Management of type 1 diabetes involves insulin therapy, dietary management, and regular monitoring of blood glucose levels.
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What is the management of type 2 diabetes?
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Management of type 2 diabetes includes lifestyle changes, oral medications, and in some cases, insulin therapy.
3
What is hypoglycemia?
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Hypoglycemia is a condition characterized by abnormally low blood glucose levels, which can lead to symptoms such as dizziness, sweating, and confusion.
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What is the number of people with diabetes in the U.S.?
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38 million
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What percentage of the U.S. population has diabetes?
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1 in every 10 people
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How many American adults have prediabetes?
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98 million
7
What is Type 1 diabetes?
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Autoimmune β-cell destruction. Classical young onset and latent autoimmune diabetes in adults.
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What is Type 2 diabetes?
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Non-autoimmune progressive loss of adequate β-cell insulin secretion/insulin resistance. Obesity is the most important environmental factor causing insulin resistance.
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What is Gestational diabetes mellitus?
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Diagnosed in the 2nd/3rd trimester of pregnancy and not overt diabetes prior to gestation.
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What is the first phase of insulin release following glucose infusion?
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A burst of insulin within a few minutes of glucose in the bloodstream that continues for up to 10-15 minutes. It prevents post-prandial hyperglycemia.
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What is the second phase of insulin release following glucose infusion?
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Sustained insulin release continues until blood glucose levels return to normal.
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What does the graph illustrate?
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Fluctuations in glucose and insulin levels throughout the day.
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What does the solid red line represent?
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Glucose blood levels.
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What does the dotted blue line represent?
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Insulin blood levels.
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What is the therapeutic goal for Type 1 diabetes?
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Rely on exogenous insulin to control hyperglycemia and avoid ketoacidosis. Maintain blood glucose near normal level, i.e HbA1C < 7 %.
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What is the therapeutic goal for Type 2 diabetes?
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Maintain blood glucose near normal levels and prevent long-term complications. Weight reduction, exercise, and dietary modification can decrease insulin resistance and correct hyperglycemia.
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What is T1DM?
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Type 1 Diabetes Mellitus
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What are anti-hyperglycemic agents?
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Medications used to manage blood sugar levels in diabetes
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What is the onset and duration of rapid-acting insulin?
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Onset 5-10 minutes and duration around 2 hours
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What is the onset and duration of regular/short-acting insulin?
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Onset 30 minutes, duration 2-4 hours
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What is the onset and duration of intermediate-acting insulin?
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Onset 2-4 hours, duration between 12-18 hours
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What is Bolus Insulin?
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Bolus Insulin is composed of short or rapid-acting insulin. It is usually consumed before meals to control the expected surge in blood sugar level.
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What is Basal Insulin?
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Basal Insulin is composed of intermediate or long-acting insulin. It is administered to keep the blood sugar level steady between meals and overnight.
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What are the four routes of insulin administration shown in the slide?
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Syringe, pen, pump, inhaler
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What does the red dot represent in the insulin administration chart?
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Rapid-acting insulin
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What are the examples of rapid-acting insulin?
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Insulin lispro (Humalog®) and insulin aspart (NovoLog®)
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What is the full name of NPH insulin?
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Insulin isophane
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What is the full name of the long-acting insulin detemir?
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Levemir®
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What is the process by which insulin mediates its action?
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Insulin mediates its action via binding to the insulin receptor, which activates insulin Receptor Substrate (IRS) and translocation of GLUT4.
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What is the role of GLUT4 in insulin action?
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GLUT4 is involved in the translocation process, which allows glucose to enter the cell.
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What is the fate of insulin after it has acted?
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Insulin is degraded by insulin-degrading enzyme, which is ubiquitously expressed.
32
What are the agents that increase blood glucose level?
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Corticosteroids
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What are the agents that decrease blood glucose level?
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Oral hypoglycemic agents and alcohol
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What supplements can decrease blood glucose level?
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Ginseng, fenugreek, and garlic
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What is the most serious and common adverse effect for insulin toxicity?
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Hypoglycemia
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What is the threshold for severe low blood sugar in mg/dL?
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54 mg/dL
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What is the association of Hypokalemia with IV insulin administration?
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Hypokalemia can increase the risk for cardiovascular and pulmonary complications.
38
What is lipodystrophy?
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Lipodystrophy is a condition characterized by the loss of subcutaneous fat in a specific area, often accompanied by local atrophy and hypertrophy of the remaining fat.
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What are the adverse effects of repeated insulin injections in the same area?
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The adverse effects include local atrophy and hypertrophy of subcutaneous fat.
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What is the first disease-modifying therapy approved by the FDA to delay the onset of type 1 diabetes?
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Teplizumab (Tzield)
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What is the mechanism of action of Teplizumab?
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Antibody directed against CD3
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What are the adverse reactions associated with Teplizumab?
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Transient decreases in white cell and lymphocyte counts, rash, and headache
43
What are the two types of surgical treatments mentioned for Type 1 Diabetes?
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Pancreas transplantation and islet transplantation
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What is the purpose of surgical treatments for Type 1 Diabetes?
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To normalize blood glucose levels and prevent long-term diabetes complications
45
What is required for patients after surgical treatment for Type 1 Diabetes?
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Lifelong immunosuppression to prevent graft rejection and/or autoimmune islet destruction
46
What are the pharmacological management options for Type 2 Diabetes Mellitus (T2DM) with an HbA1c < 7?
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1- Antihyperglycemic agents (single or combination). 2- Weight control medications. 3- Insulin.
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What are the three pharmacological management options for T2DM?
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1- Antihyperglycemic agents (single or combination). 2- Weight control medications. 3- Insulin.
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What are oral anti-hyperglycemic agents?
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Medications taken by mouth to lower blood sugar levels in diabetes management.
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List the oral anti-hyperglycemic agents mentioned in the slide.
What are the two main classes of insulin secretagogues mentioned in the slide?
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Sulfonylureas and non-sulfonylureas
51
What is the mechanism of action for biguanides in the context of Type 2 diabetes?
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Promote glucose excretion
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What is the main mechanism of action (MOA) of Biguanides like Metformin?
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Reduces hepatic gluconeogenesis and lipogenesis.
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What are the adverse effects of Biguanides like Metformin?
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GI symptoms like nausea, vomiting, and diarrhea; decreased absorption of vitamin B12 intrinsic factor complex; altered taste.
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What are the examples of insulin secretagogues?
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Glipizide (Glucotrol®), Glyburide (Diabeta) and glimepiride (Amaryl®)
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What is the mechanism of action (MOA) of sulfonylureas?
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Block K+/ATP channels in β cells, causing calcium influx and stimulating insulin secretion. They may also reduce hepatic gluconeogenesis.
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What are the adverse effects of sulfonylureas?
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Hypoglycemia, hyperinsulinemia, and weight gain.
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What are the main characteristics of meglitinides?
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Rapid onset, short duration of action, and low risk of hypoglycemia.
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What is the mechanism of action of meglitinides?
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Stimulate insulin secretion, most effective in the early release of insulin after a meal.
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What are Thiazolidinediones?
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Insulin sensitizers that increase insulin sensitivity in adipose tissue, liver, and skeletal muscles.
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What is the mechanism of action (MOA) of Thiazolidinediones?
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They act on cell receptors to increase insulin sensitivity, thereby increasing glucose uptake by adipose tissue, liver, and skeletal muscles.
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What are the adverse effects of Thiazolidinediones?
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Liver toxicity, CVS effects, and weight gain (with a boxed warning for increased risk of myocardial ischemia and congestive heart failure).
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What are Alpha-glucosidase inhibitors?
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Enzymes that inhibit alpha-glucosidase in the intestinal brush border cells, delaying carbohydrate digestion and lowering glucose levels.
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What is the main mechanism of action (MOA) of Alpha-glucosidase inhibitors?
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Inhibit alpha-glucosidase enzymes in the intestinal brush border cells that digest dietary starch.
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What are the adverse effects of Alpha-glucosidase inhibitors?
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Flatulence, diarrhea, and abdominal pain.
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What is the mechanism of action (MOA) of Sodium-glucose co-transporter-2 (SGLT2) inhibitors?
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They inhibit 90% glucose reabsorption in the proximal tubule, resulting in the excretion of glucose in urine (glycosuria) which lowers plasma glucose levels.
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What is the example of a SGLT2 inhibitor mentioned in the slide?
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Empagliflozin (Jardiance®)
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What is the indication for the medication mentioned in the slide?
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Type 2 Diabetes and decrease the risk of cardiovascular and kidney disease.
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What are the adverse effects of the medication mentioned in the slide?
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Increase urinary urgency and risk of urinary tract infections, can cause orthostatic hypotension and stress-induced hypoglycemia.
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What are DPP-4 inhibitors and how do they work?
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DPP-4 inhibitors are a class of drugs that inhibit the dipeptidyl peptidase (DPP-4) enzyme, which inactivates glucagon-like peptide-1 (GLP-1). By blocking DPP-4, they indirectly stimulate insulin release and inhibit glucagon release, thereby lowering blood glucose levels.
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What are the adverse effects of DPP-4 inhibitors?
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The rare adverse effects of DPP-4 inhibitors include oral mucosal ulcers and pancreatitis.
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What is the adverse effect associated with Glinides and Sulfonylureas?
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Hypoglycemia
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Which class of drugs is associated with gastrointestinal disturbances?
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Biguanides
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What is the adverse effect linked to DPP-4 inhibitors?
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Pancreatitis
74
What does 'Parenteral route' refer to in the context of anti-hyperglycemic medications?
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The administration of drugs directly into the bloodstream or other body tissues, bypassing the digestive system.
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What are some examples of anti-hyperglycemic medications that can be administered via the parenteral route?
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Insulin and other injectable glucose-lowering drugs.
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What is the mechanism of action (MOA) of GLP-1 agonists?
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GLP-1 agonists stimulate insulin secretion in response to a meal and decrease gastric emptying and glucagon secretion, increasing satiety.
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What are some examples of GLP-1 agonists?
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Dulaglutide (Trulicity®) and semaglutide (Ozempic®).
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What is the indication for the medication mentioned in the slide?
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To improve glycemic control in type 2 diabetes in conjunction with diet and exercise.
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What are the adverse effects of the medication mentioned in the slide?
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GI symptoms due to delayed gastric emptying like nausea, vomiting, and decreased appetite. Halitosis and xerostomia. Increased risk of pancreatitis and thyroid tumors.
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What is the mechanism of action (MOA) of Amylin analogues?
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Synthetic amylin analogue delays gastric emptying and decreases glucagon secretion.
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For which conditions are Amylin analogues indicated as adjunct therapy?
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Type 1 and type 2 diabetes.
82
What are the adverse effects of Pramlintide (Symlin®) when used with insulin?
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Increased risk for hypoglycemia and gastrointestinal symptoms like nausea and vomiting.
83
What is the significance of weight management in the context of type 2 diabetes management?
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Weight management is an impactful component of glucose-lowering management in type 2 diabetes.
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What are glycemic/weight control drugs?
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Glycemic/weight control drugs are medications used to manage both blood glucose levels and weight in patients with type 2 diabetes.
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What is the mechanism of action (MOA) of Tirzepatide injection?
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Dual GIP and GLP-1 receptor agonist to stimulate insulin secretion, improve glycemic control, increase satiety, and increase lipolysis.
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What are the adverse effects of Tirzepatide injection?
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Same as GLP-1
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What is glycemic control?
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Glycemic control refers to the regulation of blood glucose levels to prevent complications associated with diabetes.
88
What are the implications of diabetes on periodontal disease?
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Diabetes patients can have progressive periodontal disease.
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What is xerostomia and how is it related to diabetes?
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Xerostomia is a condition characterized by dry mouth, which can be caused by uncontrolled diabetes.
90
What are the possible precautions for diabetic patients during surgical procedures?
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Infection, stress, and surgical procedures can disturb the control of diabetes.
91
What is the recommended source of sugar for diabetic patients in clinics?
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Glucose.
92
What should diabetic patients do before invasive procedures?
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Have controlled blood glucose levels.
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What are the key lifestyle interventions recommended for preventing Type 2 diabetes?
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Low-fat diet and moderate exercise
94
What is the Diabetes Prevention Program Lifestyle arm designed to do?
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To manage weight, plan exercise, and plan dietary changes
95
How long is the Lifestyle Change Program in the Diabetes Prevention Program?
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1-year interval with an educational curriculum, coach, and support group
96
What is the blood glucose range for mild-moderate hypoglycemia?
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55-70 mg/dL
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What is the management for mild-moderate hypoglycemia?
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Consume fast carbohydrates, juice or glucose tablets and reassess blood glucose
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What is the blood glucose range for severe hypoglycemia?
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<55 mg/dL
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What is the management for severe hypoglycemia?
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Consume fast carbohydrates, juice or glucose tablets. Measure blood glucose. For unconscious patients, administer IV glucose or glucagon injection (HypoPen) or glucagon nasal spray (Baqsimi)