DM 2

Question 1

What are the complications of Diabetes?

Answer 1

Microvascular
-retinopathy, neuropathy, nephropathy
Macrovascular
-Cerebrovasc disease, peripheral vasc, coronary HD

Question 2

What is the criteria for diagnosis of DM?

Answer 2

1. Symptoms of DM with causal glucose of >200
   -Casual
   -Polyuria, dipsia, weight loss
2. FBG >126 x 2 occ
3. 2 hour post prandial glu >200
   Hba1c >6.5%

Question 3

What cell types are included in the islets of langerhans?

Answer 3

Beta cells: Insulin
Alpha Cells: Glucagon
D cells: somatostatin

Question 4

What does the Hba1c tell you?

Answer 4

Correlates with 3 month blood sugar average (RBC lifespan)

Question 5

WHat can falsely elevate or lower a Hba1c measurement?

Answer 5

False Elevation: Hemoglobinopathy, Sickle cell trait

False Depression: Recent transfusion, anemia

Question 6

What are the treatments for DM2?

Answer 6

Diet/Exercise/WL
Oral Meds
GLP1 agonists, DPP-4 inhibitors
Insulin
Sodium Glucose co-transporter inhibitor

Question 7

What is included in intensive lifestyle management of DM2?

Answer 7

Diet/Exercise behavior
Dec fat and total cals
Exercise 150 min/wk
Lose 7% BW

Question 8

What is the MOA, SE and Contra of Alpha Glucosidase Inhibitors?

Answer 8

Dec Carb abs from the gut
A1c dec .5-1%
Best for patients with mild post-prandial hyperglycemia
SE: Gastrointestinal upset
Contra: Malabsorption

Question 9

What is the MOA, SE and Contra of Secretagogues?

Answer 9

Stim Insulin Secretion by closing ATP linked K channels in B cells
Dec A1c 1.5%
SE: Hypoglycemia, weight gain
Contra: Renal/Hepatic Disease

Question 10

What is the MOA, SE and Contra of Biguanides?

Answer 10

Dec Hepatic Gluconeogenesis
Dec A1c 1.5-2%
Dec Appetitie/PRomote Wt loss
SE: GI upset/Lactic acidosis
Contra: CRI, CHF, Liver Dis

Question 11

What is the MOA, SE and Contra of Thiazolidinediones?

Answer 11

PPAR gamma Ag
Peroxizome proliferator activated receptor
Nuclear Receptors
Promotes FA storage/Fat cell redistribution
Inc glucose Uptake
SE: fluid Retention/Wt gain
Contra: CHF III, IV, severe liver disease

Question 12

What is the MOA, SE and Contra of Incretin Mimetics ?

Answer 12

Stimulate secretion ofinsulin from B cells
SE: hypoglycemia, nausea
Contra: ESRD, Gastric Disease
Combo with metformin/ sulfonylurea/TZDs

Question 13

What is the MOA, SE and Contra of Dipeptidyl Peptidase-4 Inhibitors?

Answer 13

DDP-4 Ez degrades GLP-1
Inc Body's Incretin level
Inc secretion of insulin
Dec Liver glucose Prod
SE: Nasal Congestion

Question 14

What is the MOA, SE and Contra of Symlin?

Answer 14

Dec Post - Prandial Glucagon
SE: hypoglycemia, nausea
Contra: Gastroparesis, hypoglycemia unawareness

Question 15

What are the indications of Insulin therapy in T2 DM?

Answer 15

Hyperglycemia at presentation
Hypergly despite max dose of oral agents
Decompensation
Surgery
Pregnancy
Renal Disease
Allergy or serious rxns to oral agents