DM II

Question 1

What is a common finding in patients with DM II (Pathophysiology)?

Answer 1

Insulin Resistance develops causing hyperglycemia in the body.

Question 2

Insulin Resistance can be

Answer 2

Genetically Determined or

Acquired based on Environmental Factors

Question 3

Insulin Resistance has an effect on

Answer 3

Muscle
Liver
Adipose Tissue
Pancreas

Question 4

DM II can cause

Answer 4

Microvascular Complications (Retinopathy, Nephropathy, Neuropathy)
Macrovascular Complications (CVD)

See DM I Notes

Question 5

When treating DM II, what should you consider with patients?

Answer 5

Level of patient’s interest of involvement!
Shared decision making is important because lifestyle of the patient, and patient control is an important thing to consider.

Question 6

Three common drugs for DM II

Answer 6

1. Metformin
2. Sulfonylurea
3. TZDs

Question 7

Body makes how many units of insulin every 24 hours?

Answer 7

25 units

Question 8

How do you diagnose DM II?

Answer 8

Oral Glucose Tolerance Test (OGTT)

Question 9

Initial Treatment for DM II

Answer 9

Monotherapy: Metformin

2 Drug therapy: Add sulfonylureas, insulin, GLP-1 receptor agonist

Question 10

Common Insulin given

Answer 10

NPH
Levamir
Lantis

Question 11

What is the #1 goal of treatment for DM II

Answer 11

Getting Glucose levels NORMAL

Question 12

The higher the glucose in the blood, the ______ Metformin will work

Answer 12

More

Question 13

Metformin has multiple beneficial effects, such as:

Answer 13

Decreasing blood glucose
Decreasing Insulin Resistance
Lowering Triglycerides
Lowering Cholesterol
Improves Fibrinolyric Defects
Vasculature is benefited

Question 14

Contraindications for Metformin usage?

Answer 14

When Creatinine is Greater than 1.4/1.5 (Female/Male)

This indicated Renal Failure, Heart Failure or Liver Failure

Question 15

Phenoformin

Answer 15

Similar Drug to Metformin

Question 16

Why isn’t phenoformin not more commonly used?

Answer 16

Issues with Mitochondria causing a decrease in ATP production

Question 17

Benefit of sulfonylurea

Answer 17

CHEAP

Question 18

Effects of Sulfonylurea:

Answer 18

Hypoglycemia
Weight Gain
Doesn’t last very long

Question 19

Sulfonylurea is commonly used in conjunction with what medication for effective DM II treatment?

Answer 19

Metformin (based off the lecture)

Question 20

What is the primary function of TZD (Thaiazolidinediones)?

Answer 20

Improves Fat Metabolism

Question 21

Why does TZD work for DM II

Answer 21

Increased metabolism of fat will cause glucose to go down because fat makes the body insulin resistant, and fat can get into the muscles and liver.

Question 22

Benefits of TZD?

Answer 22

Reduced rate of MI and stroke.
Reduces NASH (fatty liver)

Question 23

When is TZD most commonly used?

Answer 23

Prediabetics to prevent DM onset

Question 24

Side Effects of TZD

Answer 24

Weight Gain
Water Retention in CHF
Bone loss in females
Bladder Cancer in Males

Question 25

What is the GLP-1 Receptor?

Answer 25

Receptor on the B-cells in the Pancreas

Causes the Beta Cells to make more Insulin (via boost of cAMP)

Question 26

When does GLP-1 Receptor not work?

Answer 26

When the blood sugars are low.

Won’t activate Beta Cells to make more insulin, so you won’t go into hypoglycemic effects.

Question 27

GLP-1 Receptor Medications are commonly used in conjunction with

Answer 27

Metformin (but also used with long-acting insulin)

Question 28

GLP-1 Receptor Meds are limiting because

Answer 28

Expensive

Question 29

Side Effects of GLP-1 Receptor Meds

Answer 29

Nausea
Pancreatitis
C-Cell Hyperplasia

Question 30

GLP-1 Receptor Drugs

Answer 30

Exenatide (Byetta)
Januvia
Liraglutide

Question 31

What does Exenatide (Byetta) do?

Answer 31

Stimulated GLP-1 and Deactivates the degradation of proteins

Question 32

What does Januvia do?

Answer 32

Inhibits the degradation enzyme of GLP-1