Diabetes Type 2

Question 1

Physiologic problems with DM Type 2?

Answer 1

Reduced Glucagon-like peptide-GLP-1
Insulin resistance
Loss of amylin

Question 2

What is Glucagon-like peptide (GLP-1)?

Answer 2

Released from distal ileum and colon in response to foods containing carbs and fats

Question 3

Risk factors for DM Type 2?

Answer 3

HDL>250
Delivering baby over 9 pounds
History of vascular disease
Atypical psychotics

Question 4

Who should we screen for diabetes?

Answer 4

BMI>25 + other risk factor

Over age 45

Question 5

What children should be screened for Type 2 DM?

Answer 5

BMI>85th percentile or wt. for ht.>85th percentile or wt.>120% of ideal plus 2 risk factors

• Start at age 10 or at puberty
• FPG every 2 years

Question 6

What are other causes of insulin resistance?

Answer 6

PCOS
Acromegaly
Cushing’s syndrome

Question 7

Most common microvascular complication in Type 2 DM?

Answer 7

Neuropathy

Question 8

When should the average woman be screened for GDM?

Answer 8

24-28 weeks

Question 9

How is GDM diagnosed?

Answer 9

FPG>95
1 hr>180
2 hr>155
3 hr>140

Question 10

How often should a person on insulin check their blood sugars?

Answer 10

3x per day

Question 11

Which drugs are the secretagogues?

Answer 11

Sulfonylureas

Meglitinides

Question 12

How do Sulfonylureas work?

Answer 12

Stimulate insulin release

At higher doses decrease hepatic glucose release

Question 13

Which drugs are Sulfonylureas?

Answer 13

Glyburide
Glipizide
Glimepiride

Question 14

ADRs of Sulfonylureas?

Answer 14

Hypoglycemia: elderly, renal impairment
Weight gain
Rash, photosensitivity, blood dyscrasias, weakness, confusion, cholestatic jaundice

Question 15

What is best Sulfonylurea to use?

Answer 15

Glipizide

-Give 30 mins before first meal

Question 16

Drug interactions/contraindications with Sulfonylureas?

Answer 16

Propanolol
ETOH-do not take
Contraindicated in pregnancy
Sulfonamides/Salicylates

Question 17

Which Secretagogues are short-acting?

Answer 17

Meglitinides

Question 18

Which Meglitinide is a derivative of phenylalanine?

Answer 18

Nateglinide

-Less A1C reduction but more rapid than Repaglinide

Question 19

ADRs of Repaglinide?

Answer 19

Hypoglycemia

Question 20

Which drugs are Biguanides?

Answer 20

Metformin

Question 21

Drug of choice for Type 2 DM?

Answer 21

Metformin

Question 22

ADRs of Metformin?

Answer 22

GI symptoms: 50%
Lactic acidosis: patients w/ renal failure, CHF, hypoxemia, ETOH
No hypoglycemia
No weight gain

Question 23

Contraindications with Metformin?

Answer 23

Metabolic acidosis
Renal impairment:
-SCr>1.5 men
-SCr>1.4 women

Question 24

What are the TZDs?

Answer 24

Rosiglitazone

Pioglitazone

Question 25

Which TZD can we not give insulin with?

Answer 25

Rosiglitazone: edema

Question 26

How do TZDs work?

Answer 26

PPAR gamma receptor activators - Regulate glucose metabolism - Increased insulin sensitivity in fat, liver, and skeletal muscle

Question 27

Cardio effects of TZDs?

Answer 27

Rosiglitazone: increased HDLs and decreased TGs Pioglitazone: increased LDLs and HDLs

Question 28

ADRs of TZDs?

Answer 28

Edema/weight gain Cardiac failure -Especially w/insulin

Question 29

Contraindications to TZDs?

Answer 29

Liver disease Class III and IV heart failure ETOH abuse

Question 30

Which TZD has a risk for MI?

Answer 30

Rosiglitazone

Question 31

What are the Alpha-Glucosidase inhibitors?

Answer 31

Miglitol Acarbose -No weight gain or hypoglycemia

Question 32

Adverse effects of Alpha-Glucosidase inhibitors?

Answer 32

Gas and diarrhea: bacteria want carbs

Question 33

How do Alpha-Glucosidase inhibitors work?

Answer 33

Inhibit carb absorption in intestines

Question 34

Contraindications to AG inhibitors?

Answer 34

Cirrhosis | Intestinal disease

Question 35

What are the DPP-4 inhibitors?

Answer 35

Sitagliptin | Saxagliptin

Question 36

What is Colesevelam?

Answer 36

Bile acid sequestrate - Not for mono therapy - Adjunct to diet and exercise - Previously used for LDL reduction

Question 37

Adverse effects of Colesevelam?

Answer 37

Constipation/nausea/indigestion | Increases TGs

Question 38

Contraindications for Colesevelam?

Answer 38

Bowel obstruction Hypertriglyceridemia-induced pancreatitis TG>500

Question 39

What is Exenatide?

Answer 39

GLP-1 agonist; not oral: injection | Adjunct therapy

Question 40

What monitoring do we need with Exenatide?

Answer 40

Renal function

Question 41

ADRs for Exenatide?

Answer 41

``` N/V/D: 40% Weight loss Hypoglycemia Antibodies to drug Can't use in Type 1 DM ```

Question 42

Treatment for hyperosmolar hyperglycemia?

Answer 42

Fluids | Insulin bolus

Question 43

Which diabetes patients get most CVD benefits from blood sugar control?

Answer 43

Type 1 DM patients