Diabetes Management Quiz

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Questions and Answers

What is the primary medication prescribed for managing blood glucose levels?

Metformin (correct)

Thiazolidinediones

Sulfonylureas

DPP-4 inhibitors

What lifestyle changes are recommended to improve blood glucose levels?

Increase sugary snacks and decrease active lifestyle

Promote a healthier diet and exercise regularly (correct)

Only rely on medication without any dietary changes

Increase intake of fried foods and reduce exercise

If blood glucose levels do not improve after 3 months, what is the next step?

Increase the dose of Metformin

Switch to insulin therapy exclusively

Eliminate all medications

Combine Metformin with DPP-4 inhibitors (correct)

What does an A1c level indicate in diabetes management?

The average blood glucose over the past 2-3 months Signup and view all the answers

What should be assessed if blood glucose levels stabilize after lifestyle improvements?

Determine the minimum dose of Metformin needed Signup and view all the answers

What is the recommended initial dosage of Metformin for treating type 2 diabetes?

500 mg twice daily or 850 mg once daily Signup and view all the answers

Which of the following is NOT a lifestyle intervention recommended for managing diabetes?

Lipid-lowering drug therapy Signup and view all the answers

Which LDL cholesterol level is preferred for patients with cardiovascular disease?

LDL < 70 mg/dL Signup and view all the answers

What is the glycemic goal for HbA1c in most non-pregnant adults with diabetes?

HbA1c < 7% Signup and view all the answers

When should insulin therapy be initiated in diabetes management?

If HbA1c is greater than 10% Signup and view all the answers

Which class of medication is recommended for primary prevention in diabetes patients with increased cardiovascular risk?

Antiplatelet medications Signup and view all the answers

What is the primary function of Metformin in diabetes management?

Slowing glucose release from the liver Signup and view all the answers

Which of the following medications is appropriate for diabetes patients with a known aspirin allergy?

Clopidogrel Signup and view all the answers

In which situation should aspirin not be recommended?

Patients with low cardiovascular risk Signup and view all the answers

What alternative medication may be prescribed for gestational diabetes if insulin therapy is not preferred?

Metformin Signup and view all the answers

Which antihypertensive classes are recommended for managing hypertension in diabetes patients?

ACE inhibitors and ARBs Signup and view all the answers

What is a key characteristic of Metformin regarding blood glucose levels?

It does not cause hypoglycemia by itself Signup and view all the answers

Which class of medications is NOT categorized under oral antidiabetic agents for diabetes management?

ACE inhibitors Signup and view all the answers

What is the primary reason for the necessity of insulin in patients with Type 1 diabetes?

There is an autoimmune reaction damaging insulin-producing cells. Signup and view all the answers

Which insulin type has a rapid onset and is typically administered before meals?

Aspart, Lispro, Glulisine (Rapid-acting Insulin) Signup and view all the answers

What is the recommended time to administer Regular Insulin relative to meals?

30-60 minutes before eating Signup and view all the answers

What characterizes Glargine (Ultra-long-acting Insulin) in terms of its insulin action?

Provides baseline insulin coverage lasting up to 24 hours or more. Signup and view all the answers

What distinguishes Type 2 diabetes from Type 1 diabetes in terms of insulin usage?

Insulin is produced but not utilized effectively. Signup and view all the answers

What is a potential benefit of using insulin analogs for diabetes management?

They can reduce the risk of hypoglycemia. Signup and view all the answers

Which insulin type has an onset time of 2-4 hours and is often used for longer coverage?

NPH (Intermediate-acting Insulin) Signup and view all the answers

What role does Pramlintide serve in addition to insulin in diabetes treatment?

It acts as a synthetic analog of human amylin. Signup and view all the answers

What is the primary role of pramlintide in individuals with type 1 diabetes?

Slows gastric emptying and promotes satiety Signup and view all the answers

In which age group are statins more frequently recommended for diabetic patients?

41 years and older Signup and view all the answers

What should be given to a conscious individual experiencing hypoglycemia?

Glucose 15-20 g orally Signup and view all the answers

When might a pancreas or islet transplant be considered for patients with diabetes?

When traditional approaches to glycemic control fail Signup and view all the answers

What role does metformin play when added as an adjuvant in type 1 diabetes treatment?

May reduce insulin dose but glycemic control effect is unclear Signup and view all the answers

Which medication is recommended for primary prevention of cardiovascular disease in patients with diabetes?

Aspirin 75 mg/day Signup and view all the answers

Which type of antihypertensive medication is suggested for diabetic patients?

ACE inhibitors or ARBs Signup and view all the answers

What is the recommended action for individuals at significant risk of severe hypoglycemia?

Prescribe glucagon and train caregivers on its use Signup and view all the answers

What is the primary mechanism of action for thiazolidinediones in diabetes management?

Decrease insulin resistance and hepatic glucose production Signup and view all the answers

Which of the following is NOT a sulfonylurea used to increase insulin secretion?

Miglitol Signup and view all the answers

What is the role of alpha-glucosidase inhibitors in managing blood glucose levels?

Slow the absorption of carbohydrates in the intestines Signup and view all the answers

What effect do SGLT-2 inhibitors have on glucose levels?

Inhibit glucose reabsorption in the kidneys Signup and view all the answers

What is the primary function of Dipeptidyl Peptidase-4 (DPP-4) inhibitors?

Prolong the action of incretins like GLP-1 Signup and view all the answers

In a patient with obesity class 1 and an A1C level between 8 and 9.5%, what initial treatment strategy should be considered?

Lifestyle changes with potential oral medication Signup and view all the answers

Which of the following is a significant cardiovascular risk factor along with obesity in diabetes management?

Low HDL cholesterol levels Signup and view all the answers

What is the main advantage of using GLP-1 mimetics like Exenatide and Liraglutide?

They promote insulin secretion in response to meals Signup and view all the answers

Study Notes

Workshop 6: Pharmacology of Diabetes

Workshop presented by Professor Vittoria Carrabs PhD, 3rd Medicine, Aa 2024-25
Focuses on the pharmacology of diabetes, including types 1 and 2.

Diabetes Types 1 and 2

Diabetes tipo 1: Caused by an autoimmune reaction destroying the islets of Langerhans (beta cells), preventing insulin production. Patients require daily insulin to survive.
Type 2 diabetes: Body does not properly use insulin and cannot maintain normal blood sugar levels.

Gestational Diabetes

A type of diabetes that develops during pregnancy.
Insulin therapy and metformin are preferred for managing gestational diabetes.

Insulins (Types)

Rapid-acting: Aspart, lispro, glulisine; rapid onset (1-2 hours), peak (2-3 hours), duration (4 hours). Taken before meals to manage post-prandial blood sugar spikes.
Short-acting: Regular insulin; onset (30 minutes-1 hour), peak (2-3 hours), duration (up to 6 hours); used to control blood sugar levels around meal times (given 30-60 minutes before eating)
Intermediate-acting: NPH; onset (2-4 hours), peak (4-12 hours), duration (12-18 hours); used for longer coverage, often combined with rapid or regular insulin.
Long-acting: Detemir; gradual onset (around 2 hours), no pronounced peak, duration (up to 24 hours); provides stable insulin levels for longer periods, suitable for background coverage.
Ultra-long-acting: Glargine; very steady effect, no significant peak, duration (up to 24 hours or more); ideal for baseline insulin coverage for an entire day.

Adjuvant Glucose-Lowering Medications

Pramlintide: A synthetic analog of human amylin; co-secreted with insulin. Associated with improved glycemic control in adults with type 1 diabetes and slows gastric emptying and promotes satiety. Administered subcutaneously before each major meal.
Metformin: May reduce insulin dose in type 1 diabetes patients, but its effect on glycemic control is unclear. Suitable for initial treatment strategy for Type 2.
Lipid-lowering drug therapy: Effective for primary and secondary prevention of major coronary events. Statins are frequently recommended for patients over 40.
Antihypertensive medications: Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin receptor blockers (ARB) commonly prescribed.

Antiplatelet Medications

Aspirin 75 mg/day: Recommended as a primary prevention strategy for patients with diabetes at increased risk of atherosclerotic cardiovascular disease (men >50 or women >50 with additional risk factors).

Diabetes 1: Pancreas or Islet Transplant

May be considered for patients with uncontrolled glucose despite traditional methods.

Diabetes 1: Hypoglycemia

Treatment: 15-20 g glucose orally (any carbohydrate) to conscious individuals. 25 g intravenous (IV) glucose for unconscious patients or those unable to consume orally.
Glucagon: Prescribe glucagon for individuals at risk of severe hypoglycemia and instruct caregivers or family members on its use.

Diabetes 2: Lifestyle Interventions

Dietary management: Individualized medical nutrition therapy (preferably by a registered dietitian)
Physical activity: At least 150 minutes per week.
Diabetes self-management education (DSME).
Diabetes psychological counseling.
Lipid-lowering drug therapy.
Weight loss.
Medications

Diabetes 2: Treatment Overview

Glycemic goals: HbA1c < 7% in most non-pregnant adults and < 6% in pregnancy.
Lipid goals: Low-density lipoprotein (LDL) cholesterol < 100 mg/dL (2.6 mmol/L). Consider LDL < 70 mg/dL (1.8 mmol/L) if cardiovascular disease is also present.
Blood pressure goals: Vary across guidelines, but typically range from < 130/80 mmHg to < 140/90 mmHg.

Diabetes 2: Medications

Metformin: First-line drug for type 2 diabetes. Initial doses are 500 mg twice daily or 850 mg once daily, increasing weekly by increments. Maximum dose is 1 g twice daily or 850 mg three times daily. May reduce insulin dose and have a positive impact on lipid metabolism.
Add second and third drug if glycemic goals are not met on maximal tolerated dose of Metformin monotherapy.
Include other oral antidiabetic agents and injectable antidiabetic agents.
Additional therapies for other comorbidities (antihypertensives, antiplatelets).

Pregnant Women

Insulin therapy and metformin: Preferred medications for gestational diabetes.

Diabetes 2: Oral Treatment: Metformin (Biguanide)

Slows glucose release by the liver and helps cells use glucose.
May also lower blood fat and cholesterol, and will not cause hypoglycemia on its own.

Thiazolidinediones (Glitazones):

Decrease insulin resistance in peripheral tissues and the liver.
Increase glucose uptake and decrease hepatic glucose production.
Pioglitazone one such example.

Sulfonylureas:

Increase insulin secretion by the pancreas and may increase tissue sensitivity to insulin.
Examples include glimepiride, glipizide, and glyburide.

Alpha-Glucosidase Inhibitors:

Slow and lower the rise of blood glucose after meals by altering intestinal glucose absorption.
Examples include miglitol, acarbose, and voglibose.

SGLT-2 Inhibitor: Dapagliflozin:

Inhibits sodium-glucose cotransporter 2 (SGLT2), increasing glucose excretion.

Incretins (GLP-1) and Dipeptidyl Peptidase IV (DPP-4) Inhibitors (Gliptins):

GLP-1 Mimics (exenatide and liraglutide) are injectables, transcribed from the same gene that codes for glucagon and secreted by cells in response to food stimuli.
DPP-4 Inhibitors(sitagliptin and vildagliptin) inhibit the enzyme that hydrolyzes incretin GLP-1.

Clinical Cases

Includes patient demographics, medical history, lifestyle factors, current medications, and initial blood glucose monitoring data. Information is provided for scenarios that help identify the best treatment path for diabetes.

Information to solve cases:

Charts, tables and other details provided to support diabetes case analysis.
- Includes details such as BMI, weight status, Blood glucose ranges, blood pressure, cholesterol, and other pertinent information.

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Description

Test your knowledge on the management of diabetes, including medication, lifestyle changes, and monitoring techniques. This quiz covers critical information related to blood glucose levels, A1c targets, and diabetes interventions that can enhance patient outcomes.