Diabetes Mellitus Overview and Pathophysiology
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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.</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.</p> Signup and view all the answers

    What characterizes Diabetes Mellitus?

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

    Which of the following is a symptom of hyperglycemia?

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

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

    <p>Scandinavia</p> Signup and view all the answers

    Which laboratory test is preferred for screening Diabetes Mellitus?

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

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

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

    What is considered a normal fasting plasma glucose result?

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

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

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

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

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

    Which medication is known to promote weight gain?

    <p>Insulin</p> Signup and view all the answers

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

    <p>HbA1c</p> Signup and view all the answers

    Which class of antidiabetic agents is considered weight-neutral?

    <p>DPP-4 inhibitors</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%</p> Signup and view all the answers

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

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

    Which medication class is associated with hypoglycemia?

    <p>Insulin</p> Signup and view all the answers

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

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

    Which class of diabetes medications promotes weight loss?

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

    What is the primary mechanism of action of Sulfonylureas?

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

    Which side effect is commonly associated with Biguanides?

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

    Which of the following medications belongs to the Thiazolidinediones class?

    <p>Pioglitazone</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</p> Signup and view all the answers

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

    <p>Hypersensitivity</p> Signup and view all the answers

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

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

    Which medication is primarily an SGLT2 inhibitor?

    <p>Canagliflozin</p> Signup and view all the answers

    What is a potential risk associated with Canagliflozin?

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

    Alpha-glucosidase inhibitors mainly function by inhibiting what?

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

    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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    Related Documents

    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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