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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
Q

What is the therapeutic management strategy for T1D?

A

Insulin therapy based on total daily insulin (TDI) requirements.

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26
Q

What is the typical insulin regimen for T1D?

A

Basal-bolus therapy using rapid-acting and long-acting insulins.

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27
Q

What is the purpose of correctional insulin needs in T1D?

A

To correct hyperglycemic excursions that occur despite optimal basal-bolus therapy.

This involves using the Insulin Sensitivity Factor.

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28
Q

What is the ‘1800 rule’ in the context of insulin sensitivity?

A

1800/TDI = calculates how much 1 unit of rapid-acting insulin will lower blood glucose (mg/dL).

TDI stands for Total Daily Insulin.

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29
Q

What does the ‘1500 rule’ apply to?

A

It applies when using regular human insulin to calculate insulin sensitivity.

The formula is 1500/TDI.

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30
Q

What are the advantages of using correctional insulin over NPH+Regular?

A
  • More physiologic
  • Less hypoglycemic
  • More flexible to patient meal times
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31
Q

What is a disadvantage of correctional insulin?

A

Cost and increased frequency and number of daily injections.

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32
Q

What should be assessed during the therapeutic management of T1D?

A
  • 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
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33
Q

What is the initial dosing for amylin analog in T1D?

A

15 mcg subcutaneously immediately before main meals.

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34
Q

What is the maximum daily dosage for amylin analog?

A

60 mcg with each meal.

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35
Q

What is the primary mechanism of action of amylin?

A

Cosecreted with insulin, it has effects similar to GLP-1.

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36
Q

What is the initial dosing for T2D?

A

60 mcg subcutaneously immediately before main meals.

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37
Q

What should be done if metformin monotherapy fails to control glycemic levels?

A

Add other agents based on criteria such as efficacy, existing comorbidities, risk of hypoglycemia, effects on weight, cost, and patient preference.

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38
Q

What are the criteria for adding agents when metformin is ineffective?

A
  • Efficacy in lowering A1C, FPG, and postprandial
  • Existing comorbidities
  • Risk of hypoglycemia
  • Effects on weight
  • Cost
  • Oral or injection preference
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39
Q

What is a preferred addition to existing oral diabetes medications according to the ADA?

A

GLP-1 agonists are preferred over insulin unless extreme or symptomatic hyperglycemia is present.

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40
Q

What is the effect of GLP-1 agonists compared to insulin?

A
  • Mildly improved A1C reduction
  • Lower risk of hypoglycemia
  • Associated with weight loss
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41
Q

What is the dosing strategy for basal insulin in T2D?

A

Weight-based dosing of 0.1-0.3 unit/kg/day.

42
Q

What are the contraindications for using amylin analog?

A
  • Substantial gastroparesis
  • History of poor adherence or monitoring of BG
  • A1C greater than 9%
  • Hypoglycemia unawareness or frequent bouts of hypoglycemia
43
Q

What are common adverse effects associated with amylin analog?

A
  • Nausea
  • Vomiting
  • Anorexia
  • Headache
44
Q

What is the efficacy of amylin analog in T1D?

A

A 0.5%–1% reduction in A1C and effective at controlling postprandial glucose excursions.

45
Q

What is the mechanism of action of metformin?

A

Reduces hepatic gluconeogenesis and improves insulin sensitivity.

46
Q

What are the common adverse effects of metformin?

A
  • Nausea
  • Vomiting
  • Diarrhea
  • Epigastric pain
47
Q

What should be monitored when using metformin?

A

Vitamin B12 concentrations periodically.

48
Q

What is the maximum daily dosage of metformin?

A

2550 mg, commonly 2000 mg/day.

49
Q

What is a key contraindication for metformin?

A

Renal impairment, particularly eGFR less than 30 mL/minute/1.73 m2.

50
Q

What is the mechanism of action of sulfonylureas?

A

Bind to receptors on pancreatic β-cells, leading to membrane depolarization and stimulation of insulin secretion.

51
Q

What is the efficacy of sulfonylureas?

A

1%–2% A1C reduction.

52
Q

What are common adverse effects of sulfonylureas?

A
  • Hypoglycemia
  • Weight gain
53
Q

What is the mechanism of action of DPP-4 inhibitors?

A

Inhibit breakdown of GLP-1, increasing pancreatic insulin secretion and limiting glucagon secretion.

54
Q

What are common adverse effects of DPP-4 inhibitors?

A
  • Upper respiratory infections
  • Headache
  • Severe joint pain
55
Q

What should be monitored when using DPP-4 inhibitors?

A

Renal function, especially when adjusting dosages based on eGFR.

56
Q

What is the initial dosing of sitagliptin?

A

100 mg once daily.

57
Q

What are the common adverse effects of thiazolidinediones?

A
  • Weight gain
  • Fluid retention
  • Risk of proximal bone fractures
58
Q

What is the mechanism of action of thiazolidinediones?

A

Peroxisome proliferator–activated receptor γ-agonist, improving insulin sensitivity.

59
Q

What are contraindications for thiazolidinediones?

A
  • Hepatic impairment
  • Class III/IV heart failure
  • Existing fluid retention
60
Q

What is the initial dosing for Sitagliptin?

A

100 mg once daily

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
Q

What are some safety concerns associated with Sitagliptin?

A

Postmarketing reports of:
* Acute pancreatitis
* Angioedema
* Stevens-Johnson syndrome
* Anaphylaxis

62
Q

What is the recommended dosing for Saxagliptin?

A

5 mg once daily

Reduce dosage with eGFR less than 45 mL/minute to 2.5 mg once daily.

63
Q

What is the dosing recommendation for Linagliptin?

A

5 mg once daily

No dosage adjustment for renal impairment.

64
Q

What is the initial dosing for Canagliflozin?

A

100 mg once daily before the first meal of the day

Maximal daily dosage: 300 mg.

65
Q

What are the contraindications for Canagliflozin?

A

Do not initiate if eGFR is less than 30 mL/minute/1.73 m2

Can continue at 100 mg once daily if on canagliflozin and has albuminuria greater than 300 mg/day.

66
Q

What are common adverse effects of SGLT-2 inhibitors?

A
  • Increased urination
  • Urinary tract infections
  • Genital mycotic infections
  • Hypotension
  • Increased hypoglycemia risk with concomitant insulin or insulin secretagogue
67
Q

What is the efficacy of Empagliflozin?

A

Average A1c reduction of 0.5%–0.8%

Can reduce cardiovascular morbidity in patients with T2D and established cardiovascular disease.

68
Q

What is the mechanism of action for GLP-1 analogs?

A

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
Q

What is the initial dosing for Exenatide?

A

5 mcg subcutaneously twice daily

Maximal dosage: 10 mcg twice daily.

70
Q

What are the adverse effects of GLP-1 analogs?

A
  • Nausea
  • Vomiting
  • Acid reflux
  • Abdominal discomfort
  • Constipation or diarrhea
71
Q

What is the dosing recommendation for Tirzepatide?

A

Initial: 2.5 mg subcutaneously once weekly

Increase at monthly intervals to 5, 10, or 15 mg once weekly.

72
Q

What is the mechanism of action of α-Glucosidase inhibitors?

A

Slows the absorption of glucose from the intestine by slowing the breakdown of large carbohydrates into smaller absorbable sugars.

73
Q

What are the contraindications for α-Glucosidase inhibitors?

A

Inflammatory bowel disease, colonic ulcerations, intestinal obstruction.

74
Q

What is the dosing for Colesevelam?

A

Six 625-mg tablets once daily or three 625-mg tablets twice daily.

75
Q

What is the mechanism of action for Bromocriptine?

A

Agonist for dopamine receptor D2 thought to reset circadian rhythm, reducing caloric intake and storage.

76
Q

What is the reduction in A1C associated with Bromocriptine treatment?

A

0.1%–0.6% reduction in A1C

77
Q

What are the contraindications for Bromocriptine?

A
  • 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
Q

What is the initial dosing recommendation for Bromocriptine?

A

0.8 mg once daily on waking; take with food

79
Q

What are common adverse effects of Bromocriptine?

A
  • Nausea
  • Somnolence
  • Fatigue
  • Dizziness
  • Vomiting
  • Headache
  • Orthostatic hypotension
  • Syncope
80
Q

What is the glycemic goal for treating inpatient diabetes in a non-critically ill population?

A

140–180 mg/dL

81
Q

What is the threshold for initiating therapy for inpatient diabetes management?

A

180 mg/dL or greater

82
Q

What is recommended for glycemic control in hospitalized patients?

A

Subcutaneous insulin administration

83
Q

What are the symptoms of hypoglycemia?

A
  • Anxiousness
  • Sweating
  • Nausea
  • Tachycardia
  • Hunger
  • Clammy skin
84
Q

What are the classifications of hypoglycemia according to the ADA?

A
  • 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
Q

What treatment is recommended for clinically significant hypoglycemia?

A
  • Glucagon 1 mg subcutaneously or intramuscularly
  • Intravenous dextrose if glucagon is ineffective
86
Q

What are common signs and symptoms of Diabetic Ketoacidosis (DKA)?

A
  • Polyuria
  • Polydipsia
  • Vomiting
  • Dehydration
  • Weakness
  • Altered mental status
  • Coma
  • Abdominal pain
  • Kussmaul respirations
  • Tachycardia
  • Hyponatremia
  • Hyperkalemia
87
Q

What is the primary goal of insulin treatment in DKA?

A

To stop ketosis, not to normalize glucose concentrations

88
Q

What intravenous fluid should be used for fluid replacement in DKA?

A

0.45%–0.9% sodium chloride

89
Q

What potassium management is required in DKA treatment?

A
  • 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
Q

What is the screening recommendation for nephropathy in T2D?

A

Annually with random spot collection of urine albumin/creatinine ratio

91
Q

What is considered a normal urinary albumin excretion rate?

A

Less than 30 mg/g

92
Q

What is the treatment of choice for nephropathy if urine albumin/creatinine concentrations are greater than 30 mg/g?

A

ACE inhibitors or ARBs

93
Q

What is the recommended screening for retinopathy in T2D?

A

Annually with dilated and comprehensive eye examinations

94
Q

What are the symptoms of diabetic neuropathies?

A
  • Numbness
  • Burning
  • Tingling sensation
  • Pain
95
Q

What is the first-line treatment for symptomatic improvement in diabetic neuropathies?

A

Glycemic control

96
Q

What medications are commonly used for diabetic neuropathic pain?

A
  • Anticonvulsants (gabapentin, pregabalin)
  • Tricyclic antidepressants (amitriptyline, desipramine)
  • Duloxetine
97
Q

What are the dietary recommendations for managing gastroparesis?

A
  • More frequent but smaller meals
  • Decrease fat and fiber intake
  • Homogenize food
98
Q

What is the recommended approach to lipid management according to the ADA?

A

Statin therapy recommendations based on age and cardiovascular risk

99
Q

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

A

Hypertensive regimen should include an ACE inhibitor, ARB, dihydropyridine calcium channel blocker, or thiazide-like diuretic

100
Q

What immunizations are recommended for diabetic patients?

A
  • Annual influenza vaccine
  • Pneumococcal polysaccharide vaccine
  • Hepatitis B vaccine

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