HRR Week 1

Question 1

How are muscle glycogen and liver glycogen different?

Answer 1

Muscle glycogen can only be used for energy but cannot be used to adjust blood glucose levels. All of the blood glucose supply during periods of fasting (e.g., overnight) comes from the liver.

Question 2

Which of the following nutrient types get stored by the liver as triglycerides:

• amino acids
• glucose
• fatty acids
• other carbohydrates

Answer 2

All of them. Excess triglycerides are then exported from the liver as VLDL.

Question 3

Which of the following organ systems CANNOT use fatty acids as a source of energy:

• Heart
• GI smooth muscle
• Brain
• Skeletal muscle

Answer 3

Brain. It can only use glucose or ketones.

Question 4

Which islet cells are responsible for the release of glucagon and insulin?

Answer 4

Glucagon: alpha cells
Insulin: beta cells

Question 5

Which form of vitamin D is typically measured when assessing someone’s vitamin D status?

Answer 5

25(OH) D3, the storage form. The active form, 1,25 (OH)2 D3, only has a half life of about 8 - 12 hours, whereas the storage form’s half life is a few months.

Question 6

Explain the action of PTH on calcium and phosphate in the kidneys:

Answer 6

Increases calcium reabsorption and decreases phosphate reabsorption.

Question 7

What’s the most common cause of hypercalcemia in the outpatient setting?

Answer 7

Hyperparathyroidism

Question 8

What’s one way to differentiate primary from secondary hyperparathyroidism?

Answer 8

Give calcium supplements. If serum calcium rises without a concomitant change in PTH, then the cause is secondary.

Question 9

Discuss macrovascular vs. microvascular complications of diabetes/pre-diabetes:

Answer 9

Macrovascular complications are common in pre-diabetes and are often present at the time of diagnosis of DM. Microvascular complications are common with DM but not pre-diabetes. Glucose control is helpful for preventing microvascular complications but not macro.

Question 10

True or false: ACE inhibitors are indicated in DM patients with albuminuria even if they’re normotensive:

Answer 10

True

Question 11

Under what conditions would you want to measure blood sugar with fructosamine instead of HbA1c?

Answer 11

In hemolytic anemia or other diseases that affect hemoglobin, since these disorders alter the lifespan of red blood cells and can lead to an artificially high or low HbA1c readings.

Question 12

What’s the effective dose of metformin, and how are side effects managed?

Answer 12

• 1000 mg bid
• Titrate up to minimize GI side effects.
• 500 qd x 1 wk, 500 bid x 1 wk, 1000 qam/500 qpm x 1 week, 1000 bid.

Question 13

Which adjunctive diabetes therapy is absolutely contraindicated in HF?

Answer 13

Thiazolidinediones

Question 14

Which sulfonylurea is NOT contraindicated in pregnancy?

Answer 14

Glyburide

Question 15

What’s the biggest disadvantage of meglitinides?

Answer 15

Only lowers A1c by 0.5 - 1 %, so not useful if greater A1c control is needed.

Question 16

What’s the black box warning on metformin?

Answer 16

Lactic acidosis

Question 17

Prominent side effects of metformin:

Answer 17

• GI
• Metallic taste
• Decrease B12 absorption
• Lactic acidosis

Question 18

Cautions/contraindications of metformin:

Answer 18

• Cr > 1.5/1.4 (m/w)
• Liver disease/ETOH abuse
• Caution in HF
• Use of IV contrast
• May increase risk of pregnancy

Question 19

Does GLP-1 affect post-prandial or fasting glucose better?

Answer 19

Post-prandial

Question 20

What’s the most common side effect of GLP-1 RA?

Answer 20

Nausea

Question 21

Precautions/contraindictions of GLP-1:

Answer 21

• Renal failure
• GI disease
• Caution with warfarin and drugs that require rapid GI absorption

Question 22

What’s the mechanism of SGLT2 inhibitors?

Answer 22

Inhibits glucose reabsorption in the proximal tubule, where 90% of glucose is reabsorbed.