes before meal.

Answer 13

Short acting insulin

Question 14

Onset 1-2 hours, peak 4-12 hrs, duration 14-24 hours. Cloudy.

Answer 14

Intermediate acting

Question 15

Onset 3-4 hours, no peak, duration 24 hours. Give once daily @ bedtime (or twice if needed). cloudy.

Answer 15

Long acting insulin

Question 16

True or False: To alleviate pain, apply heat to SC injection sites of insulin.

Answer 16

FALSE! Do not rub or place heat on injection site.

Question 17

Rapid acting or short acting insulin given based on blood glucose levels. Reactive approach to blood sugar control.

Answer 17

Sliding Scale Insulin

Question 18

What is the MOA of insulin?

Answer 18

Moves glucose transporters to the cell surface, facilitating taking glucose into the cell.

Question 19

Hypoglycemia can occur at any blood sugar level below…

Answer 19

70 mg/dL.

Question 20

True or false: Insulin has drug-drug interactions with drugs that decrease hypoglycemic effects (not drugs that increase hypoglycemic effects).

Answer 20

False! It interacts with both. (decrease: antiretrovirals, corticosteroids, thizaides, loop diuretics, thyroid preparations. Increase: alcohol, beta blockers, lithium, MAOIS, sulfonylureas, salicylates).

Question 21

Dizziness, irritability, diaphoresis, blurred vision, confusion, difficulty paying attention, and seizures are symptoms of what?

Answer 21

Hypoglycemia

Question 22

What do you give a pt in a state of hypoglycemia?

Answer 22

Sugar or glucagon.

Question 23

Induces liver glycogen breakdown, releasing glucose from the liver.

Answer 23

Glucagon.

Question 24

Non-insulin dependent diabetes

Answer 24

Type 2 DM

Question 25

What is one of the major risk factors for developing type 2 DM?

Answer 25

Obesity

Question 26

Oral antidiabetic drug that is not metabolized, reduces liver glucose production and increases insulin receptor sensitivity, can cause lactic acidosis. Does not increase risk of hypoglycemia by itself.

Answer 26

Metformin (a biguanide)

Question 27

What is contraindicated in pateints with serum creatinine >1.5, hepatic disease, alcohol abuse, and heart failure?

Answer 27

Metformin (a biguanide).

Question 28

What requires beta cell functions for its effect?

Answer 28

Sulfonylureas

Question 29

What oral antidiabetic drug carries a risk of hypoglycemia?

Answer 29

Sulfonylureas (Meglitinides do too, but to a lesser extent)

Question 30

What antidiabetic drug reduces glucose production and increases insulin receptor sensitivity, but increases risk of bladder cancer, heart attack, and stroke?

Answer 30

Thiazolidinediones (TZDs)

Question 31

Which oral antidiabetic is most useful in pts with postprandial hyperglycemia?

Answer 31

Meglitinides

Question 32

Which oral antidiabetic delays carbohydrate absoprtion (by inhibiting an enzyme), has a high discontinuation rate, and is administered with the first bite of each meal?

Answer 32

Alpha-Glucosidase Inhibitors

Question 33

SC administration, analog of amylin. Causes nausea and hypoglycemia with insulin.

Answer 33

Amylinomimetic

Question 34

SC administration. Analog of incretin. Causes acute pancreatitis.

Answer 34

GLP-1 Receptor Agonists.

Question 35

Inhibits the enzyme that rapidly inactivates incretin. Adverse effects are the common cold, upper respiratiory infection, acute pancreatitis.

Answer 35

DPP-4 Inhibitors

Question 36

First in new class. Blocks glucose reabsorption in kidneys and increases glucose excretion. Adverse effects are vaginal yeast infection and hypotension

Answer 36

Canagliflozin