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Questions and Answers
What is diabetes mellitus characterized by?
What is diabetes mellitus characterized by?
What is a complication associated with type 1 diabetes?
What is a complication associated with type 1 diabetes?
Why is routine screening for thyroid dysfunction recommended for patients with type 1 diabetes?
Why is routine screening for thyroid dysfunction recommended for patients with type 1 diabetes?
What is one of the criteria for testing for type 2 diabetes in children and adolescents?
What is one of the criteria for testing for type 2 diabetes in children and adolescents?
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When is lactic acidosis extremely rare complication of metformin?
When is lactic acidosis extremely rare complication of metformin?
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What is the age of initiation for testing for type 2 diabetes in children and adolescents?
What is the age of initiation for testing for type 2 diabetes in children and adolescents?
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What is Gibenclamide considered as?
What is Gibenclamide considered as?
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What is a key component for better compliance and less adverse outcomes in diabetes management?
What is a key component for better compliance and less adverse outcomes in diabetes management?
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What is an associated condition with type 1 diabetes?
What is an associated condition with type 1 diabetes?
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Why should Gibenclamide be avoided in elderly patients above 60 years?
Why should Gibenclamide be avoided in elderly patients above 60 years?
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What is a consequence of untreated type 1 diabetes?
What is a consequence of untreated type 1 diabetes?
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What is the maximum dose of Gibenclamide?
What is the maximum dose of Gibenclamide?
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What is Gliclazide considered as?
What is Gliclazide considered as?
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What is the starting dose of Gliclazide?
What is the starting dose of Gliclazide?
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What is Glimepiride considered as?
What is Glimepiride considered as?
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In which patients is Glimepiride contraindicated?
In which patients is Glimepiride contraindicated?
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What is the primary goal of educating a patient with diabetes?
What is the primary goal of educating a patient with diabetes?
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When should combination therapy be considered for a patient with diabetes?
When should combination therapy be considered for a patient with diabetes?
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What is the recommended starting dose of metformin?
What is the recommended starting dose of metformin?
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Why is it recommended to start with a small dose of metformin and increase it gradually?
Why is it recommended to start with a small dose of metformin and increase it gradually?
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What is a potential complication of metformin therapy?
What is a potential complication of metformin therapy?
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What is the maximum dose of Amaryl that provides efficacy without increasing the risk of hypoglycemia?
What is the maximum dose of Amaryl that provides efficacy without increasing the risk of hypoglycemia?
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When should insulin therapy be initiated in a patient with diabetes?
When should insulin therapy be initiated in a patient with diabetes?
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What is the class of medications that Actos belongs to?
What is the class of medications that Actos belongs to?
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What is the recommended frequency of self-monitoring of blood glucose (SMBG) in a patient with diabetes?
What is the recommended frequency of self-monitoring of blood glucose (SMBG) in a patient with diabetes?
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What is the advantage of DDP4 INHIBITORS in managing type 2 diabetes?
What is the advantage of DDP4 INHIBITORS in managing type 2 diabetes?
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Why is metformin considered the backbone of treatment for diabetes?
Why is metformin considered the backbone of treatment for diabetes?
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What is the mechanism of action of SGLT 2 INHIBITORS?
What is the mechanism of action of SGLT 2 INHIBITORS?
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What is a common side effect of SGLT 2 INHIBITORS?
What is a common side effect of SGLT 2 INHIBITORS?
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What is the advantage of Empagliflozin?
What is the advantage of Empagliflozin?
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What is a contraindication for the use of TZDS?
What is a contraindication for the use of TZDS?
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What is a risk of using SGLT 2 INHIBITORS in type 1 diabetes patients?
What is a risk of using SGLT 2 INHIBITORS in type 1 diabetes patients?
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What is the benefit of liraglutide in patients with cardiovascular risk factor?
What is the benefit of liraglutide in patients with cardiovascular risk factor?
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What is the recommended starting dose of insulin in a 7-year-old child with type 1 DM?
What is the recommended starting dose of insulin in a 7-year-old child with type 1 DM?
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What is the indication for insulin therapy in type 2 patients?
What is the indication for insulin therapy in type 2 patients?
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What is the recommended dose of premixed insulin in an 80 kg type 2 patient?
What is the recommended dose of premixed insulin in an 80 kg type 2 patient?
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What is the benefit of glucagon-like peptide-1 (GLP-1) receptor agonists in diabetes management?
What is the benefit of glucagon-like peptide-1 (GLP-1) receptor agonists in diabetes management?
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What is the recommended insulin regimen for a 7-year-old child with type 1 DM?
What is the recommended insulin regimen for a 7-year-old child with type 1 DM?
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What is the indication for insulin therapy in recently diagnosed type 2 patients?
What is the indication for insulin therapy in recently diagnosed type 2 patients?
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What is the adjustment of premixed insulin dose in hospital admission?
What is the adjustment of premixed insulin dose in hospital admission?
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Study Notes
Diabetes Mellitus
- Diabetes mellitus is a metabolic disorder with multiple etiologies, characterized by chronic hyperglycemia due to defects in insulin action or insulin secretion.
Pathogenesis
- People with type 1 diabetes are at increased risk for other autoimmune diseases, such as thyroid disease, celiac disease, and pernicious anemia (vitamin B12 deficiency).
- Associated conditions include autoimmune hepatitis, primary adrenal insufficiency (Addison disease), dermatomyositis, and myasthenia gravis.
Type 1 Diabetes
- May also occur with other autoimmune diseases in the context of specific genetic disorders or polyglandular autoimmune syndromes.
- Routine screening for thyroid dysfunction is recommended for all patients with type 1 diabetes.
- Screening for celiac disease should be considered in adult patients with suggestive symptoms or signs.
Criteria for Testing for T2DM in Children & Adolescents
- Overweight plus any 2 of the following:
- Family history of type 2 diabetes in 1st or 2nd degree relatives.
- Race/ethnicity.
- Signs of insulin resistance or conditions associated with insulin resistance.
- Maternal history of diabetes or GDM.
- Age of initiation: 10 years or at onset of puberty.
Strategies of DM Management
- Health education is key for better compliance and fewer adverse outcomes.
- Patient needs to know about:
- The disease.
- Alarming clinical manifestations of hypo- or hyperglycemia.
- Complications of the disease.
- Medical treatment and types of insulin.
- How to use insulin correctly and storage/injection instructions.
- Importance of:
- Fixing times for insulin and meals.
- Following dietary recommendations.
- Asking a nutritionist for a diet plan.
- Performing SMBG for better optimization of blood glucose.
Anti-Diabetic Drugs
- Metformin:
- Considered the backbone of diabetes treatment.
- Should be prescribed to every patient unless contraindicated or non-tolerated.
- Forms: immediate release and extended-release.
- Dose: starting dose 500 mg with main meals, optimal dose 1000 mg twice daily, maximum dose 2550 mg (up to 3000 mg in some guidelines).
- Practical issues: start with a small dose and increase gradually to avoid GIT upset.
- Complications: GIT disturbance, vit B12 malabsorption, and lactic acidosis (extremely rare).
- Sulphonylurea:
- Take care of risk of hypoglycemia and weight gain.
- Classified into 3 generations: Gibenclamide, Gliclazide, and Glimepride.
- TZDS (Thiazolidinediones):
- One of the most potent insulin sensitizers.
- Act on PPAR gamma receptors in liver and adipose tissue.
- Can be used in treatment of fatty liver and polycystic ovary.
- Take care of cardiovascular risk: avoid in heart failure, no renal dose adjustment, and avoid in renal impairment.
- DDP4 (Dipeptidyl Peptidase-4) Inhibitors:
- Leader group in management of type 2 diabetes.
- Control blood glucose in a glucose-dependent manner with less incidence of hypoglycemia and weight-neutral effect.
- SGLT2 (Sodium-Glucose Cotransporter 2) Inhibitors:
- One of the promising groups in treatment of type 2 diabetes.
- Act by inhibiting 90% of glucose reabsorption in the first segment of the proximal convoluted tubule.
- Glucosuric and natriuretic effects.
- Complications: urinary tract infection, mycotic vaginal infection, euglycemic ketoacidosis, and osteoporesis.
- GLP1 (Glucagon-Like Peptide-1) Receptor Agonists:
- One of the promising drugs in diabetes.
- Control blood glucose in a glucose-dependent manner with less incidence of hypoglycemia and decrease satiety, leading to weight loss.
- May be the first line therapy in treatment of diabetic patients with cardiovascular risk factors.
Insulin Therapy
- Indications:
- Type 1 patients (IDDM).
- Uncontrolled type 2 patients on two or more oral drugs at maximum dose and HbA1c is still more than 8.5%.
- Recently diagnosed type 2 patients with HbA1c 10% or more and blood glucose more than 300 mg, especially if there is a catabolic state (weight loss-ketones) or associated increased triglycerides level.
- At hospital admission.
- Insulin types:
- Premixed insulin.
- Basal bolus regimen (MDI).
- Starting dose of insulin: 0.5 unit per kg per day, divided into two-thirds as morning dose and one-third as night dose.
- Example: 7-year-old child recently diagnosed with type 1 DM, weight 20 kg, insulin regimen suggested is basal bolus regimen including rapid-acting analogue and long-acting analogue.
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Description
This quiz covers the pathogenesis of diabetes mellitus, a metabolic disorder characterized by chronic hyperglycemia due to defects in insulin action or secretion. It also touches on the increased risk of other autoimmune diseases in people with type 1 diabetes.
