Diabetes

Match the correct statements 1. Metformin 2. Glyburide and repaglinide 3. Incretin enhancers 4. Sodium-glucose co-transporters A. Block renal glucose reabsorption B. Inhibits an inhibitory pathway of insulin C. Stimulates insulin secretion via closure of potassium channels D. This medication decreases hepatic gluconeogenesis , decreases intestinal absorption of glucose, and improves insulin sensitivity.

1. Metformin D. This medication decreases hepatic gluconeogenesis , decreases intestinal absorption of glucose, and improves insulin sensitivity. 2. Glyburide and repaglinide C. Stimulates insulin secretion via closure of potassium channels 3. Incretin enhancers B. Inhibits an inhibitory pathway of insulin 4. Sodium-glucose co-transporters A. Block renal glucose reabsorption

You want to start pharmacologic treatment for a patient with type 2 diabetes, and continue with his current treatment of lifestyle modification. Which medication has been shown to reduce the risk of diabetic complications, and to improve mortality in patients having type 2 DM? - Regular/NPH Insulin regimen twice daily regimen - Metformin - Lantus/Novolog Insulin regimen - Glyburide

Metformin

Which of the following drugs is taken during the first part of a meal for the purpose of delaying the absorption of dietary carbohydrates? - Exenatide - Pioglitazone - Acarbose - Repaglinide

Acarbose To be absorbed, carbohydrates are converted into monosaccharides by the action of α-glucosidase enzymes found in the gastrointestinal tract. Acarbose inhibits α-glucosidase and, when present during digestion, delays the uptake of carbohydrates.

Which of the following is NOT a contraindication to the use of metformin? - Metabolic Acidosis - Renal Failure - Parenteral radiographic contrast administration - Any condition associated with hypoxemia, dehydration, or sepsis. - As adjunct treatment of patients with hyperinsulinemia secondary to polycystic ovary syndrome (PCOS), especially as a treatment of infertility in these patients.

As adjunct treatment of patients with hyperinsulinemia secondary to polycystic ovary syndrome (PCOS), especially as a treatment of infertility in these patients

An adolescent with type 1 diabetes is brought to the ED complaining of dizziness. Laboratory findings include severe hyperglycemia, ketoacidosis, and a blood pH of 7.15. Which of the following agents should be administered to achieve rapid control of the severe ketoacidosis in this diabetic? - NPH Insulin - Insulin Glargine - Crystalline zinc insulin - Glyburide

Crystalline zinc insulin Regular Insulin = Crystalline zinc insulin

Which of the following drugs is most likely to cause hypoglycemia when used as monotherapy in the treatment of type 2 diabetes? - Acarbose - Glyburide - Metformin - Canagliflozin

Glyburide Agents that stimulate the release of insulin , like the sulfonylurea medication glyburide, cause hypoglycemia as a result of their ability to increase serum insulin levels. The biguanides, α-glucosidase inhibitors, and canagliflozin are unlikely to cause hypoglycemia when used alone.

Select the recommended dose for initiation of metformin therapy in patients diagnosed with type 2 diabetes. - Initiate metformin therapy with 1000mg PO twice daily or 2000mg PO once daily, given with meals. - Initiate metformin therapy with 2.5—5 mg PO of conventional tablets once daily, with the first main meal of the day or breakfast. Or with 1.5—3 mg PO once daily of micronized tablets. - Initiate metformin therapy with 500 mg PO twice daily or 850 mg PO once daily, given with meals. - Skip metformin and use a medication that has a unique mechanism of action.

Initiate metformin therapy with 500 mg PO twice daily or 850 mg PO once daily, given with meals.

Identify the correct statement: - Drugs classified as Sulfonylurea agents act by preventing the secretion of insulin into the urine. - Hypoglycemic reactions are rarely seen in patients whose diabetes is managed by Sulfonylurea agents. - Acarbose (an alpha-glucosidase inhibitor) increases the oral absorption of carbohydrates, and promotes the utilization of non-insulin dependent metabolic pathways for glucose. - Metformin and Pioglitazone (a thiazolidinedione) act to increase the activity of insulin receptors.

Metformin and Pioglitazone (a thiazolidinedione) act to increase the activity of insulin receptors.

A 26-year-old woman with type 1 diabetes wishes to try tight control of her diabetes to improve her long-term prognosis. Which of the following regimens would you prescribe? - Morning injections of mixed insulin lispro and insulin apart - Evening injections of mixed regular insulin and insulin glargine - Morning and evening injections of regular insulin, supplemented by small amounts of NPH insulin at mealtimes - Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtimes - Morning injection of NPH insulin and evening injection of regular insulin

Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtime Insulin regimens for tight control usually establish a basal level of insulin with a small amount of a long-acting preparation (eg, insulin glargine) and supplementing the insulin levels, when called for by food intake, with short-acting insulin lispro. Less tight control may be achieved with 2 injections of intermediate-acting insulin per day. Because intake of glucose is mainly during the day, long-acting insulins are usually given in the morning, not at night.

Which of the following situations is most likely to be treated with intravenous glucagon? - Severe bradycardia and hypotension resulting from an overdose of atenolol - lactic acidosis as a complication of severe infection and shock - severe diarrhea caused by a flare in her inflammatory bowel disease - cocaine overdose with blood pressure of 190/110 mm Hg

Severe bradycardia and hypotension resulting from an overdose of atenolol Glucagon acts through cardiac glucagon receptors to stimulate the rate and force of contraction of the heart. Because glucagon's effect is independent of cardiac β adrenoceptors, glucagon is useful in the treatment of β-blocker-induced cardiac depression.

Identify the correct statement about insulin: - The most convenient and practical classification of insulin is by time course of onset, and duration of effects - All types of insulin can be given intravenously - Glucagon and epinephrine enhance the effects of insulin. - Insulin inhibits the entry of glucose into peripheral tissues, and prevents its conversion to storage forms such as glycogen

The most convenient and practical classification of insulin is by time course of onset, and duration of effects

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes, recommends that the combination of metformin with lifestyle interventions should be initiated at the time of diagnosis. Metformin was chosen as the initial drug therapy because: - This recommendation was based on the efficacy, safety, and cost of metformin. Additionally, in a follow-up to the UKPDS, researchers found that after 10-years, patients originally randomized to metformin therapy had a 33% relative reduction (RR 0.67, 95% CI 0.51—0.89; p=0.005) in the risk of myocardial infarction and a 27% relative reduction (RR 0.73, 95% CI 0.59—0.89; p=0.002) in the risk of death from any cause as compared to patients originally randomized to conventional therapy; it should be noted that these reductions in cardiovascular risks persisted even though HbA1c concentrations were similar in the 2 groups after 1 year of follow-up. - This recommendation was based upon the unique mechanism of action of metformin. - The recommendation to initiate therapy with metformin was not an evidence based recommendation. - You should initiate therapy with any of the FDA approved medications. All of the medications improve laboratory values to the same extent. And our goal is to improve laboratory values.

This recommendation was based on the efficacy, safety, and cost of metformin. Additionally, in a follow-up to the UKPDS, researchers found that after 10-years, patients originally randomized to metformin therapy had a 33% relative reduction (RR 0.67, 95% CI 0.51—0.89; p=0.005) in the risk of myocardial infarction and a 27% relative reduction (RR 0.73, 95% CI 0.59—0.89; p=0.002) in the risk of death from any cause as compared to patients originally randomized to conventional therapy; it should be noted that these reductions in cardiovascular risks persisted even though HbA1c concentrations were similar in the 2 groups after 1 year of follow-up.

Which statement is correct about tight glucose control? - Twice daily injections of regular insulin combined with NPH is considered the best option for tight control of blood glucose in type 1 diabetics. - Tight control of blood glucose has been shown to reduce microvascular complications of type 1 diabetes. - Tight control of blood glucose is always the best option for management of type 2 diabetes. - Tight control of blood glucose is always the best option for management of elevated blood glucose in critically ill non diabetic patients.

Tight control of blood glucose has been shown to reduce microvascular complications of type 1 diabetes.

What would you tell your patient about the medication selected in question 1? (Metformin) - Watch for signs and symptoms of hypoglycemia - You may experience some GI side effects such as nausea and GI upset - You do not need to get your renal function checked regularly - none of the above

You may experience some GI side effects such as nausea and GI upset

Which of the following is the drug of choice for treatment of pregnant women with type 2 diabetes? - metformin - insulin - canagliflozin - liraglutide

insulin Insulin does not cross the placenta. It is secreted into human breast milk, but women who use insulin can breastfeed safely.Metformin is relatively safe for use in pregnancy.There is not enough safety information about the use of the other medications in pregnancy to recommend any of the others.