Diabetes Mellitus and Insulin Therapy

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Questions and Answers

Which of the following are examples of fast-acting carbohydrates?

Fruit juice (correct)

Glucose tablets (correct)

Sugar or honey (correct)

Hard candies (correct)

The ______ of action of insulin is to promote glucose uptake by cells.

mechanism

Metformin, a biguanide, is contraindicated in patients with renal impairment.

True

What is the main mechanism of action for sulfonylureas?

They stimulate the pancreas to release more insulin. Signup and view all the answers

Pioglitazone, a thiazolidinedione, can cause heart failure.

True Signup and view all the answers

Which class of antidiabetic drugs is known for its ability to delay carbohydrate digestion and absorption, leading to lower postprandial glucose levels?

Alpha-glucosidase inhibitors Signup and view all the answers

What is the primary mechanism of action for GLP-1 receptor agonists?

They mimic the incretin hormone GLP-1, which increases insulin secretion and slows gastric emptying. Signup and view all the answers

Pramlintide, an amylin mimetic, is primarily used in patients with type 2 diabetes.

False Signup and view all the answers

Which of the following is NOT a common symptom of hypoglycemia?

Increased appetite Signup and view all the answers

What is the recommended A1C target for most patients with diabetes?

Less than 7% Signup and view all the answers

Which of the following thyroid hormones is primarily responsible for regulating metabolism, energy production, and growth?

Thyroxine (T4) Signup and view all the answers

Hypothyroidism is characterized by excessive thyroid hormone levels.

False Signup and view all the answers

Levothyroxine (T4) is a synthetic form of thyroid hormone that is converted to T3 in the body.

True Signup and view all the answers

What is the main mechanism of action for thionamides, a class of antithyroid drugs?

They inhibit thyroid hormone synthesis by blocking the enzyme thyroid peroxidase. Signup and view all the answers

Which of the following is NOT a common side effect of antithyroid drugs?

Hypotension Signup and view all the answers

Propylthiouracil (PTU) is preferred during pregnancy because it has a lower risk of ______ compared to methimazole.

teratogenic effects Signup and view all the answers

Radioactive iodine (I-131) is a non-invasive treatment that is used to destroy thyroid tissue.

True Signup and view all the answers

What is the primary mechanism of action for non-radioactive iodine?

It inhibits thyroid hormone release and synthesis. Signup and view all the answers

Beta blockers are used to directly reduce thyroid hormone levels.

False Signup and view all the answers

Which of the following is NOT a common symptom of thyroid storm?

Hypoglycemia Signup and view all the answers

Propylthiouracil (PTU) is the primary treatment for thyroid storm.

False Signup and view all the answers

Study Notes

Diabetes Mellitus

Chronic disorder with abnormal carbohydrate metabolism
Characterized by either insufficient insulin production (Type 1 DM) or insulin resistance (Type 2 DM)
Long-term complications include macrovascular (heart disease, stroke) and microvascular (retinopathy, nephropathy, neuropathy) issues.

Insulin Therapy

Mechanism of Action: Promotes glucose uptake by cells, stores glucose in the liver, and prevents fat and protein breakdown.
Rapid-acting: (e.g., Lispro, Aspart, Glulisine): Onset 10-30 min, peak 0.5-3 hr, duration 3-6 hr.
Short-acting: (e.g., Regular insulin): Onset 30-60 min, peak 1-5 hr, duration 6-10 hr.
Intermediate-acting: (e.g., NPH insulin): Onset 1-2 hr, peak 6-14 hr, duration 16-24 hr.
Long-acting: (e.g., Glargine, Detemir): Onset 1-2 hr, no peak, duration 24 hr or more.
Ultra-long acting: (e.g., Degludec): Duration over 42 hours, no peak.
Administered subcutaneously or intravenously (only regular insulin).
Sites should be rotated to prevent lipohypertrophy.
Side effects include hypoglycemia, weight gain, and allergic reactions.
Management and dosage are individualized based on blood glucose monitoring.

Rule of 15

Consume 15 grams of fast-acting carbohydrates (e.g., 4 glucose tablets, 4 ounces fruit juice, 1 tablespoon sugar/honey, 6-7 hard candies)
Wait 15 minutes, and recheck blood glucose level.
Repeat process if blood glucose is still low (below 70mg/dL or 3.9 mmol/L)
After blood glucose returns to normal, eat a small snack with protein and complex carbohydrates to stabilize blood sugar.

Oral Antidiabetic Drugs (Type 2 DM)

Biguanides (e.g., Metformin): Reduce glucose production by the liver, enhance insulin sensitivity.
Benefits: No risk of hypoglycemia, weight loss.
Side Effects: Gastrointestinal upset, lactic acidosis (rare but serious).
Contraindications: Renal impairment, liver disease, alcohol abuse.
Sulfonylureas (e.g., Glipizide, Glyburide, Glimepiride): Stimulate the pancreas to release more insulin. -Side Effects: Hypoglycemia, weight gain. -Drug Interactions: Alcohol, beta-blockers.
Meglitinides (e.g., Repaglinide, Nateglinide): Similar to sulfonylureas, but shorter acting. -Administration: Take before meals to prevent postprandial hyperglycemia. -Side Effects: Hypoglycemia (less risk than sulfonylureas), weight gain.
Thiazolidinediones (e.g., Pioglitazone, Rosiglitazone): Reduce insulin resistance by increasing glucose uptake in muscles and adipose tissue.

-Side Effects: Fluid retention, heart failure, bladder cancer (pioglitazone), fractures in women. -Monitoring: Liver function tests, heart function
Alpha-Glucosidase Inhibitors (e.g., Acarbose, Miglitol): Delay carbohydrate digestion and absorption in intestine, lowering postprandial glucose. -Side Effects: Flatulence, cramps, diarrhea, liver dysfunction (acarbose).
DPP-4 Inhibitors (e.g., Sitagliptin, Saxagliptin, Linagliptin): Inhibit enzyme DPP-4, preventing breakdown of incretin hormones, which help regulate glucose levels.
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 -Side Effects: Upper respiratory infections, pancreatitis, joint pain.
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SGLT-2 Inhibitors (e.g., Canagliflozin, Dapagliflozin, Empagliflozin): Increase glucose excretion through the urine by inhibiting glucose reabsorption in the kidneys.

-Benefits: Weight loss, reduced blood pressure, cardiovascular benefits. -Side Effects: Genital infections, UTIs, dehydration, ketoacidosis.
GLP-1 Receptor Agonists (e.g., Exenatide, Liraglutide, Dulaglutide): Mimic the incretin hormone GLP-1. -Administration: Subcutaneous injection -Side Effects: Nausea, vomiting, weight loss, pancreatitis.
Amylin Mimetics (e.g., Pramlintide): Reduces postprandial glucose by slowing gastric emptying and suppressing glucagon secretion. -Administration: Subcutaneous injection, typically used in Type 1 and insulin-dependent Type 2 DM, -Side Effects: Hypoglycemia (especially with insulin), nausea

Hypoglycemia Management

Mild: 15-20g of fast-acting carbohydrates
Severe: Glucagon injection or IV dextrose for unconscious patients

Monitoring and Patient Education

Self-monitoring of blood glucose
Importance of lifestyle changes (diet, exercise)
Recognize symptoms of hyperglycemia and hypoglycemia.
Proper insulin injection technique and site rotation.

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Description

This quiz covers key concepts about Diabetes Mellitus, including its types, causes, and long-term complications. Additionally, it delves into various insulin therapies, their mechanisms, and classifications based on duration and action. Test your knowledge on this essential topic in diabetes management.