Diabetes Mellitus Overview Quiz

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Questions and Answers

What is a common outcome of untreated diabetes mellitus?

Enhanced immune response

Heart disease (correct)

Sharp vision

Increased energy levels

Which type of diabetes is characterized by a lack of insulin production?

Prediabetes

Type 1 Diabetes Mellitus (correct)

Gestational Diabetes

Type 2 Diabetes Mellitus

What percentage of the population has Type 2 Diabetes Mellitus?

About 10%

About 50%

About 90% (correct)

About 25%

What is the primary medication used for managing gestational diabetes?

Insulin Signup and view all the answers

What does a HbA1c level greater than 6.5% indicate?

Diabetes Signup and view all the answers

Which of the following symptoms is NOT associated with diabetes mellitus?

Sharp memory Signup and view all the answers

Which condition results from the resistance of many tissues to insulin?

Type 2 Diabetes Mellitus Signup and view all the answers

What is a key characteristic of diabetic ketoacidosis (DKA)?

Lack of insulin production Signup and view all the answers

What is the primary action of recombinant human insulins?

They function as a substitute for endogenous insulin. Signup and view all the answers

What distinguishes rapid-acting insulins from other types?

They start working within 10-15 minutes. Signup and view all the answers

Which type of insulin is characterized by a cloudy appearance?

Intermediate-acting insulin. Signup and view all the answers

What is the typical duration of action for short-acting insulins?

6-7 hours. Signup and view all the answers

What is one component of Basal Bolus Insulin Therapy (BBIT)?

Basal insulin, short-acting insulin, and correction insulin. Signup and view all the answers

How does long-acting insulin function compared to other types?

It has no pronounced peak and lasts up to 24 hours. Signup and view all the answers

What is the recommended target blood sugar range as per the Diabetes Canada guidelines?

5-10 mmol/L. Signup and view all the answers

What is the function of 'correction insulin' in BBIT?

To lower blood sugar levels when they are high. Signup and view all the answers

What is a key feature of combination insulin products?

They come premixed in one solution. Signup and view all the answers

When are rapid-acting insulins typically administered?

With each meal. Signup and view all the answers

What is the primary feature of Type 2 Diabetes Mellitus?

Insulin deficiency and/or resistance Signup and view all the answers

Which of the following is a common complication of untreated diabetes mellitus?

Heart disease Signup and view all the answers

What does the presence of a HbA1c level over 6.5% indicate?

Diabetes diagnosis Signup and view all the answers

Which type of diabetes requires exogenous insulin for management?

Type 1 Diabetes Mellitus Signup and view all the answers

What is a key characteristic of gestational diabetes?

It typically resolves after pregnancy. Signup and view all the answers

Which of the following is NOT a symptom of diabetes mellitus?

Vision improvement Signup and view all the answers

What is the role of oral antihyperglycemic agents in Type 1 Diabetes Mellitus treatment?

They can be used as adjunctive agents. Signup and view all the answers

Which testing method is used to measure the average blood glucose over the past three months?

HbA1c test Signup and view all the answers

What is the primary function of rapid-acting insulins?

To control postprandial blood sugar spikes Signup and view all the answers

What characterizes long-acting insulins?

They have no pronounced peak and last for 24 hours. Signup and view all the answers

Which of the following is a component of Basal Bolus Insulin Therapy?

Basal insulin Signup and view all the answers

How long does the action of short-acting insulins typically last?

6-7 hours Signup and view all the answers

What is the onset time for rapid-acting insulin analogues?

10-15 minutes Signup and view all the answers

What type of insulin is represented by the trade name Humulin N?

Intermediate-acting insulin Signup and view all the answers

What is the peak action time for insulin lispro?

1-1.5 hours Signup and view all the answers

Which combination of insulins is premixed for convenience?

Insulin regular 30% and NPH 70% Signup and view all the answers

What is the treatment goal for blood glucose levels in diabetes management?

Achieve regular levels between 5-10 mmol/L Signup and view all the answers

What is the duration of action for insulin regular (Humulin R)?

6-7 hours Signup and view all the answers

Which of the following statements is true regarding Type 2 Diabetes Mellitus?

It is associated with insulin resistance and deficiency. Signup and view all the answers

What is a significant risk factor for developing type 2 diabetes among Indigenous populations?

Higher-than-average likelihood compared to the general population. Signup and view all the answers

What role does HbA1c serve in diabetes management?

It measures average blood glucose levels over three months. Signup and view all the answers

Which of the following symptoms is commonly associated with untreated diabetes mellitus?

Frequent urination. Signup and view all the answers

What is a common complication associated with both Type 1 and Type 2 Diabetes Mellitus?

Diabetic ketoacidosis (DKA). Signup and view all the answers

What is the main treatment approach for managing gestational diabetes?

Lifestyle changes and regular monitoring. Signup and view all the answers

What does extreme fatigue in individuals with diabetes indicate?

Poorly managed blood glucose levels. Signup and view all the answers

Which of the following testing methods assesses the average blood glucose over the past three months?

HbA1c test. Signup and view all the answers

What is the duration of action for rapid-acting insulin analogues?

3-5 hours Signup and view all the answers

Which type of insulin has an onset time of 1-3 hours?

Intermediate-acting insulin Signup and view all the answers

Which insulin is characterized by its clear, colorless solution and has no pronounced peak?

Insulin glargine Signup and view all the answers

What percentage of the meal-time insulin does Novolin 30/70 contain of regular insulin?

30% Signup and view all the answers

Which of the following statements accurately describes short-acting insulins?

Onset is 30-60 minutes and duration is 6-7 hours. Signup and view all the answers

What is the primary purpose of using basal bolus insulin therapy (BBIT)?

To achieve good glycemic control Signup and view all the answers

Which class of insulin is used primarily for basal therapy and has a duration around 24 hours?

Long-acting insulin Signup and view all the answers

What is the target blood glucose range in Basal Bolus Insulin Therapy?

5-10 mmol/L Signup and view all the answers

What is the unique feature of combination insulin products?

They contain both basal and bolus insulin in one solution. Signup and view all the answers

Study Notes

Drugs for Diabetes Mellitus

Objectives include reviewing diabetes incidence and causes, insulin types and administration, mechanisms of action, adverse effects and interactions of diabetes medications, and client care issues related to insulins and oral medications.
422 million people worldwide have diabetes (WHO).
In Canada, over 9 million people live with diabetes or prediabetes.
Indigenous Canadians are 3-5 times more likely than the general population to develop type 2 diabetes.
Untreated diabetes can lead to heart disease, kidney disease, eye disease, erectile dysfunction, nerve damage, immunosuppression, and poor wound healing.
Symptoms include unusual thirst, frequent urination, weight change, extreme fatigue, blurred vision, frequent infections, slow-healing cuts/bruises, tingling/numbness in hands/feet, and erectile difficulties. Many people with type 2 diabetes don't experience any symptoms.
Diabetes Canada provides guidelines for healthcare providers and patients.
Two main types are type 1 (~10%) and type 2 (~90%), and gestational diabetes. Other forms are also possible like drug-induced.
Type 1 diabetes involves a lack of insulin production or defective insulin production demanding exogenous insulin. Complications include retinopathy, nephropathy, and neuropathy. Diabetic ketoacidosis (DKA) is also associated. Insulin is the absolute requirement for drug therapy; some oral agents may be used as adjunctive therapy.
Type 2 diabetes is the most common type (90% of cases), caused by insulin deficiency and/or resistance. Many tissues are resistant to insulin, often due to reduced insulin receptors or lessened receptor responsiveness.
Gestational diabetes is high blood glucose during pregnancy that resolves after delivery. Insulin is usually the medication of choice, but metformin may also be used.
Testing for diabetes includes blood glucose measurement, glucose tolerance testing, and measuring HbA1c (glycated hemoglobin). HbA1c measures average blood glucose over 3 months. Non-diabetic levels are typically 4-5.9%, while diabetic levels are >6.5%. Blood glucose treatment targets are usually 5-10 mmol/L.
Diabetes Canada guidelines suggest an A1C target of ≤7% for most patients with type 1 and type 2 diabetes.
Treatment of diabetes includes insulins (recombinant human insulins), non-insulin oral and injectable drugs. These drugs target different aspects of glucose control, such as increasing insulin production, improving insulin sensitivity, altering glucose absorption/excretion, etc.
Insulins come in various types (rapid-acting, short-acting, intermediate-acting, and long-acting). Time frames of action, onset, peak and duration, determine timing of administration. Specific examples are included for different types (e.g., insulin lispro, insulin aspart, insulin glargine, insulin detemir, insulin regular, NPH, etc).
Medication action sites vary. For example, Biguanides like metformin act on the liver to reduce glucose production.
Important client care aspects for insulins include correct route, type, timing, and dosage, and double-checking orders with another nurse. Specific oral drugs may have different administration schedules

Medication Sites of Action

Various medications act on different organs. Biguanides affect the liver, muscle and fat cells involve insulin and thiazolidinediones, pancreas involves DPP-4 inhibitors, glinides, sulfonylureas, and injectable hormones, and intestines involve alpha-glucosidase inhibitors and sometimes injectable hormones. Specific sites of action are mentioned for various drug types.

Insulins

Function as substitutes for endogenous hormones, mirroring the effects of normal, endogenous insulin.
Improves the diabetic's ability to absorb glucose into cells, to make proteins and triglycerides, to convert glucose into glycogen in the liver, and to convert glucose to fatty acids in adipose tissue.

Types of Insulins

Rapid-acting, short-acting, intermediate-acting, and long-acting insulins each have distinct onset, peak, and duration profiles impacting when they are administered. Specific examples, timing details and administration methods are detailed.

Human-Based Insulins

Characteristics of each type of insulin, like onset, peak, and duration, are crucial.
Diabetes Canada suggests using basal and rapid-acting insulins to control blood glucose. Specific examples (e.g., insulin lispro, insulin aspart, insulin glargine, insulin detemir, insulin regular, NPH) and their characteristics, plus example dosages and routes are included.

Combination Insulin Products

Some insulins are premixed (example: 30% regular and 70% NPH) and this simplifies dosing. Specific examples are given like Novolin 30/70 etc. Further information on combined products is available.

Basal Bolus Insulin Therapy (BBIT)

Involves using basal (long-acting) insulin, bolus (short-acting/mealtime) insulin, and correction insulin.
The goal is to maintain blood glucose levels in a target range of 5-10 mmol/L. Strategies and steps for implementing this therapy effectively are mentioned.

Too Much Insulin (Hypoglycemia)

Hypoglycemia warning signs include an alert value of <3.9 mmol/L. Levels 2 and 3 require additional assistance. Issues include CNS effects and SNS activation (giving initial symptoms). Severe cases may result in coma and death.
Symptoms of hypoglycemia include trembling, palpitations, sweating, anxiety, hunger, nausea and tingling. Specific examples and treatment steps (e.g., glucose tablets or juice) are included.

Adverse Effects of Insulin

Detailed description of both adrenergic (autonomic) symptoms and neuroglycopenic symptoms. Specific examples of adverse effects for insulin are included.

Interactions with Insulins

Several medications can either increase or reduce the effect of insulins on blood glucose levels including beta blockers, alcohol, glucocorticoids, and diuretics. Specific examples of interactions and their effects are given (e.g., beta blockers masking hypoglycemia symptoms). Interactions noted include those between insulin and other drugs.

Oral and Other Injectable Drugs for Diabetes

Oral drugs aim to lower blood glucose levels in type 2 diabetes, used alone or with other agents, in addition to diet and lifestyle changes. Detailed examples of specific drug classes, e.g., Metformin, Sulphonylureas and their roles in managing blood glucose are included.

Diabetes Drugs

Different classes of diabetes medications have different actions like increasing insulin secretion (Insulin secretagogues - e.g. Sulphonylureas, Meglitinides), improving insulin sensitivity (e.g. Biguanides and Thiazolidinediones, DPP-4 Inhibitors), altering glucose absorption/excretion (e.g., alpha-glucosidase inhibitors), and more. Specific examples are included (e.g., metformin, glyburide). Drug classes are listed for actions and effects.

Incretins

Incretins, released by intestinal contents (e.g., GLP-1 and GIP), stimulate insulin release—enzymes like DPP-4 can inactivate or break these down.
Several drugs function by inhibiting the DPP-4 enzyme allowing a rise in plasma incretin levels, thereby potentially reducing glucose levels. Specific types of incretin mimetics and inhibitors are included (e.g., sitagliptin, exenatide, liraglutide, etc.). Further updates on uses for managing appetite and weight may be included.

Incretin Preparations

Many incretin preparations exist, including daily and weekly injectable options. Specific examples are included (e.g., exenatide, liraglutide, dulaglutide, tirzepatide etc.). Key details and administration instructions are included.

Na-Glucose Transporter Inhibitors

Newer diabetes medications target sodium-glucose transporter subtype 2 (SGLT2) in the kidneys, leading to glucose excretion in the urine. Specific drug examples are included (e.g., canagliflozin, dapagliflozin, empagliflozin). Effects on urination and risk of UTIs, etc. are mentioned.

SGLT2 Inhibitors Adverse Effects

Increased urination and potential for hypotension/dizziness. UTIs are possible but usually not a concern. Potential additional adverse effects and related management may be included.

Other Injectable Drugs

Amylin mimetics (e.g., pramlintide) are generally used in combination with insulin therapies to reduce postprandial glucose levels by delaying gastric emptying and reducing glucagon secretion. Specific examples of use and administration, etc. are detailed

Alpha-glucosidase Inhibitors

These medications reversibly inhibit the enzyme alpha-glucosidase in the small intestine, thereby hindering digestion of oligosaccharides and disaccharides. This delays glucose absorption. Specific drug examples are included (e.g., acarbose, miglitol.) Detailed effects and administration notes are included. Detailed effects are listed.

Medication Interactions with Oral/Non-Insulin Agents

Glucocorticoids decrease the effectiveness of blood-glucose lowering drugs, potentially raising blood glucose levels. Important interaction notes are included

Antihyperglycemic Agents Client Care Implications

Assess for signs of hypoglycemia. If hypoglycemia occurs, treatment includes glucagon (if needed), 120-200 ml of clear juice, glucose tablets/gel, honey, or soft drinks. Follow-up with a meal/snack (carbohydrates plus protein). Monitor blood glucose levels. Specific examples of treatments (e.g., glucose tablets) and instructions for administering the correct therapy are provided. Additional client care implications are also detailed.

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Test your knowledge on diabetes mellitus with this comprehensive quiz. Explore key concepts including types, symptoms, management, and complications associated with diabetes. Perfect for students and healthcare professionals alike!