Diabetes Mellitus Overview and Pathophysiology
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Questions and Answers

What is the primary reason for starting metformin monotherapy at the diagnosis of type 2 diabetes?

  • It is the only medication available.
  • It has no side effects.
  • It significantly increases insulin levels.
  • It blocks gluconeogenesis and is preferred unless contraindicated. (correct)

Which condition would require immediate adjustment of metformin dosage?

  • Uncomplicated hypertension.
  • Renal insufficiency with a GFR <45 ml/min. (correct)
  • Occasional mild hypoglycemia.
  • Slightly elevated blood glucose levels.

When should combination injectable therapy be considered in the management of type 2 diabetes?

  • When A1c is <9%.
  • When RBS is <300 mg/dL.
  • When there are no symptoms present.
  • When A1c is ≥10%, RBS ≥300 mg/dL, or with symptoms of catabolism. (correct)

Which of the following is a treatment goal for adults with diabetes regarding glycemic control?

<p>HbA1c &lt;7.0% is the ideal target for most adults. (D)</p> Signup and view all the answers

What is a major consideration when selecting second-line therapy for a patient with no established ASCVD or CKD?

<p>Minimizing hypoglycemia is a compelling need. (A)</p> Signup and view all the answers

What characterizes Diabetes Mellitus?

<p>Hyperglycemia and relative impairment in insulin secretion (D)</p> Signup and view all the answers

Which of the following is a symptom of hyperglycemia?

<p>Weight loss (D)</p> Signup and view all the answers

In which population is the highest incidence of Type 1 Diabetes Mellitus found?

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

Which laboratory test is preferred for screening Diabetes Mellitus?

<p>Fasting plasma glucose (D)</p> Signup and view all the answers

Which risk factor is NOT considered a contributor to the development of Diabetes Mellitus?

<p>Advanced age over 50 (C)</p> Signup and view all the answers

What is the common pattern of dyslipidemia in individuals with Diabetes Mellitus?

<p>Hypertriglyceridemia and reduced HDL (D)</p> Signup and view all the answers

When should screening for Diabetes Mellitus be initiated according to ADA 2022 recommendations?

<p>At age 35 for all individuals (B)</p> Signup and view all the answers

What is required for confirming the diagnosis of Diabetes Mellitus?

<p>A second test for confirmation unless clear clinical diagnosis is present (A)</p> Signup and view all the answers

What should be done if there are two discordant test results for diabetes?

<p>Repeat the test that is abnormal (C)</p> Signup and view all the answers

What is considered a normal fasting plasma glucose result?

<p>&lt; 100 mg/dL (D)</p> Signup and view all the answers

How often should HbA1c testing be conducted for patients with diabetes?

<p>2-4 times a year (B)</p> Signup and view all the answers

Which of the following is NOT part of the comprehensive care for diabetes patients?

<p>Monthly kidney function tests (B)</p> Signup and view all the answers

What is the significance of performing tests like CBC for diabetes patients?

<p>To check for anemia which can affect HbA1c reliability (C)</p> Signup and view all the answers

Which lifestyle management component is NOT specifically mentioned for diabetes care?

<p>Frequent medical examinations (A)</p> Signup and view all the answers

How is random blood sugar defined regarding time from the last meal?

<p>Without regard to time since last meal (C)</p> Signup and view all the answers

According to the guidelines, how should diabetes-related conditions be managed?

<p>Perform specific tests annually or quarterly as needed (D)</p> Signup and view all the answers

Which medication is known to promote weight gain?

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

What laboratory test should be requested during every follow-up visit for a diabetic patient?

<p>HbA1c (C)</p> Signup and view all the answers

Which class of antidiabetic agents is considered weight-neutral?

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

For which of the following situations should Metformin therapy be considered for the prevention of Type 2 Diabetes Mellitus (T2DM)?

<p>Age under 60 with prior gestational diabetes and a rising HbA1c of 5.8% (B)</p> Signup and view all the answers

What is the duration of action of Rapid-acting Insulin?

<p>30 minutes to 4 hours (C)</p> Signup and view all the answers

Which medication class is associated with hypoglycemia?

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

Which insulin preparation has an onset of action lasting between 2 - 4 hours?

<p>Intermediate-acting Insulin (C)</p> Signup and view all the answers

Which class of diabetes medications promotes weight loss?

<p>GLP-1 receptor agonists (A)</p> Signup and view all the answers

Which of the following therapies is recommended to minimize hypoglycemia in patients with chronic kidney disease (CKD) without albuminuria?

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

What treatment should be preferred for patients with CKD and a history of heart failure (HF) who are at high cardiovascular risk?

<p>SGLT2 inhibitors (SGLT2i) (B)</p> Signup and view all the answers

What is the primary mechanism of action of Sulfonylureas?

<p>Increases insulin secretion (C)</p> Signup and view all the answers

Which factor is important to consider in the choice of first-line therapy for diabetes management?

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

Which side effect is commonly associated with Biguanides?

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

Patients with CKD and albuminuria should preferably receive treatment with which of the following?

<p>SGLT2 inhibitors (SGLT2i) (A)</p> Signup and view all the answers

Which of the following medications belongs to the Thiazolidinediones class?

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

Which of the following statements regarding weight management in diabetes treatment is correct?

<p>GLP-1 receptor agonists (RA) help promote weight loss (C)</p> Signup and view all the answers

What is a known side effect of DPP-IV inhibitors?

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

Which class of diabetes medications is known for causing gastrointestinal symptoms after injection?

<p>GLP-1 agonists (A)</p> Signup and view all the answers

Which medication is primarily an SGLT2 inhibitor?

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

What is a potential risk associated with Canagliflozin?

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

Alpha-glucosidase inhibitors mainly function by inhibiting what?

<p>Intestinal absorption of sugars (C)</p> Signup and view all the answers

Flashcards

Discordant Test Results

When two test results on the same parameter differ significantly.

HbA1c

A blood test measuring average blood sugar levels over several months.

Fasting Plasma Glucose (FPG)

Blood glucose level after an 8-hour fast.

Glycemic Goals

Individualized targets for blood sugar levels.

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Diabetes Self-Management

Techniques and strategies for managing diabetes.

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Diabetes Complications

Potential problems associated with diabetes, such as eye, foot, and kidney damage.

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Annual/Biannual Exams

Medical checkups done once or twice a year, focusing on complications of diabetes.

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Blood Pressure Monitoring

Regularly checking blood pressure to control its level.

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Diabetes Mellitus

A group of metabolic disorders with hyperglycemia as a key feature, involving insulin resistance and impaired insulin secretion.

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Type 1 Diabetes

A type of diabetes with auto-antibodies present and diagnosis following the same criteria as Type 2.

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Type 2 Diabetes

A type of diabetes caused by insulin resistance and relative impairment of insulin secretion.

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Hyperglycemia

High blood sugar levels.

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Risk Factors for Diabetes

Factors increasing the chance of developing diabetes, including family history, obesity, inactivity, race, and specific medical conditions.

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Diagnosis of Diabetes

Confirmed by screening tests, such as fasting plasma glucose, oral glucose tolerance test, and HbA1c.

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Diabetes Screening

Diabetes screening is recommended for individuals over 35, or those with concerning risk factors such as weight and additional risk factors every 3 years, with an earlier screening if applicable due to risk factors.

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Laboratory Diagnosis Criteria

Laboratory tests, such as fasting plasma glucose, oral glucose tolerance test, and HbA1c, confirm the diagnosis of diabetes when symptoms and clinical findings are present.

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Initial T2DM treatment

Diet, exercise, and weight loss are the initial therapy, followed by metformin if no contraindications.

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Metformin Contraindications

Renal insufficiency (GFR <30 mL/min), acidosis, unstable CHF, liver disease, and severe hypoxemia.

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HbA1c target (general)

HbA1c level less than 7.0% for most adults.

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HbA1c for high-risk patients

8% or higher for elderly or individuals with multiple chronic illnesses, and limited daily activities

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Metformin MOA

Blocks gluconeogenesis (the creation of glucose in the body).

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First-line Therapy for Diabetes

Initial treatment approach for diabetes, typically involving metformin and lifestyle modifications. The specific therapy depends on individual factors like comorbidities, patient preferences, cost, and access to care.

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ASCVD/High Risk Diabetes Treatment

For patients with established cardiovascular disease or high risk factors, treatment prioritizes medications like SGLT2 inhibitors and GLP-1 receptor agonists, which have proven benefits in reducing cardiovascular risk and potentially slowing kidney disease progression.

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CKD and Diabetes Management

Treatment for patients with CKD is tailored based on albuminuria presence. For those without albuminuria, minimizing hypoglycemia and weight gain/promoting weight loss is key. For those with albuminuria, SGLT2 inhibitors are strongly recommended due to their proven benefits in slowing kidney disease progression.

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Hypoglycemia: What is it?

A dangerous condition of low blood sugar, characterized by symptoms like sweating, dizziness, confusion, and even loss of consciousness.

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Whipple's Triad

A set of three criteria that helps diagnose hypoglycemia: symptoms of low blood sugar, low blood glucose levels, and improvement of those symptoms after raising blood glucose levels.

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Sulfonylureas

Drugs that lower blood sugar by stimulating the pancreas to release more insulin.

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Biguanides

Drugs that improve insulin sensitivity, making cells more responsive to insulin.

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Thiazolidinediones

Drugs that improve insulin sensitivity by acting on fat cells.

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Alpha-glucosidase inhibitors

Drugs that delay the digestion of carbohydrates, slowing down sugar absorption into the bloodstream.

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DPP-IV Inhibitors

Drugs that enhance the effects of GLP-1, a naturally occurring hormone that stimulates insulin release.

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GLP-1 agonists

Drugs that mimic the action of GLP-1, increasing insulin secretion and slowing down gastric emptying.

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Na-Glucose Transporter-2-inhibitors (SGLT2i)

Drugs that block the reabsorption of sugar in the kidneys, increasing sugar excretion in urine.

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What are the most common side effects of sulfonylureas?

The most common side effects of sulfonylureas are hypoglycemia (low blood sugar) and weight gain.

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Metformin's Role in Prevention

Metformin is considered for preventing type 2 diabetes in people with prediabetes, especially if they have a BMI over 35, are under 60 years old, have a history of gestational diabetes, or have rising HbA1c levels (5.7-6.0%) and fasting blood sugar levels around 100-125 mg/dL.

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Incretins

Incretins are hormones that stimulate insulin release and decrease glucagon secretion, helping to regulate blood sugar levels.

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Rapid-acting Insulin

Rapid-acting insulin works quickly, taking effect within 15 minutes and peaking after 30-90 minutes. It lasts about 2-4 hours, ideal for mealtime coverage.

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GLP-1 Receptor Agonist

GLP-1 Receptor Agonists are medications that mimic the action of GLP-1, helping regulate blood sugar and promoting weight loss.

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Sulfonylurea Effect

Sulfonylureas are a class of diabetes medications that can cause weight gain, unlike GLP-1 RA, SGLT2 inhibitors, and metformin.

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TZD's Role in Weight

Thiazolidinediones (TZD's) are diabetes medications that contribute to weight gain, similar to sulfonylureas and insulin.

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Blood Pressure Diary

A blood pressure diary helps you track your blood pressure over time. This helps you and your doctor understand patterns and make adjustments to your medication or lifestyle.

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Study Notes

Diabetes Mellitus

  • Defined as a group of metabolic disorders characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion.
  • Symptoms include polyuria, polydipsia, weight loss, fatigue, blurred vision, frequent infections, and slow-healing sores.
  • Type 1 diabetes follows the same diagnostic criteria as Type 2, but auto-antibodies are present in Type 1.

Pathophysiology of Type 2 Diabetes

  • Insulin secretion is impaired
  • Beta-cell apoptosis
  • Impaired incretin effect
  • Insulin resistance in adipocytes, liver, and muscle
  • Increased hepatic glucose output
  • Hyperglucagonemia
  • Increased circulating fatty acids
  • Hyperlipidemia

Risk Factors for Diabetes

  • Family history of diabetes
  • Obesity (BMI ≥ 25 kg/m²)
  • Physical inactivity
  • Certain ethnicities (Asian, Asian American, African American, Pacific Islander)
  • History of gestational diabetes (GDM) or large babies ( >4kg)
  • Hypertension (BP ≥ 140/90)
  • Low HDL (<35 mg/dL) and/or high triglycerides (>250 mg/dL)
  • Polycystic ovary syndrome or acanthosis nigricans
  • History of cardiovascular disease

Laboratory Diagnosis

  • Confirmed by various tests:
    • Fasting plasma glucose (preferred)
    • 75g oral glucose tolerance test
    • HbA1c
  • A second test may be required to confirm the diagnosis if there is no immediate confirmation of DM

Clinical Pearls

  • ADA recommends screening individuals > 35 every 3 years, or sooner for those overweight (BMI > 25) with additional risk factors.
  • Repeat abnormal screening tests without delay.
  • If two tests are discordant, repeat the abnormal one.
  • Clinical manifestations, along with abnormal test results, should be considered together to make a conclusive diagnosis.

Guidelines for Ongoing, Comprehensive Medical Care for Patients with Diabetes

  • Individualized glycemic goals and therapeutic plan
  • Self-monitoring of blood glucose (frequency should be individualized)
  • HbA1c testing (2-4 times/year)
  • Lifestyle management (education, nutrition, physical activity, psychosocial care)
  • Diabetic complication management (eye, foot, nerve, kidney exams as needed)
  • Consider antiplatelet therapy.
  • Influenza, pneumococcal, hepatitis B immunizations

Insulin Preparations

  • Rapid-acting: Lispro, Aspart, Glulisine
  • Short-acting: Regular human insulin
  • Intermediate-acting: Isophane (NPH), Human NPH
  • Basal insulin analogs: Glargine, Detemir, and Degludec

Glycemic Management of Type 2 Diabetes

  • Diet, exercise, and weight loss (best initial therapy)
  • Metformin is the preferred initial pharmacologic agent for Type 2.
  • Metformin blocks gluconeogenesis.
  • Choosing second-line therapy depends on factors such as cardiovascular disease or kidney disease. (GLP-1 RA, SGLT2i, DPP-4i, or TZDs).

Treatment Goals for Adults with Diabetes

  • HbA1c <7.0%
  • Pre-prandial capillary plasma glucose 4.4-7.2 mmol/L (80-130 mg/dL)
  • Post-prandial capillary plasma glucose <10 mmol/L (<180 mg/dL)
  • Blood pressure <140/90 mmHg

Adverse Effects of Oral Hypoglycemics/Insulin:

  • Hypoglycemia (Whipple's triad: symptoms of hypoglycemia, low blood glucose, and relief of symptoms after glucose intake).
  • Chronic complications: macrovascular (coronary, peripheral arterial, and cerebrovascular disease); microvascular (retinopathy, nephropathy, neuropathy); others (cataracts, erectile dysfunction, gastroparesis, wound infections).

Clinical Pearls (additional):

  • Dawn phenomenon: Increased blood glucose in the morning due to growth hormone and cortisol secretion.
  • Somogyi effect: A rebound effect from hypoglycemia during the night, causing hyperglycemia in the morning.
  • For non-proliferative retinopathy, prevention is best.
  • Diabetic nephropathy is a leading cause of chronic kidney disease, end-stage renal disease, and kidney replacement therapy.
  • Distal symmetric polyneuropathy is the most common form of diabetic neuropathy.

Other Key Concepts

  • Various medication classes for diabetes management (Sulfonylureas, Biguanides, Thiazolidinediones, Alpha-glucosidase inhibitors, DPP-IV Inhibitors, GLP-1 agonists, SGLT2 inhibitors).
  • MOA's and Side effects of each class of medication

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Diabetes Mellitus Supplemental Notes PDF

Description

This quiz explores the fundamentals of Diabetes Mellitus, including its definitions, symptoms, and risk factors. It also delves into the pathophysiology of Type 2 diabetes, outlining key mechanisms involved in the disease. Test your knowledge on this critical health topic and understand the complexities of diabetes.

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