Diabetes mellitus type II

Question 1

what are the microvascular complications of diabetes?

Answer 1

• retinopathy
• neuropathy
• nephropathy

Question 2

what are the macrovascular complications of diabetes?

Answer 2

• cerebrovascular disease
• peripheral vascular disease
• coronary heart disease

Question 3

what are the criteria for diagnosis of diabetes?

Answer 3

1. symptoms of diabetes and a casual glucose of over 200 mg/dL
2. fasting blood glucose over 126 mg/dL on TWO occasions
3. two hour post prandial glucose over 200 mg/dL

Question 4

what is the effect of insulin on glycogen formation?

Answer 4

increase

Question 5

what is the effect of insulin on protein synthesis?

Answer 5

increase

Question 6

what is the effect of insulin on lipid synthesis?

Answer 6

increase

Question 7

HbA1C correlates with what parameter of glucose metabolism?

Answer 7

3 month blood sugar AVERAGE (RBC lifespan)

Question 8

how will hemoglobinopathies (eg sickle cell) affect HbA1C levels?

Answer 8

falsely elevated

Question 9

how will recent transfusions or anemia affect HbA1C?

Answer 9

falsely low

Question 10

what will cause falsely elevated HbA1C levels?

Answer 10

hemoglobinopathies (eg sickle cell)

Question 11

what will cause falsely low HbA1C levels?

Answer 11

recent transfusions, anemia

Question 12

what are drug choices for T2DM?

Answer 12

• GLP-1 agonists
• DPP-4 inhibitors
• sodium-glucose co-transporter inhibitors

Question 13

what class of drugs inhibits glucose influx?

Answer 13

a-glucosidase inhibitors

Question 14

what class of drugs promotes insulin secretion?

Answer 14

insulin secretagogues

Question 15

what class of drugs lower hepatic glucose output?

Answer 15

metformin

Question 16

what class of drugs increase peripheral glucose uptake?

Answer 16

thiazoladinediones

Question 17

what are the a-glucosidase inhibitor drugs?

Answer 17

acarbose (precose)

miglitol (glyset)

Question 18

what drug class is the best option for diabetic patients with mild post-prandial hyperglycemia?

Answer 18

a-glucosidase inhibitors

Question 19

what are the contraindications to a-glucosidase inhibitors?

Answer 19

malabsorption

Question 20

what are the side effects of the a-glucosidase inhibitors?

Answer 20

GI upset, bloating

Question 21

insulin secretagogues (sulfonylureas): MOA

Answer 21

stimulate insulin secretion by closing ATP sensitive potassium channels of pancreatic beta cells

Question 22

what are the 1st generation sulfonylureas?

Answer 22

chlorpromide

tolbutamide

Question 23

what are the 2nd generation sulfonylureas?

Answer 23

glyburide
glipizide
glimipiride

Question 24

what are the meglitinides?

Answer 24

repaglinide

nateglinide

Question 25

what are the side effects of the secretagogues?

Answer 25

hypoglycemia, weight gain

Question 26

what are the contraindications of the secretagogues?

Answer 26

severe renal / hepatic disease

Question 27

biguanides: MOA

Answer 27

- decrease hepatic gluconeogenesis - lower Alc 1.5-2.0% - decrease appetite / promote weight loss

Question 28

what are the biguanide drugs?

Answer 28

metformin | glucophage

Question 29

what are the side effects of the biguanides?

Answer 29

LACTIC ACIDOSIS, GI upset

Question 30

what are the contraindications for the biguanides?

Answer 30

CRI CHF liver disease

Question 31

thiazoladinediones: MOA

Answer 31

- PPARy agonists - induce adipose differentiation - promote fatty acid storage / fat cell redistribution - large insulin resistant cells ----> small insulin sensitive cells - net result: flux of FFA to subcutaneous tissue away from viscera; increase in insulin sensitivity

Question 32

what are the thiazolidinedione drugs?

Answer 32

- pioglitazone (actos) | - rosiglitazone (avandia)

Question 33

what are the side effects of the thiazolidinedione drugs?

Answer 33

fluid resuscitation / weight gain

Question 34

what are the contraindications of the thiazolidinedione drugs?

Answer 34

CHF III and IV | severe liver disease

Question 35

what type of drug is exenatide?

Answer 35

GLP-1 analogue (incretin mimetic)

Question 36

incretin mimetics: MOA

Answer 36

in response to gut detection of glucose, incretin hormones (glucose like peptide 1) are released and stimulate secretion of insulin from beta cells

Question 37

what are the side effects of the incretin mimetics?

Answer 37

hypoglycemia, nausea

Question 38

what are the contraindications of the incretin mimetics?

Answer 38

ESRD | severe gastric disease

Question 39

dipeptidyl peptidase 4 (DPP-4) inhibitors: MOA what are the effects?

Answer 39

DDP-4 enzyme degrades GLP-1 - increase body's active incretin hormone levels - increase pancreatic secretion of insulin - decreased liver glucose production

Question 40

what are the DPP-4 inhibitor drugs?

Answer 40

siltagliptin saxagliptin linagliptin

Question 41

what are the side effects of the DPP-4 inhibitors?

Answer 41

nasal congestion

Question 42

pramlitide: MOA

Answer 42

lowers post prandial glucagon

Question 43

what are the side effects of pramlitide?

Answer 43

hypoglycemia, nausea

Question 44

what are the contraindications of pramlitide?

Answer 44

gastroparesis | hypoglycemia unawareness

Question 45

what are the indications for insulin therapy in T2DM?

Answer 45

- significant hyperglycemia at presentation - hyperglycemia despite maximal doses of oral agents - decompensation - surgery - pregnancy - renal disease - allergy or serious reaction to oral agents

Question 46

what is the regimen when medications alone are failing?

Answer 46

1. continue oral agents 2. add single injection at bedtime NPH or Lantus 10 units 3. titrate to achieve FBG under 100 mg/dL