Diabetes mellitus

Question 1

exocrine cells involves synthesis and release of what?

Answer 1

digestive enzymes and sodium bicarbonate

Question 2

what does the exocrine cells play an essential role in what?

Answer 2

digestion and absorption of food in small intestine

Question 3

endocrine cells involves synthesis and release of what?

Answer 3

hormones

Question 4

which cells are produced from acini cells?

Answer 4

exocrine

Question 5

which cells are produced from islets of langerhans

Answer 5

endocrine

Question 6

what does the endocrine cells play an essential role in what?

Answer 6

blood glucose levels

Question 7

Insulin comes from which cells

Answer 7

beta

Question 8

glucagon comes from which cells

Answer 8

alpha

Question 9

somatostatin comes from which cells

Answer 9

delta

Question 10

glycogenesis

Answer 10

glucose is stored in liver as glycogen

Question 11

lipogenesis

Answer 11

glycogen coverts to glucose which converts to fatty acids which is stored as triglycerides in fat cells

Question 12

what happens between meals?

Answer 12

liver releases glucose to maintain blood glucose within normal limits

Question 13

glycogenolysis

Answer 13

glycogen broken down to release glucose

Question 14

gluconeogenesis

Answer 14

synthesis of glucose from amino acids, glycerol and lactic acid

Question 15

which type of diabetic goes into DKA?

Answer 15

type I

Question 16

which type of diabetic has islet cell Ab

Answer 16

type I

Question 17

AlC should be greater than or equal to what to diagnose Diabetes? fasting BG?

Answer 17

6.5/ >126mg/dl

Question 18

A normal A1C should be? fasting BG should be?

Answer 18

below 5.7/ <100mg/dl

Question 19

prediabetic A1C? fasting BG?

Answer 19

5.7-6.4/100-125mg/dl

Question 20

when are all pregnant women screened for diabetes regaurdless of risk with an OGTT?

Answer 20

24-28 weeks

Question 21

primary goal of diabetes treatment?

Answer 21

prevent long term complications

Question 22

preferred treatment for severe hypoglycemia

Answer 22

IV glucose or Glucagon

Question 23

macrovascular damage

Answer 23

heart disease HTN, stroke

Question 24

microvascular damage

Answer 24

retinopathy, neuropathy, erectile dysfunction

Question 25

what drug is important to prescribe for a diabetic who has HTN?

Answer 25

ACE inhibitor (lisinopril) or ARB (losartan)

Question 26

treatment principles for diabetic management step 1

Answer 26

initiate lifestyle changes, start metformin

Question 27

treatment principles for diabetic management step 2

Answer 27

add 2nd drug to metformin, continue lifestyle changes

Question 28

treatment principles for diabetic management step 3

Answer 28

add 3rd drug to metformin and the other drug

Question 29

treatment principles for diabetic management step 4

Answer 29

add insulin to to 3 other drugs,

Question 30

A1C treatment goal

Answer 30

<7%

Question 31

preprandial

Answer 31

before a meal

Question 32

Preprandial plasma glucose treatment goal?

Answer 32

80-130 mg/dl

Question 33

peak postprandial plasma glucose treatment goal?

Answer 33

<180

Question 34

BP treatment goal for risk CVD and non risk CVD

Answer 34

Risk = 130/80 | non risk= <140/90

Question 35

LDL, triglycerides and HDL treatment goals

Answer 35

LDL <100 triglycerides <150 HDL >50

Question 36

when is tight glycemic control inappropriate?

Answer 36

``` long standing type 2 advanced microvascular or macrovascular damage comorid conditions hx severe hypoglycemia limited life expectancy ```

Question 37

which drugs help with nephropathy

Answer 37

ACE1 or ARB

Question 38

which drugs help with neuropathy?

Answer 38

tricylic antidepressants, gabapentin

Question 39

which drugs help with patients at high risk for hypoglycemia

Answer 39

metformin or pioglitazone

Question 40

which drugs help with postprandial hyperglycemia

Answer 40

alpha-glucosidase inhibitor, Byetta

Question 41

How does insulin effect K?

Answer 41

it increases K uptake into cells

Question 42

how does insulin effect adipose tissue?

Answer 42

helps to breakdown fat

Question 43

how does insulin effect muscle?

Answer 43

increases glycogen and protein synthesis

Question 44

how does insulin effect liver?

Answer 44

increases storage of glucose as glycogen | inhibits glycogenolysis, glucomeogensis, ketogenesis

Question 45

insulin analog example

Answer 45

Glargine (lantus)

Question 46

Rapid acting insulin

Answer 46

Lispro (Humalog), aspart (Novolog), glulisin (Apidra)

Question 47

how fast is rapid acting insulin and when does it peak, How long does it last

Answer 47

10-30 minutes, peaks 1 hour, lasts 3-6 hours

Question 48

Short acting insulin

Answer 48

Regular (Humulin) Novolin R

Question 49

When is short acting insulin given, peak? duration?

Answer 49

given 30-45 minutes, peaks at 1-5 hours and lasts about 6-10 hours

Question 50

Intermediate-acting insulin

Answer 50

NPH

Question 51

how fast is intermediate-acting insulin, peak? and duration?

Answer 51

1-2 hours, peaks 6-14 hours and lasts 16-24 hours

Question 52

Long acting insulin, peak? duration?

Answer 52

Glargine (Lantus) and Detemir (Levemir) no peak, lasts 12-24 hours

Question 53

ultra long acting insulin? peak? duration?

Answer 53

Degludec (Tresiba), no peak, lasts 42 hours

Question 54

NPH can only be mixed with which type of insulin?

Answer 54

short acting (Regular (Humulin) Novolin R)

Question 55

when mixing NPH which is drawn up first?

Answer 55

short acting (Regular (Humulin) Novolin R)

Question 56

which type of insulin can cause bronchospasm in patients since you can give it via oral inhalation

Answer 56

short acting (Regular (Humulin) Novolin R)

Question 57

short acting (Regular (Humulin) Novolin R) route

Answer 57

subq, IV infusion, IM, oral inhalation

Question 58

how much does 15gm CHO raise BG?

Answer 58

50gm/dl

Question 59

1 unit bolus of insulin lowers glucose by how much?

Answer 59

20-60mg/dl

Question 60

metformin is which type of oral hypoglycemic?

Answer 60

Biguanides

Question 61

Biguanides

Answer 61

metformin

Question 62

most common side effects of Biguanides (metformin)

Answer 62

GI upset, B12 deficiency

Question 63

when are Biguanides (metformin) given to a non diabetic?

Answer 63

Polycystic ovary syndrome (PCOS), to increase changes of pregnancy, prevention of type 2

Question 64

which antidiabetics increase insulin secretion?

Answer 64

sulfonyureas, incretins, meglitinides

Question 65

which antidiabetics increase glucose uptake and utilization?

Answer 65

Thiazolidinediones and Beguanides

Question 66

In order for Biguanides to work, what is needed?

Answer 66

they need to be making insulin for this to work

Question 67

Meglitinides (glinides)

Answer 67

Repaglinide (Prandin), Nateglinide (Starlix)

Question 68

which type of oral hypoglycemics are Repaglinide (Prandin), Nateglinide (Starlix)

Answer 68

Meglitinides ("glinides")

Question 69

Thiazolidinediones (glitazones)

Answer 69

Rosi"glitazone" (Avandia)

Question 70

which type of oral hypoglycemics are Rosi"glitazone" (Avandia)

Answer 70

Thiazolidinediones (glitazones)

Question 71

Function of Biguanides (metformin)

Answer 71

prevents liver from making glucose decreases intestinal absorption of glucose increases insulin sensitivity to the tissues lowers cholesterol does NOT stimulate insulin secretion

Question 72

oral hypoglycemic for patients with secondary beta cellfailure

Answer 72

metformin

Question 73

Should you take Biguanides (metformin) with food?

Answer 73

no

Question 74

warnings precautions with Biguanides (metformin)

Answer 74

impaired hepatic function, decreased B12 absorption, elderly

Question 75

Sulfonylureas start with?

Answer 75

"Gli"

Question 76

which oral meds are bad for pregnancy?

Answer 76

sulfonylureas, thiazolidinediones (really nothing except for metform)

Question 77

bladder ca is a side effects of which med?

Answer 77

Thiazolidinediones