Endocrine - Diabetes Management

Question 0

Risk factors for diabetes?

Answer 0

1 BMI >25
2 metabolic syndrome (hypertension, low HDL, triglycerides >250)
3 relatives with diabetes
4 hx of gestational diabetes
5 ethnic minorities

Question 1

Target blood pressure in diabetics?

Target LDL?

Answer 1

Under 130/80

<100

Question 2

Screening for high-risk adults? For high-risk children?

Answer 2

Every three years after age 45; every two years after age 10

Question 3

Most specific test for diabetes?

Answer 3

Fasting plasma glucose.

Hemoglobin A1c is not a recommended screening test because of lack of standardization between laboratories

Question 4

Glucose levels with increased risk of microvascular complications versus macrovascular complications

Answer 4

Microvascular complications (Retinopathy, nephropathy) >126

Macrovascular complications (cardiovascular/cerebrovascular disease) > 110

Question 5

Fasting glucose, random glucose, oral glucose tolerance test levels in diabetics?

Hbg A1c?

Answer 5

> 126, >200, >200

Over 6.5

Question 6

Prediabetes levels?

Answer 6

Fasting glucose 100 – 126

Oral glucose tolerance test 140 – 200

Question 7

Pros and cons of intensive glycemic control?

Answer 7

Pro: hemoglobin A-1 C <7% leads to fewer microvascular complications

Con: intensive therapy leads to hypoglycemia (not appropriate for elderly patients or patients with other comorbid conditions)

Question 8

Role of ACE inhibitors and ARBs in diabetics?

Answer 8

Preventing progression of proteinuria and kidney disease

Question 9

Sulfonylureas : Mechanism of action? Use in which patients? Avoid in which patients?

Answer 9

Works at pancreatic beta cells to increase insulin production. Best for young patients with glucose <300. Avoid in patients with renal failure because stroke will accumulate.

Question 10

Metformin: Mechanism of action? Use in which patients? Avoid in which patients?

Answer 10

Decreases gluconeogenesis and decreases insulin resistance. Decreases appetite so use in obese patients. Avoid in patients with renal insufficiency because it may cause lactic acidosis.

Question 11

Alpha-glucosidase: mechanism of action? Adverse effects?

Answer 11

Inhibits breakdown of disaccharides in GI tract. Hepatotoxicity

Can be use in pts with renal failure

Question 12

Pioglitazone and rosiglitazone: Mechanism of action? Adverse effects?

Answer 12

Increased skeletal muscle glucose uptake and decrease insulin resistance

Hepatotoxicity, fluid overload. (contraindicated in CHF)

Question 13

Repaglinide : Mechanism of action? Avoid in patients with?

Answer 13

Non-sulfonylurea that increases insulin production. Avoid in patients with renal or hepatic insufficiency

Question 14

Initial treatment for type two diabetes?

Answer 14

Exercise and weight loss – decreasing adipose tissue helps decrease insulin resistance

Question 15

Incretins mimetics and DPP4 inhibitors (exenatide, sitagliptin) : Mechanism of action? Avoid in patients with?

Answer 15

Increases insulin-stimulating GI hormones (GLP-1) vs inhibits incretin degradation. Also decrease gastric motility and help in weight loss

Pancreatitis, medullary thyroid cancer

Question 16

Pranlintide: Mechanism of action? Avoid in patients with?

Answer 16

Amylin analog – decreases gastric emptying, decreases glucagon, decreases appetite

Question 17

Medications for diabetes patients?

Answer 17

#Pneumococcal vaccine
#Statin if LDL over 100
#ACE/ARB if microalbumin urea
#Aspirin
#Yearly eye exam for retinopathy
#Yearly foot exam for neuropathy

Question 18

Treatment for diabetic gastroparesis?

Answer 18

Metoclopramide and erythromycin

Question 19

Neuropathic pain controlled by?

Answer 19

Pregabalin, gabapentin, or tricyclics

Question 20

SGLT-2 inhibitors - names? Mechanism of action?

Answer 20

-Gliflozins

Increase glucose excretion by kidney