Diabetes Mellitus Overview Quiz
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Questions and Answers

Which of the following statements accurately describes the difference in onset between Type 1 and Type 2 Diabetes Mellitus (DM)?

  • Type 1 DM has a sudden onset, while Type 2 DM has a gradual onset. (correct)
  • Type 1 DM typically has a more gradual onset, while Type 2 DM is characterized by a sudden onset.
  • Both Type 1 and Type 2 DM typically have a sudden onset.
  • Both Type 1 and Type 2 DM typically have a gradual onset.

    • What is the primary role of insulin in the body?

  • To increase the levels of glucagon in the bloodstream.
  • To promote the breakdown of stored glycogen in the liver.
  • To facilitate the uptake of glucose from the blood into cells. (correct)
  • To stimulate the production of glucose in the liver.

    • Which of the following is NOT a characteristic commonly associated with Type 1 Diabetes Mellitus?

  • Obesity (correct)
  • Ketoacidosis
  • Low or absent endogenous insulin production
  • Presence of autoantibodies

    • A patient presents with frequent urination, excessive thirst, and unexplained weight loss. Which of the following is the most likely diagnosis?

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

    Which of the following is a key difference between Type 1 and Type 2 Diabetes Mellitus?

    <p>Type 1 DM involves an autoimmune attack on the pancreas, while Type 2 DM involves insulin resistance. (B)</p> Signup and view all the answers

    What is the recommended duration for moderate intensity exercise per week for individuals with diabetes?

    <p>150 minutes (D)</p> Signup and view all the answers

    Which of these is NOT a recommended dietary strategy for individuals with diabetes?

    <p>Increased fat intake (A)</p> Signup and view all the answers

    Which of the following is NOT a triggering factor for smoking relapse?

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

    What is the target BMI range for individuals with diabetes?

    <p>18.5 - 23 kg/m² (C)</p> Signup and view all the answers

    What is the recommended maximum heart rate percentage for moderate intensity exercise?

    <p>50-70% (C)</p> Signup and view all the answers

    What type of diabetes is characterized by the body's immune system attacking its own beta cells, resulting in zero insulin production?

    <p>Type 1 Diabetes Mellitus (T1DM) (A)</p> Signup and view all the answers

    What is the main characteristic of Type 2 Diabetes Mellitus (T2DM) that distinguishes it from Type 1 Diabetes Mellitus (T1DM)?

    <p>A gradual decline in beta cell function with insulin resistance (D)</p> Signup and view all the answers

    Which of the following is NOT a recommended approach for weight reduction in individuals with diabetes?

    <p>Restricting food intake to only fruits and vegetables (A)</p> Signup and view all the answers

    Which of the following is NOT a complication associated with Diabetes Mellitus?

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

    Which of the following is NOT a non-pharmacological treatment option for diabetes?

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

    What is the recommended weight reduction goal for individuals with diabetes over 6 months?

    <p>5-10% (B)</p> Signup and view all the answers

    What is the primary underlying cause of Diabetes Mellitus?

    <p>Elevated blood glucose levels (A)</p> Signup and view all the answers

    Which of the following is NOT a symptom of Diabetes Mellitus?

    <p>High blood pressure (B)</p> Signup and view all the answers

    Which of the following is a risk factor for developing Type 2 Diabetes Mellitus?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary goal of non-pharmacological management of Diabetes Mellitus?

    <p>To reduce the risk of complications (D)</p> Signup and view all the answers

    Which of the following is NOT a classification of antidiabetic drugs?

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

    What is the mechanism of action of Sulphonylureas (SU)?

    <p>Increase insulin production in the pancreas (D)</p> Signup and view all the answers

    Which of the following is NOT a side effect of Sulphonylureas (SU)?

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

    When should Gliclazide MR be taken?

    <p>Immediately before or after breakfast (A)</p> Signup and view all the answers

    What is the recommended dosage for Acarbose?

    <p>50mg or 100mg tablet (C)</p> Signup and view all the answers

    Which of the following is NOT a contraindication for Alpha-glucoxidase Inhibitors (AGI)?

    <p>Basal-bolus insulin regimen (B)</p> Signup and view all the answers

    What is the mechanism of action of Dipeptidyl-peptidase 4 Inhibitors (DPP4-i)?

    <p>Inhibit the breakdown of incretin secreted during meals (B)</p> Signup and view all the answers

    Which of the following drugs is an example of a Dipeptidyl-peptidase 4 Inhibitor (DPP4-i)?

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

    Which of the following antidiabetic drugs can be combined with any other antidiabetic agent?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is NOT a side effect associated with Metformin?

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

    Which of the following is NOT an example of a Glucagon-like Peptide-1 Receptor Agonist?

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

    Which of the following formulations of Metformin is recommended for patients experiencing significant gastrointestinal side effects?

    <p>Extended-release tablet (A)</p> Signup and view all the answers

    What is the potential benefit of using a DPP4-i like Sitagliptin?

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

    In which of the following patient populations is Metformin contraindicated due to a potential risk of lactic acidosis?

    <p>Patients with severe renal impairment (D)</p> Signup and view all the answers

    Metformin exerts its antidiabetic action by which of the following mechanisms?

    <p>Reducing insulin resistance in peripheral tissues (D)</p> Signup and view all the answers

    Which of the following is a common side effect associated with Glucagon-like Peptide-1 Receptor Agonists?

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

    What is the main way Sodium-Glucose Transporter 2 inhibitors (SGLT2-i) lower blood glucose?

    <p>Increase glucose excretion in urine (C)</p> Signup and view all the answers

    Which of the following statements regarding Metformin is TRUE?

    <p>Metformin is safe for use during pregnancy and breastfeeding. (C)</p> Signup and view all the answers

    Which of the following medications is available in an immediate release tablet formulation?

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

    Which of the following is the recommended dosing strategy for Metformin to minimize side effects?

    <p>Start with a low dose and gradually increase as tolerated. (C)</p> Signup and view all the answers

    What counseling points are common to DPP4-i and GLP-1 RA?

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

    What is the maximum daily dose of Metformin that is generally considered to be effective for glycemic control?

    <p>2000mg (D)</p> Signup and view all the answers

    Which of the following is considered a cardio-protective medication?

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

    Which of the following is a potential long-term side effect of Metformin therapy?

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

    Which medication is licensed for weight reduction?

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

    Flashcards

    Diabetes Mellitus (DM)

    A group of diseases characterized by high blood sugar levels over a prolonged period.

    Type 1 Diabetes Mellitus (T1DM)

    An autoimmune condition where the pancreas produces little or no insulin.

    Type 2 Diabetes Mellitus (T2DM)

    A condition where the body becomes resistant to insulin or doesn't produce enough.

    Ketoacidosis

    A serious complication of diabetes that occurs when the body produces high levels of ketones due to low insulin.

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    Endogenous Insulin in T1DM vs T2DM

    T1DM has zero or low endogenous insulin; T2DM has insufficient or resistant insulin.

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    Non-Pharmacological Treatments

    Lifestyle changes like diet and exercise to manage DM.

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    Low Calorie Diet

    A dietary approach to reduce overall calorie intake for weight management.

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    Physical Activity Recommendations

    Aim for 150 minutes of moderate exercise weekly to manage DM.

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    Weight Management Goals

    Achieve a normal BMI (18.5-23 kg/m²) and aim for a 5-10% weight reduction.

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    Symptoms of Diabetes Mellitus

    Common symptoms include increased thirst, frequent urination, and fatigue.

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    Sulphonylureas (SU)

    Antidiabetic drugs that increase insulin production in the pancreas.

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    Common side effects of SU

    Most common adverse effects include hypoglycemia and weight gain.

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    Gliclazide dosage

    Gliclazide should be taken 30 minutes before meals, or immediately for MR.

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    Alpha-glucosidase Inhibitors (AGI)

    Drugs like Acarbose that delay carbohydrate digestion and slow glucose absorption.

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    Common side effects of AGI

    Side effects include bloating, abdominal discomfort, diarrhea, and flatulence.

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    Acarbose administration

    Must be taken with the first mouthful of food for effectiveness.

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    Dipeptidyl-peptidase 4 Inhibitors (DPP4-i)

    Drugs that inhibit the breakdown of incretin hormones during meals.

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    Combination with other drugs

    Both SU and AGI can be combined with other antidiabetic medications.

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    Biguanides

    A class of antidiabetic drugs that reduce glucose production and increase insulin sensitivity.

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    Metformin

    The most common biguanide, used to reduce gluconeogenesis and increase insulin sensitivity.

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    Mechanism of Metformin

    Reduces gluconeogenesis, increases insulin sensitivity, and reduces glucose absorption in intestines.

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    Common Side Effects of Metformin

    Nausea, vomiting, diarrhea, gastrointestinal discomfort stemming from its action.

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    Long-term effects of Metformin

    Long-term use may cause reduced B12 absorption potentially leading to peripheral neuropathy.

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    Lactic Acidosis

    Serious condition caused by Metformin accumulation in renally impaired patients, leading to high lactate levels.

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    Immediate vs. Extended Release Metformin

    Metformin is available as immediate and extended-release formulations with various strengths.

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    Counseling Points for Metformin

    Take with meals to minimize side effects; swallow XR whole and take after dinner.

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    Types of DM

    Includes Type 1, Type 2, Gestational, and Idiopathic Diabetes Mellitus.

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    Symptoms of DM

    Common symptoms include increased thirst, frequent urination, and fatigue.

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    Risk Factors for DM

    Includes obesity, physical inactivity, family history, and age.

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    Complications of DM

    Can lead to heart disease, kidney damage, nerve damage, and vision problems.

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    Incretin Functions

    Increase insulin secretion, reduce glucagon secretion, slow gastric emptying, and promote satiety.

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    DPP4 Inhibitors

    Dipeptidyl-peptidase 4 Inhibitors inhibit the breakdown of incretins, improving blood sugar control.

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    GLP-1 Agonists

    Agonists that mimic incretin effects, increasing insulin and reducing glucagon.

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    Side Effects of GLP-1 Agonists

    Common side effects include nausea, vomiting, diarrhea, and weight loss.

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    SGLT2 Inhibitors

    Inhibit glucose reabsorption in kidneys, increasing glucose excretion in urine.

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    Risks of SGLT2 Inhibitors

    Increased risk of urinary tract infections and dehydration.

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    Formulations of DPP4 Inhibitors

    Available as immediate release tablets in varying mg strengths.

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    Counseling for GLP-1 Agonists

    Counsel patients about injection techniques, nausea, and vomiting management.

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    Study Notes

    Diabetes Mellitus Overview

    • Diabetes mellitus (DM) is a chronic disease characterized by elevated blood glucose levels, leading to damage to organs like the heart, blood vessels, eyes, kidneys, and nerves.
    • Types of DM include Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), Gestational Diabetes Mellitus (GDM), and Idiopathic Diabetes Mellitus.

    Objectives of the Lecture

    • Students should understand the definition and types of DM.

    • Students should differentiate between the pathophysiology and features of T1DM and T2DM.

    • Students should identify the symptoms of DM.

    • Students should know the risk factors and diagnosis of DM.

    • Students should identify complications of DM.

    • Students should identify non-pharmacological treatment of DM.

    • Students should differentiate antidiabetic drugs (classifications, mechanisms of action, side effects, generic and trade names).

    • Students should understand general information regarding DM management.

    Pathophysiology of T1DM and T2DM

    • T1DM: Characterized by an autoimmune reaction where the body's immune system attacks and destroys insulin-producing beta cells in the pancreas, resulting in little to no insulin production.
    • T2DM: Characterized by a progressive decline in beta-cell function and/or insulin resistance, where the body's cells do not respond properly to insulin.

    Features of T1DM & T2DM

    • Onset: T1DM - sudden, T2DM - gradual

    • Age of Onset: T1DM - any age, mostly young, T2DM - mostly in adults

    • Body Type: T1DM - thin or normal, T2DM - often obese

    • Ketoacidosis: T1DM - common, T2DM - rare

    • Autoantibodies: T1DM - usually present, T2DM - absent

    • Endogenous Insulin: T1DM - zero/low, T2DM - insufficient/resistance

    Symptoms of Diabetes

    • Blurred vision
    • Nausea
    • Sudden weight loss
    • Wounds that won't heal
    • Frequent urination
    • Always tired
    • Always thirsty
    • Numbness/tingling in hands or feet
    • Always hungry

    Risk Factors and Diagnosis of DM

    • Risk factors: increasing age, obesity, history of cardiovascular disease, GDM, PCOS, mental health conditions, family history of DM, smoking, specific ethnicities, physical inactivity, typical medication use.
    • Diagnosis: Confirm diagnosis is in symptomatic or asymptomatic individuals with one or two abnormal values. HbA1c ≥ 6.3%, Fasting venous plasma glucose ≥ 7.0mmol/L (8 hours fasting), and random venous plasma glucose ≥ 11.1mmol/L.

    Non-Pharmacological Treatment of DM

    • Diet: Low calorie diet, reduce carbohydrate intake, avoid snacking, weight reduction for overweight.
    • Weight reduction: Monitor body weight regularly, aim for 5-10% weight loss in 6 months, low calorie diet increase physical activity, intermittent fasting.
    • Physical activity: Aim 150 minutes/week moderate intensity exercise, moderate exercise.
    • Smoking cessation: Set quit date, Recognize triggering factors, seek support

    Acute Complications of DM

    • Hypoglycemia: Low blood sugar caused by excessive insulin, skipped meals, or vigorous exercise. Symptoms include Shakiness, sweating, confusion, rapid heartbeat, seizures, loss of consciousness.
    • Hyperglycemia: High blood sugar due to insufficient insulin or illness (stress). Symptoms include Increased thirst, frequent urination, fatigue, blurred vision. Diabetic ketoacidosis (DKA): Excess ketone buildup in the blood, leading to acidity. Symptoms include Nausea, vomiting, Fruity-smelling breath, abdominal pain, confusion or coma. Hyperosmolar hyperglycemic state (HHS): Extremely high blood sugar without significant ketone buildup (common in Type 2 diabetes). Symptoms including severe dehydration, extreme thirst, confusion, or coma.

    Chronic Complications of Diabetes

    • Macrovascular Disease: damage to large blood vessels increases the risk of heart disease, heart attacks, and other cardiovascular problems, damage to blood vessels in the brain can lead to ischemic or hemorrhagic strokes, and Peripheral Arterial Disease (PAD) - narrowing of the arteries in the legs and feet due to plaque buildup, leading to poor circulation, pain, and increased risk of amputation.
    • Microvascular Disease: Diabetic nephropathy =damage to the small blood vessels in the kidneys leading to dysfunction or failure.
    • Diabetic Retinopathy: damage to small blood vessels in the retina, leading to vision loss or blindness.
    • Diabetic Neuropathy: damage to the small blood vessels that supply nerves, leading to nerve damage (especially in the feet and hands).

    Antidiabetic Drugs

    • Biguanides: Metformin (Glucophage®), reduce gluconeogenesis (production of glucose from glycogen) increase insulin sensitivity in cells, reduce absorption of glucose in small intestines. Side effects – Nausea, vomiting, diarrhea, G1 discomfort. Formulations: immediate release and extended-release tabs.
    • Sulphonylureas (SU): Gliclazide (Diamicron®), increase insulin production in pancreas. Side effects: hypoglycemia, and weight gain. Formulations: Immediate and extended-release tabs. Counseling Points: taken with meals, adjust dose gradually.
    • Alpha-glucosidase Inhibitors (AGI): Acarbose (Glucobay®), slows down glucose absorption in small intestine, delay digestion of carbohydrates. Side effects: bloating, abdominal discomfort, diarrhea, flatulence. Formulations: immediate-release chewable tablet.
    • Dipeptidyl-peptidase 4 Inhibitors (DPP4-i): Sitagliptin, Vildagliptin, Linagliptin, inhibits the breakdown of incretins, increase insulin secretion, reduce glucagon secretion, slows gastric emptying. Side effects: GI discomfort, diarrhea, hypoglycemia. Formulations: Immediate release tablet.
    • Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RA): Exenatide, Liraglutide, Lixisenatide, Dulaglutide, Semaglutide, mimicking effects of incretins, increase insulin secretion, reduce glucagon secretion, slows gastric emptying, promotes satiety. Side effects: nausea, vomiting, diarrhea, weight loss. Formulations: injection. Counseling Points: common side effects, counseling on injection techniques.
    • Sodium-Glucose Transporter 2 Inhibitors (SGLT-2i): Empagliflozin, Dapagliflozin, Canagliflozin, selectively inhibits the SGLT-2 protein, decrease glucose reabsorption, increase glucose excretion in urine. Side effects: increased risk of uti, dehydration, hypotension. Formulas, immediate-release tablets. Counseling Points: increase water intake, proper hygiene, postural hypotension.

    Combination Antidiabetics Drugs

    • Glucovance, Janumet, Galvusmet, Xigduo, Invokamet, Glyxambi, Kombiglyze XR. These are combinations of different types of antidiabetic drugs.

    Insulin

    • Mechanism of action: facilitate glucose uptake by body cells.
    • Side effects: Hypoglycemia, weight gain, lipodystrophy.
    • Formulations: injection. Strengths: 3ml of 1000U/ml and 4.5ml of 3000U/ml.

    Types of Insulin

    • Short-acting, intermediate-acting, long-acting, premixed, rapid-acting analogs. Each has its onset, peak, and duration of action.

    Insulin Regimen

    • Basal-bolus regimen: 1x long-acting (night) for basal coverage, 3x rapid-acting before meals to manage post-meal blood sugar spikes.

    Counseling Points for Insulin

    • Counseling on injection techniques, site rotation to reduce lipodystrophy, rotate injection site, storage. General information: can be combined with other agents except sulphonylureas, and safe pregnancy.

    General Information for DM

    • Management of Hypoglycemia, Management of Hyperglycemia, counseling points for particular drugs.

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    Description

    Test your knowledge on the differences between Type 1 and Type 2 Diabetes Mellitus, including symptoms, management strategies, and exercise recommendations. This quiz covers essential information about insulin, dietary guidelines, and more for individuals living with diabetes.

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