Podcast
Questions and Answers
Which of the following are examples of fast-acting carbohydrates?
Which of the following are examples of fast-acting carbohydrates?
The ______ of action of insulin is to promote glucose uptake by cells.
The ______ of action of insulin is to promote glucose uptake by cells.
mechanism
Metformin, a biguanide, is contraindicated in patients with renal impairment.
Metformin, a biguanide, is contraindicated in patients with renal impairment.
True
What is the main mechanism of action for sulfonylureas?
What is the main mechanism of action for sulfonylureas?
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Pioglitazone, a thiazolidinedione, can cause heart failure.
Pioglitazone, a thiazolidinedione, can cause heart failure.
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Which class of antidiabetic drugs is known for its ability to delay carbohydrate digestion and absorption, leading to lower postprandial glucose levels?
Which class of antidiabetic drugs is known for its ability to delay carbohydrate digestion and absorption, leading to lower postprandial glucose levels?
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What is the primary mechanism of action for GLP-1 receptor agonists?
What is the primary mechanism of action for GLP-1 receptor agonists?
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Pramlintide, an amylin mimetic, is primarily used in patients with type 2 diabetes.
Pramlintide, an amylin mimetic, is primarily used in patients with type 2 diabetes.
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Which of the following is NOT a common symptom of hypoglycemia?
Which of the following is NOT a common symptom of hypoglycemia?
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What is the recommended A1C target for most patients with diabetes?
What is the recommended A1C target for most patients with diabetes?
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Which of the following thyroid hormones is primarily responsible for regulating metabolism, energy production, and growth?
Which of the following thyroid hormones is primarily responsible for regulating metabolism, energy production, and growth?
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Hypothyroidism is characterized by excessive thyroid hormone levels.
Hypothyroidism is characterized by excessive thyroid hormone levels.
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Levothyroxine (T4) is a synthetic form of thyroid hormone that is converted to T3 in the body.
Levothyroxine (T4) is a synthetic form of thyroid hormone that is converted to T3 in the body.
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What is the main mechanism of action for thionamides, a class of antithyroid drugs?
What is the main mechanism of action for thionamides, a class of antithyroid drugs?
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Which of the following is NOT a common side effect of antithyroid drugs?
Which of the following is NOT a common side effect of antithyroid drugs?
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Propylthiouracil (PTU) is preferred during pregnancy because it has a lower risk of ______ compared to methimazole.
Propylthiouracil (PTU) is preferred during pregnancy because it has a lower risk of ______ compared to methimazole.
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Radioactive iodine (I-131) is a non-invasive treatment that is used to destroy thyroid tissue.
Radioactive iodine (I-131) is a non-invasive treatment that is used to destroy thyroid tissue.
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What is the primary mechanism of action for non-radioactive iodine?
What is the primary mechanism of action for non-radioactive iodine?
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Beta blockers are used to directly reduce thyroid hormone levels.
Beta blockers are used to directly reduce thyroid hormone levels.
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Which of the following is NOT a common symptom of thyroid storm?
Which of the following is NOT a common symptom of thyroid storm?
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Propylthiouracil (PTU) is the primary treatment for thyroid storm.
Propylthiouracil (PTU) is the primary treatment for thyroid storm.
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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)
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Biguanides (e.g., Metformin): Reduce glucose production by the liver, enhance insulin sensitivity.
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Benefits: No risk of hypoglycemia, weight loss.
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Side Effects: Gastrointestinal upset, lactic acidosis (rare but serious).
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Contraindications: Renal impairment, liver disease, alcohol abuse.
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Sulfonylureas (e.g., Glipizide, Glyburide, Glimepiride): Stimulate the pancreas to release more insulin. -Side Effects: Hypoglycemia, weight gain. -Drug Interactions: Alcohol, beta-blockers.
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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.
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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
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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).
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DPP-4 Inhibitors (e.g., Sitagliptin, Saxagliptin, Linagliptin): Inhibit enzyme DPP-4, preventing breakdown of incretin hormones, which help regulate glucose levels.
-Side Effects: Upper respiratory infections, pancreatitis, joint pain. -
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.
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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.
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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.
