Exam 3 - Clinical Diabetes (Douglas)

Question 1

Symptoms of Type 2 DM

Answer 1

• frequent urination
• feeling thirsty
• feeling hungry even after eating
• fatigue
• blurry vision
• tingling, pain, or numbness in hands or feet

Question 2

What is the pathophys of DM

Answer 2

• peripheral insulin resistance

- progressive pancreatic failure

Question 3

How to diagnose DM?

Answer 3

-fasting BS
* >126 DM *100-125 pre DM
-random BS
*>200 + sxs DM
NO acute illness/steroids
-HgbA1C
*>6.5 DM *5.7-6.4 Pre DM
Best for monitoring
-2hr glucose tolerance test
*>200 DM

Question 4

What is treatment for DM?

Answer 4

• diet and exercise
• oral meds
• injectables
• tx of BP, cholesterol, vaccines

Question 5

What is MOA of sulfonylureas?

Answer 5

Increases release of endogenous insulin from pancreas

Question 6

What are the specific sulfonylureas medications?

Answer 6

Glyburide (Diabeta)

Glimepride (Amaryl)

Question 7

What is MOA of Thiazolidinediones (TZDs) - Pioglitazone(Actos)?

Answer 7

• Increases insulin sensitivity of tissue
• decreases glucose production in liver
• increase # of beta cells

Question 8

What is MOA of Biguanides (Metformin)?

Answer 8

• decreases liver glucose production
• increases insulin sensitivity
• decreases intestinal glucose absorption

Question 9

What are 2 DPP-4 inhibitors?

Answer 9

• Sitagliptin (Januvia)

- Linagliptin (Tradjenta)

Question 10

What is MOA of DPP-4 inhibitors?

Answer 10

DDP breaks down GLP-1

*GLP-1 has multiple actions on glucose control

Question 11

What is a non insulin injectable and GLP-1 agonist?

Answer 11

Liraglutide (Victoza)

-SC inj 1-2x daily

Question 12

What are 3 meds that are a long acting insulin?

Answer 12

• glargine (lantus)
• detemir (levemir)
• degludec (tresiba)

Question 13

How to take long acting (basal) insulin?

Answer 13

• once daily at bedtime
• dose on AM fasting blood sugar <140, goal is 100ish
• can gain 10lbs avg on initiation
• 24 hr half life - takes 5-7d to see effects

Question 14

When to prescribe long acting insulin?

Answer 14

After failing 3 medications

Question 15

What are 3 ultra short acting (pre-prandial) insulins?

Answer 15

• Lispro (Humalog)
• Aspart (Novolog)
• Glulisine (Apidra)

Question 16

When to prescribe an ultra short acting insulin?

Answer 16

after failing long acting insulin or used as needed

Question 17

How to prescribe ultra short acting insulin?

Answer 17

• first added after largest meal of the day > 5 units
• Avoid long term sliding scales > use correction scales
• determine need and dose based on secondary post prandial BG

Question 18

What are 2 intermediate acting insulins?

Answer 18

• NPH
  
  • Humulin N
  • Novolin N