Diabetes Mellitus Quiz

Diabetes Mellitus

• Diabetes mellitus is a metabolic disorder of multiple etiologies, characterized by chronic hyperglycemia due to defects in insulin action or insulin secretion.
• 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).

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

Strategies of DM Management

• Health education is key for better compliance and patient outcomes.
• Patient education should include:
  • Understanding of the disease
  • Alarming clinical manifestations of hypo or hyperglycemia
  • Complications of the disease
  • Information about medical treatment and types of insulin
  • Instructions on insulin storage and injection places
• Fixing times for insulin and meals, and following dietary recommendations are important.
• Remind patients to perform self-monitoring of blood glucose (SMBG) for better optimization of blood glucose.

Anti-Diabetic Drugs

• Start monotherapy if HbA1c is less than 1.5% above target HbA1c.
• Start combination therapy if HbA1c is more than 1.5-2% above target.
• Consider metformin as the backbone of treatment for diabetes, unless contraindicated or not tolerated.
• Metformin dosing:
  • Starting dose: 500mg with main meals, either once or twice
  • Optimal dose: 1000mg, twice daily
  • Maximum dose: 2550mg (up to 3000mg in some guidelines)

Sulphonylurea

• Classified into 3 generations:
  • 1st generation: Gibenclamide (conventional sulphonylurea)
  • 2nd generation: Gliclazide (less risk of hypoglycemia and weight gain)
  • 3rd generation: Glimepride (more efficacy and less hypoglycemia)
• Take care of risk of hypoglycemia and weight gain.
• Glibenclamide:
  • Starting dose: 2.5-5mg before breakfast, can be increased to twice daily dose
  • Maximum dose: 20mg
• Gliclazide:
  • Starting dose: 30mg before breakfast, can be increased by 30mg on a weekly basis
  • Maximum dose: 120mg

TZDs

• One of the most potent insulin sensitizers, acting 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, but avoid in renal impairment due to risk of fluid retention

DDP4 Inhibitors

• Leader group in management of type 2 diabetes.
• Controls blood glucose in glucose-dependent manner with less incidence of hypoglycemia and weight neutral effect.
• Examples: Sitagliptin, Vildagliptin, Linagliptin, Saxagliptin, Alogliptin

SGLT2 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.
• Examples: Dapagliflozin, Empagliflozin
• Has a proven cardioprotective effect, as seen in the EMPA-REG trial.
• Complications:
  • Urinary tract infections due to glucosuric effect
  • Mycotic vaginal infection
  • Euglycemic ketoacidosis if used off-label in type 1 patients or started at high dose

GLP1 Receptor Agonist

• One of the promising drugs in diabetes.
• Controls blood glucose in glucose-dependent manner with less incidence of hypoglycemia and decreases satiety, leading to weight loss.
• Examples: Liraglutide, Dulaglutide, Semaglutide

Insulin Therapy

• Indications:
  • Type 1 patients (IDDM)
  • Uncontrolled type 2 patients on two or more oral drugs at maximum dose, with HbA1c > 8.5%
  • Recently diagnosed type 2 patients with HbA1c > 10% or blood glucose > 300mg, especially if there is catabolic state 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: 80kg type 2 patient, starting premixed insulin at 40 units daily, divided into 25 units before breakfast and 15 units before dinner.

This quiz covers the basics of diabetes mellitus, a metabolic disorder characterized by chronic hyperglycemia due to defects in insulin action or secretion.