Wk2 Diabetes Clinical

Question 1

Alpha cells role in:

1 Blood glucose levels?

2. glucagon?
3. liver and kidney?

Answer 1

1. elevate blood glucose
2. secrete glucagon
3. liver–secrete glucose kidney– retain glucose

Question 2

How to differentiate between injected and endogenous insulin:

Answer 2

C-peptide levels

**if C-peptide present= endogenous

Question 3

Autoimmune B-cell destruction:

Answer 3

DM1

Question 4

Progressive insulin secretory defect with insulin resistance:

Answer 4

DM2

Question 5

antibodies to GAD-65?

Answer 5

DM1

Question 6

Big cause of drug induced hyperglycemia:

Answer 6

glucocorticoids

Question 7

Diagnosed by glucose tolerance test?

Answer 7

gestational diabetes

Question 8

Re-read screening guidelines….

Answer 8

slide 26-27

Question 9

How does Hgb A1c work?

Answer 9

measures % of glycosylation on RBC’s

recheck every 3 months (RBC life-span)

Question 10

Diagnostic criteria for diabetes (4):

Answer 10

1. fasting glucose of 126 on two separate occasions
2. random plasma glucose of 200 with sx (polyuria, polydipsia, weight loss)
3. A1c > 6.4%
4. (if pregnant) plasma glucose > 200 two hours after 75g oral glucose bolus

Question 11

A1c range for pre-diabetes?

Answer 11

5.7-6.4%

Question 12

PE findings in diabetes:

Answer 12

1. BMI – >25 is RF
2. BP > 140
3. HEENT – retinal exam (microangiopathic hemorrhage)
4. Neck – thyroid – possible MEN syndrome
5. CV/Lungs: weak pulses, carotid bruits
6. skin: ulcers, brown pigment
7. reflexes and sensation: monofilament test

Question 13

Microvascular complications of DM:

Answer 13

retinopathy

neuropathy

nephropathy (microalbumin screening)

Question 14

Macrovascular complications of DM:

Answer 14

atherosclerosis (should be on aspirin px)

Question 15

Labs to check in DM: (7)

Answer 15

glucose

A1c

lipids

microalbumin (urine??)

TSH

liver panel

Question 16

BP goal in DM management:

Answer 16

140/80

Question 17

LDL goal in DM management:

Answer 17

100 mg/dL

Question 18

First line therapy for mild DM:

Answer 18

diet!!!

Question 19

Two drug that can lower A1c the most:

Answer 19

Metformin (a biguanide)

Sulfonylureas

• glyburide
• glipizide
• glimipiride

**can lower 1-2%

Question 20

Two drug classes that increases satiety:

Answer 20

amylin analogs (Pramlintide)

GLP-1 agonists (Exenatide, Liraglutide)

Question 21

Drug class that decreases glucose absorption in the gut:

Answer 21

Alpha-glucosidase inhibitors (acarbose, miglitol)

Question 22

Three drug classes that decrease gastric emptying:

Answer 22

GLP-1 agonists —- Exenatide, Liraglutide

DPP-IV inhibitors —- “–gliptins”

amylin analogs —- Pramlintide

Question 23

Two drugs that decrease glucose production:

Answer 23

Metformin

TZDs —- Pioglitazone, Posiglitizone

Question 24

4 drugs that increase insulin secretion:

Answer 24

1. sulfonylureas – Glimepiride, Glipizide, Glyburide
2. GLP-1 agonists — Exenatide, Liraglutide
3. DDP-IV inhibitors — “–gliptins”
4. Meglitinides

Question 25

3 drugs that decrease glucagon secretion:

Answer 25

1. GLP-1 agonists — Exenatide, Liraglutide
2. DPP-IV inhibitors — “–gliptins”
3. Amylin analogs — Pramlintide

Question 26

Two drugs that increase peripheral glucose uptake:

Answer 26

Metformin

TZDs — Pioglitazone, Rosiglitazone

Question 27

Drug that decreases glucose reabsorption:

Answer 27

SGLT2 inhibitors — Canagliflozin

Question 28

Contraindications for Metformin:

Answer 28

renal impairment

cardiac/respiratory deficiency

sepsis

lactic acidosis

liver disease/EtOH abuse

**radiographic contrast

Question 29

Creatinine cutoff for Metformin:

Answer 29

males: > 1.5
females: >1.4

Question 30

Patient case…

Answer 30

slide 50

Question 31

MOA of sulfonylureas:

Answer 31

bind sulfonylurea receptor on beta cells –> stimulate insulin release

Question 32

side fx of sulfonylureas:

Answer 32

hypoglycemia

weight gain

potential cardiac probs

Question 33

MOA of TZDs:

Answer 33

increase glucose uptake in muscle

keeps liver from overproducing glucose

Question 34

side fx of TZD’s:

Answer 34

edema***

CHF??

MI??

$$$$$

Question 35

MOA of GLP-1 agonists:

Answer 35

increased glucose dependent insulin secretion

decrease glucagon secretion

delay gastric emptying

$$$$$

Question 36

MOA of DPP-IV inhibitors:

Answer 36

prevents degradation of GLP-1 and GIP

$$$$

Question 37

Contraindication of GLP-1’s:

Answer 37

Thyroid cancer

Question 38

Short acting insulins:

Answer 38

Rapid**

• Aspart
• Lispro
• Glulisine

Short**
Regular

Question 39

Long acting insulins (for establishing basal levels):

Answer 39

NPH —– intermediate

Detemir —– long 6-24 hrs

Glargine (Lantus)—— long > 24 hrs

Question 40

A1c target for most patients:

Question 41

When is A1c target 6-6.5%?

Answer 41

short disease duration

long life expectancy

no CVD

Question 42

When is A1c goal 7.5-8%?

Answer 42

h/o severe hypoglycemia

short life expectancy

comorbidities and complications

difficult control

Question 43

Only medical therapy without a ceiling?

Answer 43

insulin

Question 44

When can oral therapy be dc’d?

Answer 44

start of insulin