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Question 1
What is the management of type 1 diabetes?
Management of type 1 diabetes involves insulin therapy, dietary management, and regular monitoring of blood glucose levels.
Question 2
What is the management of type 2 diabetes?
Management of type 2 diabetes includes lifestyle changes, oral medications, and in some cases, insulin therapy.
Question 3
What is hypoglycemia?
Hypoglycemia is a condition characterized by abnormally low blood glucose levels, which can lead to symptoms such as dizziness, sweating, and confusion.
Question 4
What is the number of people with diabetes in the U.S.?
38 million
Question 5
What percentage of the U.S. population has diabetes?
1 in every 10 people
Question 6
How many American adults have prediabetes?
98 million
Question 7
What is Type 1 diabetes?
Autoimmune β-cell destruction. Classical young onset and latent autoimmune diabetes in adults.
Question 8
What is Type 2 diabetes?
Non-autoimmune progressive loss of adequate β-cell insulin secretion/insulin resistance. Obesity is the most important environmental factor causing insulin resistance.
Question 9
What is Gestational diabetes mellitus?
Diagnosed in the 2nd/3rd trimester of pregnancy and not overt diabetes prior to gestation.
Question 10
What is the first phase of insulin release following glucose infusion?
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.
Question 11
What is the second phase of insulin release following glucose infusion?
Sustained insulin release continues until blood glucose levels return to normal.
Question 12
What does the graph illustrate?
Fluctuations in glucose and insulin levels throughout the day.
Question 13
What does the solid red line represent?
Glucose blood levels.
Question 14
What does the dotted blue line represent?
Insulin blood levels.
Question 15
What is the therapeutic goal for Type 1 diabetes?
Rely on exogenous insulin to control hyperglycemia and avoid ketoacidosis. Maintain blood glucose near normal level, i.e HbA1C < 7 %.
Question 16
What is the therapeutic goal for Type 2 diabetes?
Maintain blood glucose near normal levels and prevent long-term complications. Weight reduction, exercise, and dietary modification can decrease insulin resistance and correct hyperglycemia.
Question 17
What is T1DM?
Type 1 Diabetes Mellitus
Question 18
What are anti-hyperglycemic agents?
Medications used to manage blood sugar levels in diabetes
Question 19
What is the onset and duration of rapid-acting insulin?
Onset 5-10 minutes and duration around 2 hours
Question 20
What is the onset and duration of regular/short-acting insulin?
Onset 30 minutes, duration 2-4 hours
Question 21
What is the onset and duration of intermediate-acting insulin?
Onset 2-4 hours, duration between 12-18 hours
Question 22
What is Bolus Insulin?
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.
Question 23
What is Basal Insulin?
Basal Insulin is composed of intermediate or long-acting insulin. It is administered to keep the blood sugar level steady between meals and overnight.
Question 24
What are the four routes of insulin administration shown in the slide?
Syringe, pen, pump, inhaler
Question 25
What does the red dot represent in the insulin administration chart?
Rapid-acting insulin
Question 26
What are the examples of rapid-acting insulin?
Insulin lispro (Humalog®) and insulin aspart (NovoLog®)
Question 27
What is the full name of NPH insulin?
Insulin isophane
Question 28
What is the full name of the long-acting insulin detemir?
Levemir®
Question 29
What is the process by which insulin mediates its action?
Insulin mediates its action via binding to the insulin receptor, which activates insulin Receptor Substrate (IRS) and translocation of GLUT4.
Question 30
What is the role of GLUT4 in insulin action?
GLUT4 is involved in the translocation process, which allows glucose to enter the cell.
Question 31
What is the fate of insulin after it has acted?
Insulin is degraded by insulin-degrading enzyme, which is ubiquitously expressed.
Question 32
What are the agents that increase blood glucose level?
Corticosteroids
Question 33
What are the agents that decrease blood glucose level?
Oral hypoglycemic agents and alcohol
Question 34
What supplements can decrease blood glucose level?
Ginseng, fenugreek, and garlic
Question 35
What is the most serious and common adverse effect for insulin toxicity?
Hypoglycemia
Question 36
What is the threshold for severe low blood sugar in mg/dL?
54 mg/dL
Question 37
What is the association of Hypokalemia with IV insulin administration?
Hypokalemia can increase the risk for cardiovascular and pulmonary complications.
Question 38
What is lipodystrophy?
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.
Question 39
What are the adverse effects of repeated insulin injections in the same area?
The adverse effects include local atrophy and hypertrophy of subcutaneous fat.
Question 40
What is the first disease-modifying therapy approved by the FDA to delay the onset of type 1 diabetes?
Teplizumab (Tzield)
Question 41
What is the mechanism of action of Teplizumab?
Antibody directed against CD3
Question 42
What are the adverse reactions associated with Teplizumab?
Transient decreases in white cell and lymphocyte counts, rash, and headache
Question 43
What are the two types of surgical treatments mentioned for Type 1 Diabetes?
Pancreas transplantation and islet transplantation
Question 44
What is the purpose of surgical treatments for Type 1 Diabetes?
To normalize blood glucose levels and prevent long-term diabetes complications
Question 45
What is required for patients after surgical treatment for Type 1 Diabetes?
Lifelong immunosuppression to prevent graft rejection and/or autoimmune islet destruction
Question 46
What are the pharmacological management options for Type 2 Diabetes Mellitus (T2DM) with an HbA1c < 7?
1- Antihyperglycemic agents (single or combination). 2- Weight control medications. 3- Insulin.
Question 47
What are the three pharmacological management options for T2DM?
1- Antihyperglycemic agents (single or combination). 2- Weight control medications. 3- Insulin.
Question 48
What are oral anti-hyperglycemic agents?
Medications taken by mouth to lower blood sugar levels in diabetes management.
Question 49
List the oral anti-hyperglycemic agents mentioned in the slide.
Acarbose, Alogliptin, Bromocriptine, Canagliflozin, Colesevelam, Dapagliflozin, Empagliflozin, Ertugliflozin, Glimepiride, Glipizide, Glyburide, Linagliptin, Metformin, Miglitol, Nateglinide, Pioglitazone, Repaglinide, Rosiglitazone, Saxagliptin, Sitagliptin, Tolbutamide.
Question 50
What are the two main classes of insulin secretagogues mentioned in the slide?
Sulfonylureas and non-sulfonylureas
Question 51
What is the mechanism of action for biguanides in the context of Type 2 diabetes?
Promote glucose excretion
Question 52
What is the main mechanism of action (MOA) of Biguanides like Metformin?
Reduces hepatic gluconeogenesis and lipogenesis.
Question 53
What are the adverse effects of Biguanides like Metformin?
GI symptoms like nausea, vomiting, and diarrhea; decreased absorption of vitamin B12 intrinsic factor complex; altered taste.
Question 54
What are the examples of insulin secretagogues?
Glipizide (Glucotrol®), Glyburide (Diabeta) and glimepiride (Amaryl®)
Question 55
What is the mechanism of action (MOA) of sulfonylureas?
Block K+/ATP channels in β cells, causing calcium influx and stimulating insulin secretion. They may also reduce hepatic gluconeogenesis.
Question 56
What are the adverse effects of sulfonylureas?
Hypoglycemia, hyperinsulinemia, and weight gain.
Question 57
What are the main characteristics of meglitinides?
Rapid onset, short duration of action, and low risk of hypoglycemia.
Question 58
What is the mechanism of action of meglitinides?
Stimulate insulin secretion, most effective in the early release of insulin after a meal.
Question 59
What are Thiazolidinediones?
Insulin sensitizers that increase insulin sensitivity in adipose tissue, liver, and skeletal muscles.
Question 60
What is the mechanism of action (MOA) of Thiazolidinediones?
They act on cell receptors to increase insulin sensitivity, thereby increasing glucose uptake by adipose tissue, liver, and skeletal muscles.
Question 61
What are the adverse effects of Thiazolidinediones?
Liver toxicity, CVS effects, and weight gain (with a boxed warning for increased risk of myocardial ischemia and congestive heart failure).
Question 62
What are Alpha-glucosidase inhibitors?
Enzymes that inhibit alpha-glucosidase in the intestinal brush border cells, delaying carbohydrate digestion and lowering glucose levels.
Question 63
What is the main mechanism of action (MOA) of Alpha-glucosidase inhibitors?
Inhibit alpha-glucosidase enzymes in the intestinal brush border cells that digest dietary starch.
Question 64
What are the adverse effects of Alpha-glucosidase inhibitors?
Flatulence, diarrhea, and abdominal pain.
Question 65
What is the mechanism of action (MOA) of Sodium-glucose co-transporter-2 (SGLT2) inhibitors?
They inhibit 90% glucose reabsorption in the proximal tubule, resulting in the excretion of glucose in urine (glycosuria) which lowers plasma glucose levels.
Question 66
What is the example of a SGLT2 inhibitor mentioned in the slide?
Empagliflozin (Jardiance®)
Question 67
What is the indication for the medication mentioned in the slide?
Type 2 Diabetes and decrease the risk of cardiovascular and kidney disease.
Question 68
What are the adverse effects of the medication mentioned in the slide?
Increase urinary urgency and risk of urinary tract infections, can cause orthostatic hypotension and stress-induced hypoglycemia.
Question 69
What are DPP-4 inhibitors and how do they work?
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.
Question 70
What are the adverse effects of DPP-4 inhibitors?
The rare adverse effects of DPP-4 inhibitors include oral mucosal ulcers and pancreatitis.
Question 71
What is the adverse effect associated with Glinides and Sulfonylureas?
Hypoglycemia
Question 72
Which class of drugs is associated with gastrointestinal disturbances?
Biguanides
Question 73
What is the adverse effect linked to DPP-4 inhibitors?
Pancreatitis
Question 74
What does 'Parenteral route' refer to in the context of anti-hyperglycemic medications?
The administration of drugs directly into the bloodstream or other body tissues, bypassing the digestive system.
Question 75
What are some examples of anti-hyperglycemic medications that can be administered via the parenteral route?
Insulin and other injectable glucose-lowering drugs.
Question 76
What is the mechanism of action (MOA) of GLP-1 agonists?
GLP-1 agonists stimulate insulin secretion in response to a meal and decrease gastric emptying and glucagon secretion, increasing satiety.
Question 77
What are some examples of GLP-1 agonists?
Dulaglutide (Trulicity®) and semaglutide (Ozempic®).
Question 78
What is the indication for the medication mentioned in the slide?
To improve glycemic control in type 2 diabetes in conjunction with diet and exercise.
Question 79
What are the adverse effects of the medication mentioned in the slide?
GI symptoms due to delayed gastric emptying like nausea, vomiting, and decreased appetite. Halitosis and xerostomia. Increased risk of pancreatitis and thyroid tumors.
Question 80
What is the mechanism of action (MOA) of Amylin analogues?
Synthetic amylin analogue delays gastric emptying and decreases glucagon secretion.
Question 81
For which conditions are Amylin analogues indicated as adjunct therapy?
Type 1 and type 2 diabetes.
Question 82
What are the adverse effects of Pramlintide (Symlin®) when used with insulin?
Increased risk for hypoglycemia and gastrointestinal symptoms like nausea and vomiting.
Question 83
What is the significance of weight management in the context of type 2 diabetes management?
Weight management is an impactful component of glucose-lowering management in type 2 diabetes.
Question 84
What are glycemic/weight control drugs?
Glycemic/weight control drugs are medications used to manage both blood glucose levels and weight in patients with type 2 diabetes.
Question 85
What is the mechanism of action (MOA) of Tirzepatide injection?
Dual GIP and GLP-1 receptor agonist to stimulate insulin secretion, improve glycemic control, increase satiety, and increase lipolysis.
Question 86
What are the adverse effects of Tirzepatide injection?
Same as GLP-1
Question 87
What is glycemic control?
Glycemic control refers to the regulation of blood glucose levels to prevent complications associated with diabetes.
Question 88
What are the implications of diabetes on periodontal disease?
Diabetes patients can have progressive periodontal disease.
Question 89
What is xerostomia and how is it related to diabetes?
Xerostomia is a condition characterized by dry mouth, which can be caused by uncontrolled diabetes.
Question 90
What are the possible precautions for diabetic patients during surgical procedures?
Infection, stress, and surgical procedures can disturb the control of diabetes.
Question 91
What is the recommended source of sugar for diabetic patients in clinics?
Glucose.
Question 92
What should diabetic patients do before invasive procedures?
Have controlled blood glucose levels.
Question 93
What are the key lifestyle interventions recommended for preventing Type 2 diabetes?
Low-fat diet and moderate exercise
Question 94
What is the Diabetes Prevention Program Lifestyle arm designed to do?
To manage weight, plan exercise, and plan dietary changes
Question 95
How long is the Lifestyle Change Program in the Diabetes Prevention Program?
1-year interval with an educational curriculum, coach, and support group
Question 96
What is the blood glucose range for mild-moderate hypoglycemia?
55-70 mg/dL
Question 97
What is the management for mild-moderate hypoglycemia?
Consume fast carbohydrates, juice or glucose tablets and reassess blood glucose
Question 98
What is the blood glucose range for severe hypoglycemia?
<55 mg/dL
Question 99
What is the management for severe hypoglycemia?
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)