Type 2 diabetes

Question 1

Confirmation of hyperglycemia - criteria

Answer 1

> = 7 mmol/L venous fasting glucose
= 11.1 mmol/L venous random glucose
=11.1 mmol/L 2 hr post 75 g OGTT
6.5% HbA1c

Question 2

3 microvascular complications of Typ2 DM

Answer 2

retinopathy
neuropathy
nephropathy

Question 3

2 macrovascular disease complications of Type 2 DM

Answer 3

• MI

- stroke

Question 4

7 year incidence of MI in people with diabetes and no prior MI is the same as

Answer 4

No DM with prior MI

Question 5

In Type 2 Diabetic what should HBA1c be

Answer 5

between 6 and 7

Question 6

What should fasting cap glucose be in a type 2 diabetic

Answer 6

between 4 and 7

Question 7

What should 2 hr postprandial cap glucose be in a type 2 diabetic

Answer 7

between 5 and 8 if HBA1c is above target, between 5 and 10 otherwise

Question 8

HBA1c levels were determined based on

Answer 8

risk for retinopathy

Question 9

Metformin is

Answer 9

an insulin sensitizer -
reduces glucose output from liver
increases glucose uptake in tissues

Question 10

Metformin, glitazone, exercise and weight loss are acting to reduce

Answer 10

insulin resistance in fat and muscle

Question 11

Insulin, sulfonylurea, meglitanide and incretins

Answer 11

on pancreas improve ability to secrete insulin

Question 12

alpha-glucosidase inhibitors, and pancreatic lipase

Answer 12

block carbohydrate absorption in the gut

Question 13

most potent insulin sensitizer is

Answer 13

Thiazolidinedione - Glitazone -

Question 14

Incretins : glucagon like peptide 1

Answer 14

act by increasing insulin secretion
decrease apetite
decrease glucose production

Question 15

Newest class to treat Type 2DM

Answer 15

• SGLT2 inhibitors prevent glucose resorption in prox tubule of kidney

Question 16

how do you screen for chronic kidney disease in diabetes

Answer 16

Urine albumin: creatinine ratio < 2

Question 17

In type 1 and type 2 diabetes when to screen for diabetic retinopathy

Answer 17

1- 5 yrs after diagnosis >15 yrs of age, annual

2- at diagosis, q1-2 years

Question 18

2 agents that cause weight loss

Answer 18

GLP1 agonist

SGLT2 inhibitor

Question 19

impaired fasting glucose

Answer 19

6.1-6.9

Question 20

impaired glucose tolerance

Answer 20

2hrpost 75g OGT, 7.8-11

Question 21

% risk reduction by lifestyle in incidence of diabetes vs metformin

Answer 21

58% vs 31%

Question 22

If someone has IFG or IGT then

Answer 22

implement moderate weight loss, and regular activity

Question 23

3 main mechanisms of Type 2 diabetes

Answer 23

1) insulin resistance
2) excess glucose output by the liver
3) relative insulin deficiency

Question 24

what is hemoglobin A1C

Answer 24

3 month reflection of average blood sugar

Question 25

those who are at risk for hypoglycemia can have what level of A1C

Answer 25

a slightly higher level >7, consider 7.1-8.5

Question 26

metformin cannot be used in

Answer 26

patients with renal failure, it can lead to lactic acidosis

Question 27

drug that can cause hypoglycemia and weight gain

Answer 27

sulfonylureas

Question 28

How do TZD’s act?

Answer 28

increase glucose uptake in liver, adipose and muscle, take 4 weeks to work

Question 29

TZD’s not used because

Answer 29

cause cardiac disease, edema

Question 30

when is GLP1 released

Answer 30

in response to glucose in GI tract

Question 31

Function of incretins

Answer 31

increases insulin secretion - no hypoglycemia

• no weight gain
• reduces gastric emptying, reduces apetite

Question 32

why is GLP1 not given generally?

Answer 32

lasts seconds needs to be given IV

Question 33

what is the incretin therapy given now?

Answer 33

GLP1 analogue
and
DPP4 inhibitors

Question 34

3 drugs that increase insulin sensitivity

Answer 34

metformin
TZDs
GLP1 analogues

Question 35

Blood pressure for Typ2 dM

Answer 35

<130/80

Question 36

Target LDL for Type 2 DM

Answer 36

<2.0

Question 37

What do you screen for CKD?

Answer 37

Microalbuminuria before overt nephropathy