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1
Q

What is T1D?

A

Insulin-Dependent Diabetes, juvenile onset diabetes

Attributable to cellular-mediated β-cell destruction leading to insulin deficiency.

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2
Q

What percentage of diabetes mellitus cases does T1D account for?

A

5%–10% of DM

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3
Q

What is T2D?

A

Non-insulin dependent Diabetes, adult onset diabetes

Results primarily from insulin resistance.

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4
Q

What percentage of diabetes mellitus cases does T2D account for?

A

90%–95% of diabetes mellitus

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5
Q

What is gestational diabetes?

A

Glucose intolerance occurring during pregnancy

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6
Q

What are the common screening recommendations for T2D?

A

Screen at age 35 or older, repeat every 3 years if normal

Screen regardless of age if BMI is 25 kg/m2 or greater.

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7
Q

What is the A1C level indicating diabetes?

A

6.5% or greater

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8
Q

What are the primary goals of diabetes management?

A

Prevent acute and chronic complications

Acute: Hypoglycemia, DKA; Chronic: Retinopathy, nephropathy, cardiovascular diseases.

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9
Q

What is the recommended A1C target for nonpregnant adults?

A

Less than 7.0%

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10
Q

What is the fasting plasma glucose (FPG) target?

A

80–130 mg/dL

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11
Q

What is the peak postprandial glucose target?

A

Less than 180 mg/dL

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12
Q

What is the primary goal for gestational diabetes management?

A

Prevent complications to mother and child.

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13
Q

What are the glycemic therapy goals for gestational diabetes?

A
  • FPG of 95 mg/dL or less
  • 1-hour postprandial glucose 140 mg/dL or less
  • 2-hour postprandial glucose 120 mg/dL or less
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14
Q

What is the ‘1800 rule’ used for?

A

Calculates how much 1 unit of rapid-acting insulin will lower blood glucose (mg/dL)

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15
Q

What is the significance of the C-peptide test in diabetes diagnosis?

A

Helps assess the type of diabetes by indicating insulin production.

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16
Q

What are the two approaches to diagnosing gestational diabetes?

A
  • One-step: 75-g OGTT
  • Two-step: 50-g OGTT followed by 100-g OGTT if necessary
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17
Q

What are the common complications of gestational diabetes for the mother?

A
  • Hypertension
  • Preeclampsia
  • T2D after pregnancy
  • Miscarriage/spontaneous abortion
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18
Q

What are the common complications of gestational diabetes for the fetus/child?

A
  • Macrosomia
  • Hypoglycemia
  • Jaundice
  • Respiratory distress syndrome
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19
Q

What is the role of insulin sensitivity factor in diabetes management?

A

Used to correct hyperglycemic excursions despite optimal therapy.

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20
Q

What insulin types are categorized based on duration of effect?

A
  • Rapid acting
  • Short acting
  • Intermediate acting
  • Long acting
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21
Q

What is the recommended blood pressure goal for patients with diabetes?

A

Less than 130/80 mm Hg

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22
Q

What are the common risk factors for developing T2D?

A
  • History of cardiovascular disease
  • A1C 5.7% or greater
  • History of PCOS
  • High-risk ethnicity
  • Insulin resistance conditions (e.g., severe obesity, acanthosisnigricans)
  • Physical inactivity
  • First-degree relative with T2D
  • Hypertension
  • HDL less than 35 mg/dLor TG greater than 250 mg/dL
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23
Q

What are the signs of hyperglycemia to counsel patients about?

A

Symptoms of hyperglycemia include excessive thirst and frequent urination.

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24
Q

What is the target for LDL cholesterol reduction in diabetes patients?

A

Lowering LDL by 30%–49% in patients aged 40–75.

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25
What is the therapeutic management strategy for T1D?
Insulin therapy based on total daily insulin (TDI) requirements.
26
What is the typical insulin regimen for T1D?
Basal-bolus therapy using rapid-acting and long-acting insulins.
27
What is the purpose of correctional insulin needs in T1D?
To correct hyperglycemic excursions that occur despite optimal basal-bolus therapy. ## Footnote This involves using the Insulin Sensitivity Factor.
28
What is the '1800 rule' in the context of insulin sensitivity?
1800/TDI = calculates how much 1 unit of rapid-acting insulin will lower blood glucose (mg/dL). ## Footnote TDI stands for Total Daily Insulin.
29
What does the '1500 rule' apply to?
It applies when using regular human insulin to calculate insulin sensitivity. ## Footnote The formula is 1500/TDI.
30
What are the advantages of using correctional insulin over NPH+Regular?
* More physiologic * Less hypoglycemic * More flexible to patient meal times
31
What is a disadvantage of correctional insulin?
Cost and increased frequency and number of daily injections.
32
What should be assessed during the therapeutic management of T1D?
* Goals for fasting and postprandial glucose concentrations * Identify when the patient is at goal and not at goal * Look for consistent trends rather than isolated events * Identify which insulin affects problematic glucose concentrations * Adjust insulin dosage or patient behavior accordingly
33
What is the initial dosing for amylin analog in T1D?
15 mcg subcutaneously immediately before main meals.
34
What is the maximum daily dosage for amylin analog?
60 mcg with each meal.
35
What is the primary mechanism of action of amylin?
Cosecreted with insulin, it has effects similar to GLP-1.
36
What is the initial dosing for T2D?
60 mcg subcutaneously immediately before main meals.
37
What should be done if metformin monotherapy fails to control glycemic levels?
Add other agents based on criteria such as efficacy, existing comorbidities, risk of hypoglycemia, effects on weight, cost, and patient preference.
38
What are the criteria for adding agents when metformin is ineffective?
* Efficacy in lowering A1C, FPG, and postprandial * Existing comorbidities * Risk of hypoglycemia * Effects on weight * Cost * Oral or injection preference
39
What is a preferred addition to existing oral diabetes medications according to the ADA?
GLP-1 agonists are preferred over insulin unless extreme or symptomatic hyperglycemia is present.
40
What is the effect of GLP-1 agonists compared to insulin?
* Mildly improved A1C reduction * Lower risk of hypoglycemia * Associated with weight loss
41
What is the dosing strategy for basal insulin in T2D?
Weight-based dosing of 0.1-0.3 unit/kg/day.
42
What are the contraindications for using amylin analog?
* Substantial gastroparesis * History of poor adherence or monitoring of BG * A1C greater than 9% * Hypoglycemia unawareness or frequent bouts of hypoglycemia
43
What are common adverse effects associated with amylin analog?
* Nausea * Vomiting * Anorexia * Headache
44
What is the efficacy of amylin analog in T1D?
A 0.5%–1% reduction in A1C and effective at controlling postprandial glucose excursions.
45
What is the mechanism of action of metformin?
Reduces hepatic gluconeogenesis and improves insulin sensitivity.
46
What are the common adverse effects of metformin?
* Nausea * Vomiting * Diarrhea * Epigastric pain
47
What should be monitored when using metformin?
Vitamin B12 concentrations periodically.
48
What is the maximum daily dosage of metformin?
2550 mg, commonly 2000 mg/day.
49
What is a key contraindication for metformin?
Renal impairment, particularly eGFR less than 30 mL/minute/1.73 m2.
50
What is the mechanism of action of sulfonylureas?
Bind to receptors on pancreatic β-cells, leading to membrane depolarization and stimulation of insulin secretion.
51
What is the efficacy of sulfonylureas?
1%–2% A1C reduction.
52
What are common adverse effects of sulfonylureas?
* Hypoglycemia * Weight gain
53
What is the mechanism of action of DPP-4 inhibitors?
Inhibit breakdown of GLP-1, increasing pancreatic insulin secretion and limiting glucagon secretion.
54
What are common adverse effects of DPP-4 inhibitors?
* Upper respiratory infections * Headache * Severe joint pain
55
What should be monitored when using DPP-4 inhibitors?
Renal function, especially when adjusting dosages based on eGFR.
56
What is the initial dosing of sitagliptin?
100 mg once daily.
57
What are the common adverse effects of thiazolidinediones?
* Weight gain * Fluid retention * Risk of proximal bone fractures
58
What is the mechanism of action of thiazolidinediones?
Peroxisome proliferator–activated receptor γ-agonist, improving insulin sensitivity.
59
What are contraindications for thiazolidinediones?
* Hepatic impairment * Class III/IV heart failure * Existing fluid retention
60
What is the initial dosing for Sitagliptin?
100 mg once daily ## Footnote Reduce dosage with eGFR if 30–45 mL/minute to 50 mg once daily; with eGFR less than 30 mL/minute to 25 mg once daily.
61
What are some safety concerns associated with Sitagliptin?
Postmarketing reports of: * Acute pancreatitis * Angioedema * Stevens-Johnson syndrome * Anaphylaxis
62
What is the recommended dosing for Saxagliptin?
5 mg once daily ## Footnote Reduce dosage with eGFR less than 45 mL/minute to 2.5 mg once daily.
63
What is the dosing recommendation for Linagliptin?
5 mg once daily ## Footnote No dosage adjustment for renal impairment.
64
What is the initial dosing for Canagliflozin?
100 mg once daily before the first meal of the day ## Footnote Maximal daily dosage: 300 mg.
65
What are the contraindications for Canagliflozin?
Do not initiate if eGFR is less than 30 mL/minute/1.73 m2 ## Footnote Can continue at 100 mg once daily if on canagliflozin and has albuminuria greater than 300 mg/day.
66
What are common adverse effects of SGLT-2 inhibitors?
* Increased urination * Urinary tract infections * Genital mycotic infections * Hypotension * Increased hypoglycemia risk with concomitant insulin or insulin secretagogue
67
What is the efficacy of Empagliflozin?
Average A1c reduction of 0.5%–0.8% ## Footnote Can reduce cardiovascular morbidity in patients with T2D and established cardiovascular disease.
68
What is the mechanism of action for GLP-1 analogs?
Synthetic analog of human GLP-1 that binds to GLP-1 receptors, resulting in: * Glucose-dependent insulin secretion * Reduction in glucagon secretion * Reduced gastric emptying * Promotes satiety
69
What is the initial dosing for Exenatide?
5 mcg subcutaneously twice daily ## Footnote Maximal dosage: 10 mcg twice daily.
70
What are the adverse effects of GLP-1 analogs?
* Nausea * Vomiting * Acid reflux * Abdominal discomfort * Constipation or diarrhea
71
What is the dosing recommendation for Tirzepatide?
Initial: 2.5 mg subcutaneously once weekly ## Footnote Increase at monthly intervals to 5, 10, or 15 mg once weekly.
72
What is the mechanism of action of α-Glucosidase inhibitors?
Slows the absorption of glucose from the intestine by slowing the breakdown of large carbohydrates into smaller absorbable sugars.
73
What are the contraindications for α-Glucosidase inhibitors?
Inflammatory bowel disease, colonic ulcerations, intestinal obstruction.
74
What is the dosing for Colesevelam?
Six 625-mg tablets once daily or three 625-mg tablets twice daily.
75
What is the mechanism of action for Bromocriptine?
Agonist for dopamine receptor D2 thought to reset circadian rhythm, reducing caloric intake and storage.
76
What is the reduction in A1C associated with Bromocriptine treatment?
0.1%–0.6% reduction in A1C
77
What are the contraindications for Bromocriptine?
* Can limit the effectiveness of agents used to treat psychosis * Should not be used in nursing mothers or patients with syncopal migraines * Concomitant use with dopamine antagonists can limit efficacy
78
What is the initial dosing recommendation for Bromocriptine?
0.8 mg once daily on waking; take with food
79
What are common adverse effects of Bromocriptine?
* Nausea * Somnolence * Fatigue * Dizziness * Vomiting * Headache * Orthostatic hypotension * Syncope
80
What is the glycemic goal for treating inpatient diabetes in a non-critically ill population?
140–180 mg/dL
81
What is the threshold for initiating therapy for inpatient diabetes management?
180 mg/dL or greater
82
What is recommended for glycemic control in hospitalized patients?
Subcutaneous insulin administration
83
What are the symptoms of hypoglycemia?
* Anxiousness * Sweating * Nausea * Tachycardia * Hunger * Clammy skin
84
What are the classifications of hypoglycemia according to the ADA?
* Level 1: Plasma glucose of 70 mg/dL or less but greater than or equal to 54 mg/dL * Level 2: Clinically significant hypoglycemia: plasma glucose less than 54 mg/dL * Level 3: A severe event requiring assistance due to altered mental and/or physical status
85
What treatment is recommended for clinically significant hypoglycemia?
* Glucagon 1 mg subcutaneously or intramuscularly * Intravenous dextrose if glucagon is ineffective
86
What are common signs and symptoms of Diabetic Ketoacidosis (DKA)?
* Polyuria * Polydipsia * Vomiting * Dehydration * Weakness * Altered mental status * Coma * Abdominal pain * Kussmaul respirations * Tachycardia * Hyponatremia * Hyperkalemia
87
What is the primary goal of insulin treatment in DKA?
To stop ketosis, not to normalize glucose concentrations
88
What intravenous fluid should be used for fluid replacement in DKA?
0.45%–0.9% sodium chloride
89
What potassium management is required in DKA treatment?
* Potassium 20-30 mEq/l of intravenous fluid if baseline serum potassium is greater than 3.3 mEq/l but less than 5.3 mEq/L * Hold if 5.3 mEq/L or greater initially
90
What is the screening recommendation for nephropathy in T2D?
Annually with random spot collection of urine albumin/creatinine ratio
91
What is considered a normal urinary albumin excretion rate?
Less than 30 mg/g
92
What is the treatment of choice for nephropathy if urine albumin/creatinine concentrations are greater than 30 mg/g?
ACE inhibitors or ARBs
93
What is the recommended screening for retinopathy in T2D?
Annually with dilated and comprehensive eye examinations
94
What are the symptoms of diabetic neuropathies?
* Numbness * Burning * Tingling sensation * Pain
95
What is the first-line treatment for symptomatic improvement in diabetic neuropathies?
Glycemic control
96
What medications are commonly used for diabetic neuropathic pain?
* Anticonvulsants (gabapentin, pregabalin) * Tricyclic antidepressants (amitriptyline, desipramine) * Duloxetine
97
What are the dietary recommendations for managing gastroparesis?
* More frequent but smaller meals * Decrease fat and fiber intake * Homogenize food
98
What is the recommended approach to lipid management according to the ADA?
Statin therapy recommendations based on age and cardiovascular risk
99
What is the recommended blood pressure management for patients with diabetes?
Hypertensive regimen should include an ACE inhibitor, ARB, dihydropyridine calcium channel blocker, or thiazide-like diuretic
100
What immunizations are recommended for diabetic patients?
* Annual influenza vaccine * Pneumococcal polysaccharide vaccine * Hepatitis B vaccine

PTH (17 decks)

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