Diabetes Management Quiz
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Questions and Answers

What type of diabetes requires insulin injections for management?

  • Type I diabetes (correct)
  • Gestational diabetes
  • Type II diabetes
  • Prediabetes

Which of the following symptoms is NOT associated with hyperglycemia?

  • Polyphagia
  • Shaky hands (correct)
  • Polydipsia
  • Polyuria

What is a common action a pharmacist should take for a patient presenting hypoglycemia with a blood glucose level of 4 mmol/L?

  • Administer long-acting insulin
  • Provide fast-acting carbohydrates (correct)
  • Advise the patient to eat a high-carb meal
  • Suggest increasing daily exercise

At what fasting plasma glucose (FPG) level is hyperglycemia indicated?

<p>FPG &gt; 6.5 mmol/L (B)</p> Signup and view all the answers

Which age group is most commonly affected by Type I diabetes?

<p>Young people under 40 (B)</p> Signup and view all the answers

What is the primary action of DPP-4 inhibitors in the treatment of type 2 diabetes mellitus?

<p>Enhance incretin hormone concentration (A)</p> Signup and view all the answers

Which DPP-4 inhibitor is safe to use in patients with a creatinine clearance of 15 ml/min?

<p>Linagliptin (B)</p> Signup and view all the answers

DPP-4 inhibitors act by inhibiting which enzyme?

<p>Dipeptidyl peptidase-4 (DPP-4) (A)</p> Signup and view all the answers

What is a common reason for using DPP-4 inhibitors in patients with type 2 diabetes?

<p>Patients are intolerant to metformin (B)</p> Signup and view all the answers

In the incretin pathway, DPP-4 inhibitors primarily affect which process?

<p>Inactivation of incretin hormones (D)</p> Signup and view all the answers

What primary role does the PPAR-γ receptor play in the action of thiazolidinediones?

<p>Activate genes involved in glucose and lipid metabolism. (B)</p> Signup and view all the answers

Which of the following is a noted warning for the use of thiazolidinediones?

<p>Increased risk of fluid retention and edema. (B)</p> Signup and view all the answers

Under what condition should thiazolidinediones not be initiated?

<p>If ALT levels exceed 2.5 times the baseline. (D)</p> Signup and view all the answers

What side effect is commonly associated with the use of thiazolidinediones?

<p>Weight gain from increased subcutaneous fat deposition. (C)</p> Signup and view all the answers

Which of the following contraindications applies to thiazolidinediones?

<p>Individuals with serious hepatic impairment. (A)</p> Signup and view all the answers

What is the primary difference between biologics and biosimilars?

<p>Biosimilars may differ in production methods but have similar biological activity. (D)</p> Signup and view all the answers

How should insulin be stored to maintain its effectiveness?

<p>In a refrigerator or at room temperature for up to 28 days. (C)</p> Signup and view all the answers

What does the '30/70' notation in premixed insulin signify?

<p>30% short acting and 70% intermediate acting insulin. (D)</p> Signup and view all the answers

What should be done if insulin shows turbidity or cloudiness?

<p>Discard it and do not use. (B)</p> Signup and view all the answers

What type of insulin is not included in the premixed insulin categories mentioned?

<p>Novolog 20/80 (D)</p> Signup and view all the answers

What is the primary mechanism of action of alpha-glucosidase inhibitors?

<p>Inhibits alpha-glucosidase in the intestinal border (D)</p> Signup and view all the answers

How do alpha-glucosidase inhibitors affect the absorption of carbohydrates?

<p>They decrease the absorption of starch and disaccharides (A)</p> Signup and view all the answers

Which type of sugar absorption is directly impacted by alpha-glucosidase inhibitors?

<p>Disaccharides and starches (D)</p> Signup and view all the answers

What is one potential outcome of using alpha-glucosidase inhibitors in diabetic treatment?

<p>Decrease in HbA1c levels (B)</p> Signup and view all the answers

What effect do alpha-glucosidase inhibitors have on starch?

<p>They inhibit starch absorption (A)</p> Signup and view all the answers

What is the duration of action for RAPID insulin?

<p>2-3 hours (C)</p> Signup and view all the answers

Which insulin type peaks at 2 to 3 hours after administration?

<p>REGULAR (R) (B)</p> Signup and view all the answers

Which of the following insulins is classified as RAPID?

<p>Humalog (Lispro) (D)</p> Signup and view all the answers

How many hours does NPH insulin last?

<p>14-18 hours (B)</p> Signup and view all the answers

What is the onset time for Regular (R) insulin?

<p>30 minutes (B)</p> Signup and view all the answers

What is the peak time for NPH insulin?

<p>4-8 hours (C)</p> Signup and view all the answers

Which insulin type is suitable for intravenous dosing?

<p>Regular (R) (B)</p> Signup and view all the answers

What effect does RAPID insulin have after being taken at mealtime?

<p>Lasts up to 3-4 hours (A)</p> Signup and view all the answers

What is a common side effect of insulin and antidiabetic drugs that affects a significant percentage of patients?

<p>Stomach upset or diarrhea (D)</p> Signup and view all the answers

Which condition is a contraindication for the use of metformin?

<p>Pregnancy (C)</p> Signup and view all the answers

What serious condition can occur due to the accumulation of metformin in patients with certain health issues?

<p>Lactic acidosis (A)</p> Signup and view all the answers

What is one common factor that increases the risk of lactic acidosis in patients taking metformin?

<p>Radiographic contrast media usage (C)</p> Signup and view all the answers

How does excessive alcohol intake affect metformin treatment?

<p>Potentiates hypoglycemia and increases lactic acidosis risk (C)</p> Signup and view all the answers

Which insulin type is characterized by its ability to mimic long-acting effects and last up to 24 hours?

<p>Long acting insulin (C)</p> Signup and view all the answers

What is a crucial characteristic of Glargine (Lantus) that distinguishes it from other insulins?

<p>It should not be mixed with other insulins. (C)</p> Signup and view all the answers

Which insulin is specifically recommended for emergency management of hyperglycemic crisis?

<p>Regular insulin (D)</p> Signup and view all the answers

What identifies the action profile of long-acting insulin?

<p>Lowers glucose levels evenly without peaks. (A)</p> Signup and view all the answers

How often is Degludec (Tresiba) administered?

<p>Once daily (D)</p> Signup and view all the answers

What potential effect does a double dosage of regular insulin have on an individual?

<p>Hypoglycemic symptoms (A)</p> Signup and view all the answers

When should rapid insulin be administered in relation to meals?

<p>10-15 minutes before meals (A)</p> Signup and view all the answers

Which of the following statements about basal insulin administration is true?

<p>It typically requires titration based on meal times. (C)</p> Signup and view all the answers

Which of the following classes of drugs increases insulin secretion from the pancreas?

<p>Sulfonylureas (A)</p> Signup and view all the answers

What is a common side effect of Sulfonylureas?

<p>Hypoglycemia (A)</p> Signup and view all the answers

What is the mechanism of action for Biguanides like Metformin?

<p>Increase insulin sensitivity (A)</p> Signup and view all the answers

DPP-4 inhibitors enhance which hormone?

<p>Incretin hormone (B)</p> Signup and view all the answers

Which of the following is a contraindication for using 1st Generation Sulfonylureas?

<p>Severe infection (B)</p> Signup and view all the answers

Which drug class does not primarily function by increasing insulin secretion?

<p>SGLT2 inhibitors (A)</p> Signup and view all the answers

Which of the following classes is an agonist of PPAR-gamma?

<p>Thiazolidinediones (B)</p> Signup and view all the answers

Which of the following medications is a 2nd generation Sulfonylurea?

<p>Gliclazide (A)</p> Signup and view all the answers

What is a key advantage of meglitinides over sulfonylureas?

<p>They provide better post-prandial glucose control. (C), They are safer for patients with renal disease. (D)</p> Signup and view all the answers

What is a significant risk associated with glyburide?

<p>Hypoglycemia, especially in the elderly. (D)</p> Signup and view all the answers

Which of the following statements regarding the therapeutic use of sulfonylureas is correct?

<p>They are typically used as adjunct therapy when metformin is contraindicated. (C)</p> Signup and view all the answers

What monitoring is essential for patients on sulfonylureas?

<p>Regular testing of blood and urine sugar levels. (D)</p> Signup and view all the answers

What is a contraindication for the use of meglitinides?

<p>Hypersensitivity to the drug. (C)</p> Signup and view all the answers

Flashcards

Type I Diabetes

Insulin-dependent diabetes; usually begins in young people and is treated with insulin injections.

Hyperglycemia

High blood sugar levels (FPG >6.5 mmol/L) characterized by increased urination, thirst, hunger, and fatigue.

Hypoglycemia

Low blood sugar (<7 mmol/L); symptoms like sweating, palpitations, and shakiness.

Fasting Plasma Glucose (FPG)

Blood glucose level measured after an overnight fast.

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Hypoglycemia Treatment (4 mmol/L)

Rapid action; patient needs a quick source of sugar or glucose.

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Premixed Insulin

Combination of short-acting and intermediate-acting insulins, typically taken 2 or 3 times a day before meals.

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Insulin Storage

Store insulin in the refrigerator; can be kept at room temperature for up to 28 days.

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Insulin Biosimilar

Highly similar to a reference biologic insulin, produced using different cell cultures or methods; essentially same activity.

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Biologic vs. Biosimilar

Biosimilars mimic the action of existing biologic drugs, but are created through different manufacturing processes.

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Insulin Turbidity

Cloudy or unusual appearance of insulin; do not use and discard.

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DPP-4 Inhibitors

Drugs that block the enzyme DPP-4, increasing the levels of incretin hormones in the blood.

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Incretin Hormones

Hormones released by the GI tract in response to glucose; they stimulate insulin release.

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DPP-4 Enzyme

An enzyme that normally breaks down incretin hormones.

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Type 2 Diabetes Mellitus (2DM)

A condition where the body does not use insulin effectively, leading to high blood sugar.

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Creatinine Clearance (CrCl)

A measure of how well the kidneys are filtering waste products from the blood.

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Thiazolidinediones Mechanism

These drugs activate PPAR-γ receptors, which increase insulin sensitivity by influencing gene expression in cells, mainly in muscles and fat.

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Thiazolidinedione Therapeutic Effect

TZDs improve insulin sensitivity primarily in peripheral tissues (muscles & fat), not as much in the liver, making them a later-line treatment option.

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Thiazolidinedione Warning

TZDs can cause fluid retention (edema) and liver toxicity, requiring careful monitoring of ALT levels and use for severe heart problems.

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Thiazolidinedione Contraindications

TZDs are contraindicated for patients with severe liver impairment, fluid retention, or heart failure due to potential cardiac risks.

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Thiazolidinedione Side Effects

TZDs lead to potential weight gain, fluid buildup, and varying effects on lipid profiles, including an increased risk of bladder cancer in some cases (pioglitazone).

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Alpha-glucosidase inhibitor

Drug that slows the body's absorption of starches and sugars from food

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Mechanism of alpha-glucosidase

Decreases absorption of starch and disaccharides by inhibiting alpha-glucosidase in the intestine

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Effect on blood sugar

Reduces the rise in blood sugar after meals

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Location of alpha-glucosidase

Intestinal border (the surface of the intestines)

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How alpha-glucosidase works

Blocks an enzyme (alpha-glucosidase) that breaks down starches and sugars

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Long-acting insulin

Insulin that lowers glucose levels steadily over a prolonged period, mimicking the continuous release of insulin in the body.

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Detemir (Levemir)

A long-acting insulin administered by subcutaneous injection only; manufactured by Novo.

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Glargine (Lantus)

A long-acting insulin administered by subcutaneous injection; manufactured by Sanofi; not for IV or IM.

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Bolus insulin

Rapid or regular acting insulin used to control glucose spike after meals, multiple doses needed daily.

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Basal insulin

Intermediate or long acting insulin used for continuous, low-level glucose control, often once a day or twice (morning/bedtime).

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Regular insulin

Rapid-acting insulin used in emergencies, rapidly absorbed to acutely lower blood glucose.

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Insulin Action Times

Describes how long different types of insulin take to work and how long their effect lasts in the body.

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Hypoglycemic symptoms

Symptoms that occur when blood sugar drops too low, such as sweating, palpitations, and shakiness.

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Rapid-Acting Insulin

Insulin types with a very quick onset, acting within 10-15 minutes, peaking in 1 hour, and lasting 2-3 hours.

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Regular Insulin

Rapid-acting type of insulin with an onset of half to one hour, peaking in 2-3 hours, and lasting 5-7 hours, sometimes longer depending on dose.

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NPH Insulin

An intermediate-acting insulin with an onset of 1-2 hours, peaking in 5-8 hours, and lasting 14-18 hours.

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Insulin Duration

Describes how long an insulin type remains effective, measured in hours.

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Insulin Onset

The time it takes for insulin to start working after administration.

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Insulin Peak

The time when the insulin reaches its highest activity level after administration.

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Insulin Usage

The appropriate time of insulin administration relative to meals or other needs.

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Rapid Insulin Types

Includes Humalog, NovoRapid, and Insulin glulisine.

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Sulfonylureas 2nd Gen

Second-generation sulfonylureas (gliclazide and glyburide) stimulate insulin production and secretion from the pancreas.

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Meglitinides (e.g., Repaglinide)

Meglitinides rapidly stimulate insulin secretion, mainly targeting post-meal blood sugar.

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Metformin (Biguanide) Mechanism

Metformin improves insulin effectiveness by reducing the liver's glucose production.

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Sulfonylureas Risk

Glyburide, a sulfonylurea, poses a higher hypoglycemia risk, especially in those with kidney problems or older age.

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Meglitinide Administration

Meglitinides are used immediately prior to eating, taken with the first food bite, and skipped when meals are missed.

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Sulfonylureas (1st Gen)

Older class of drugs that stimulate insulin release from the pancreas, less used due to pharmacokinetics and drug interactions.

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Metformin (Biguanide)

Increases insulin sensitivity, glucose uptake, and decreases gluconeogenesis and glycogenolysis.

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SGLT2 Inhibitors

Increase glucose excretion in the urine by inhibiting the SGLT2 transporter.

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GLP-1 Enhancers

Improve insulin release in response to glucose and suppress glucagon, often used in weight management.

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DPP-4 Inhibitors

Inhibit the DPP-4 enzyme which breaks down incretin hormones, increasing insulin release.

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Thiazolidinediones

Increase insulin sensitivity and lower the blood glucose.

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α-glucosidase Inhibitors

Slow down the breakdown of carbohydrates into glucose, reducing post-meal blood sugar.

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Meglitinides

Stimulate rapid release of insulin from pancreas.

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Metformin Therapeutic Use

First-line treatment for type 2 diabetes, often used in obese patients; improves ovulation by elevating androgen and insulin levels.

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Metformin Side Effects

Common side effects include stomach upset and diarrhea; anorexia, no weight gain.

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Metformin Lactic Acidosis Risk

Lactic acidosis, a serious but rare complication, can occur in patients with kidney or liver problems, excessive alcohol intake, or contrast dye use.

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Metformin Contraindications

Contraindicated in pregnancy, severe kidney problems (CrCl < 30 ml/min), liver impairment, and patients with a prior history of lactic acidosis.

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Metformin Drug Interactions

Alcohol increases the risk of lactic acidosis; potentiates other diabetic drugs and avoid use with radiographic contrast media within 48 hours of each other.

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Study Notes

Insulin and Antidiabetic Drugs

  • Two types of diabetes mellitus exist: type I and type II.
  • Type I diabetes is also known as insulin-dependent diabetes mellitus (IDDM).
  • Type I diabetes usually begins in younger people under 40 and of normal weight.

Hyperglycemia

  • Fasting plasma glucose (FPG) >6.5 mmol/L
  • Symptoms include: polyuria, polydipsia, polyphagia, and fatigue.

Hypoglycemia

  • FPG <4 mmol/L
  • Symptoms include: sweating, shaking, tremor, hungry and palpitation, confusion, disorientation, dizziness.

Normal Blood Sugar Levels (BSL)

  • Fasting blood sugar levels 5 to 6 mmol/L (100 mg/dL)

  • Random blood sugar levels 11 mmol/L

  • Post prandial sugar levels

  • HbA1c: normal is 4 to 6%, measures past three months blood sugar levels.

  • Treatment of diabetes begins if HbA1c >6.5% and FPG >7 mmol.

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Description

Test your knowledge on diabetes management, including types of diabetes, symptoms of hyperglycemia, and treatment options such as DPP-4 inhibitors and thiazolidinediones. This quiz covers key concepts important for healthcare professionals and students in the field of medicine.

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