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Questions and Answers
What is diabetes mellitus characterized by?
What is a complication associated 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?
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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?
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What is Gibenclamide considered as?
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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?
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Why should Gibenclamide be avoided in elderly patients above 60 years?
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What is a consequence of untreated type 1 diabetes?
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What is the maximum dose of Gibenclamide?
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What is Gliclazide considered as?
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What is the starting dose of Gliclazide?
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What is Glimepiride considered as?
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In which patients is Glimepiride contraindicated?
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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?
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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?
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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?
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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?
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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?
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Why is metformin considered the backbone of treatment for diabetes?
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What is the mechanism of action of SGLT 2 INHIBITORS?
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What is a common side effect of SGLT 2 INHIBITORS?
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What is the advantage of Empagliflozin?
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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?
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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?
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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?
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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?
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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?
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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.
