Diabetes (Pharm included)

Question 1

What are the serum glucose and A1c levels for normoglycemia, impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus, respectively?

Answer 1

Normoglycemia: 99 mg/dL or less fasting BG, 140 mg/dL or less 2 hr OGTT, 5.7% of less A1c.

Impaired fasting glucose: 100-125 fasting BG, 5.7-6.4% A1c.

Impaired glucose tolerance: 140-199 2hr OGTT, 5.7-6.4% A1c.

DM: 126+ fasting BG, 200+ random BG, 200+ 2hr OGTT, 6.5% or higher A1c.

Needs to be done on two separate occasions to make the Dx.

Question 2

Which HLA classes are associated with T1DM?

Answer 2

DR and DQ - patients should avoid DR. pepper and Dairy Queen (DQ).

Question 3

How does type 1 diabetes typically present for the first time (in an undiagnosed patient)?

Answer 3

DKA

Question 4

Do type 1 diabetics need to lose most of their beta cells before symptoms appear?

Answer 4

Yeah

Question 5

True or false: Type 2 DM is characterized by both insulin resistance and (relative or absolute) insulin deficiency.

Answer 5

True dat

Question 6

Name three major complications of diabetes.

Answer 6

1. Diabetic retinopathy
2. Diabetic nephropathy
3. Non-traumatic amputation

Question 7

Name a sulfonylurea and how they work.

Answer 7

Glipizide - stimulates insulin secretion (need Beta cells!)

Question 8

What are the side effects of sulfonylureas?

Answer 8

Weight gain and hypoglycemia

Question 9

What drug is first line treatment for T2DM? How does it work?

Answer 9

Metformin increases insulin sensitivity in peripheral tissues and decreases hepatic glucose production.

Question 10

What is the major side effect of metformin?

Answer 10

GI stuff like diarrhea

Question 11

Name a long-acting form of insulin.

Answer 11

Glargine (lantus)

Question 12

Name a post-prandial type of insulin.

Answer 12

Lispro (humalog)

Question 13

What is GLP-1 and what are its roles physiologically?

Answer 13

Glucagon-like peptide

It is secreted by L cells in the small intestine when people eat and it stimulates insulin secretion, suppresses glucagon, slows gastric emptying, and reduces food intake.

Question 14

Name two GLP-1 agonists.

Answer 14

Exenatide, liraglutide

Question 15

Do you need working beta cells for GLP-1 agonists to work? What is their main side-effect?

Answer 15

Yeah you need beta cells. NOT hypoglycemia because they work when you eat food.

Question 16

Name a thiazolidinedione. What is its mechanism of action? Why are these drugs not often used?

Answer 16

Pioglitazone. Activates peroxisome proliferator activated receptors (PPARs) that regulate genes involved in glucose and lipid metabolism. Not used because of increased risk of heart failure and myocardial ischemia.

Question 17

Name an intermediate-acting form of insulin.

Answer 17

NPH

Question 18

When do you need to correct for serum sodium levels? What is the equation?

Answer 18

In the setting of hyperglycemia, you need to use this formula to correct for serum [Na+]:

corrected Na+ = measured Na+ + 1.6(measured glucose - 250)/100