dm

Question 1

fx of insulin 3

Answer 1

inhibit glucose producion in liver

suppress lipolysis in adipose tissue

stimulates glucose uptake in target cells

Question 2

in what pts is A1C not accurate? 3

Answer 2

liver, kidneys, ETOH

Question 3

if one of the DM testing is positive, do they have DM?

Answer 3

no, do another test another day

Question 4

what helps with microvascular benefits? Marco?

Answer 4

micro - BG controls

macro - multiactorial, WEADS, meds, BP controls and BG controls

Question 5

what A1C to start lifestyle changes vs start meds?

Answer 5

<8.5 - lifestyle +/- metformin - give it 3 months trial

> 8.5 start metformin - consider other antihyperglycemics

Question 6

when to start insulin?

Answer 6

symptomatic hyperglycemia with metabolic decompensation

can add metformin at this time too

Question 7

when should target of A1C be reached?

Answer 7

3-6 mos

Question 8

7 classes of antihyperglycemics

Answer 8

Biguanides - metformin

Sulfonylureas - glyburide/gliclazide

Meglitinides - repaglinide

Alpha Glucosidase inhibotors - Acarbose

DipeptidylPeptidsase DDP-4 (gliptans) - sitagliptin/linagliptin

Glucagon like peptide 1 receptor GLP1) -

Sodium-glucose co transporters (SGLT - 2) inhibitors - ….pagliflozin

Question 9

4 fx of biguanides

Answer 9

stop leaky liver

decrease liver glucose production

increase insulin sensitivity and cellular glucose uptake and utilization

slows the rise in overnight BG and before meals

Question 10

benefits of metformin? 2

when to RA?

max?

monitor what blood level?

Answer 10

weight loss - 2kg
decrease A1C - 1 -1.5

RA in 2 weeks - take 2 weeks to take effect

max 1000 BID

monitor serum b12

Question 11

caution or avoid metformin in what type of conditions 3

Answer 11

renal dysfx

liver dysfx

risk of lactic acidosis

Question 12

sulfonylrea 5

Answer 12

squeeze last bit of insulin out of pancrease

increase beta cell insulin release

decrease hepatic gluconeogenesis

increase glycogen storage

enhance peripheral sensitivity to insulin

Question 13

first line for dm?

2nd line?

both are cleared by?

Answer 13

1st - metformin

2nd - sulfonylrea - glyburdie/gliclazide

renally cleared - caution

Question 14

consideration for sulfonylurea?

Answer 14

need to eat to avoid hypo

caution in sulfa allergy, renal dysfx, risk for hypo and G6PD def

BB may mask hypo effects

Question 15

what drugs squeeze out insulin in pancreas? 2

Answer 15

sulfonylurea - stimulate insulin release regardless of plasma glucose

meglitinides - does not cause insuline release in absense of exogenous glucose

shorter acting on b cells than solfonylurea, skip meal skip meds, extra meal, extra med

Question 16

acarbose aka, fx?

SE - 2

Answer 16

alpha glucosidase inhibitor

interferes with postprandial absorption of carbs in intestine

helps weight loss and Cardiovascular risk

has for GI effects cuz undigested carbs are fermented in the colon- have diet high in complex carbs helps

monitor LFS 6-12mos

Question 17

TZD

need pts written consent only use if other meds dont work

Answer 17

Thiazolidindion

Insulin sensitizer, helps body use insulin better - increase peripheral insulin uptake

decrease hepatic output of glucose

onset >4 wks max effect 8-16wks

good A1C control, but cause weight gain

Question 18

what drug not to use with insulin and ischemic heart disease?why?

Answer 18

TZD - increase edema

Question 19

2 drugs that activates the incretins system?

Answer 19

DPP - 4 blockers

GLP1 activators

Question 20

incretin?

Answer 20

metabolic hormones - helps lower BG, slow nurtition absorption, increase of fullness

Question 21

dosage for basal insulin?

when to titrate?

Answer 21

0.1-0.2units/kg at hs

titrate by 2 units every 2-3 days

Question 22

eg of postprandial insulin

basal insulin

Answer 22

post - lispro, novarapid or humalin R

basal - NPH, lantus, detemir

Question 23

in combo therapy, ie 50/0 or 30/70, which is which

Answer 23

bolus/basal