Diabetes Mellitus Quiz
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Questions and Answers

What is crucial for a patient to know about their disease?

  • Only the instructions about insulin injection places
  • Only the medical treatment and types of insulin
  • The disease, its clinical manifestations, complications, and treatment (correct)
  • Only the dietary recommendations and insulin storage

    • What is the recommended course of action if HbA1c is less than 1.5% above target?

  • Start combination therapy
  • Start insulin therapy
  • Prescribe metformin only
  • Start monotherapy (correct)

    • When should insulin therapy be initiated?

  • If HbA1c is less than 1.5% above target
  • If initial HbA1c is above 10% with catabolic manifestations (correct)
  • If RBS is above 200mg/dl
  • If HbA1c is more than 1.5-2% above target

    • What is the maximum dose of metformin?

    <p>2550 mg</p> Signup and view all the answers

    What is a rare complication of metformin therapy?

    <p>Lactic acidosis</p> Signup and view all the answers

    Why should metformin be taken with or after meals?

    <p>To avoid GIT upset</p> Signup and view all the answers

    What is the primary concern when using sulphonylureas?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is a possible complication of metformin?

    <p>GIT disturbance</p> Signup and view all the answers

    What is Glibenclamide classified as?

    <p>First generation sulphonylurea</p> Signup and view all the answers

    Why is it recommended to start with a small dose of metformin and increase gradually?

    <p>To avoid GIT upset</p> Signup and view all the answers

    What is recommended for patients taking metformin with low Vitamin B12 levels?

    <p>Prescribing Vitamin B12 supplements</p> Signup and view all the answers

    In which patients should Glibenclamide be avoided?

    <p>Elderly patients above 60 years</p> Signup and view all the answers

    What is the maximum daily dose of Glibenclamide?

    <p>20 mg</p> Signup and view all the answers

    What is the advantage of Gliclazide over Glibenclamide?

    <p>Less risk of hypoglycemia</p> Signup and view all the answers

    In which patients should Glimepiride be used with caution?

    <p>Patients with EGFR less than 60 ml/min</p> Signup and view all the answers

    What is the starting dose of Gliclazide?

    <p>30 mg</p> Signup and view all the answers

    What is the primary characteristic of diabetes mellitus?

    <p>Chronic hyperglycemia due to defect of insulin action or secretion</p> Signup and view all the answers

    Which of the following autoimmune diseases is NOT associated with type 1 diabetes?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    What is the recommended screening strategy for thyroid dysfunction in patients with type 1 diabetes?

    <p>Routine screening for all patients with type 1 diabetes</p> Signup and view all the answers

    What is the criteria for testing for T2DM in children and adolescents?

    <p>Overweight plus any 2: family history of type 2 diabetes, race/ethnicity, signs of insulin resistance or conditions associated with insulin resistance</p> Signup and view all the answers

    What is the key to better compliance for patients with diabetes?

    <p>Health education</p> Signup and view all the answers

    What is the age of initiation for screening for T2DM in children and adolescents?

    <p>10 years or at onset of puberty</p> Signup and view all the answers

    What is the term used to describe the condition of insulin resistance?

    <p>Diabesity</p> Signup and view all the answers

    What is the diagnosis of diabetes based on?

    <p>American Diabetes Association Standards of Medical Care in Diabetes</p> Signup and view all the answers

    What is the benefit of liraglutide in the treatment of diabetic patients with cardiovascular risk factors?

    <p>Proven benefit in reducing cardiovascular risk, especially atherosclerotic disease</p> Signup and view all the answers

    What is the indication for insulin therapy in Type 2 diabetic patients?

    <p>Uncontrolled Type 2 patients on two or more oral drugs with HbA1c more than 8.5%</p> Signup and view all the answers

    What is the starting dose of premixed insulin for an 80 kg Type 2 patient?

    <p>40 units daily divided into two doses</p> Signup and view all the answers

    What is the preferred starting dose of insulin in prepubertal and adolescent patients?

    <p>0.7 unit per kg per day</p> Signup and view all the answers

    What is the insulin regimen suggested for a 7-year-old child recently diagnosed with Type 1 diabetes?

    <p>Basal-bolus regimen with rapid-acting analogue and long-acting analogue</p> Signup and view all the answers

    What is the calculation for the starting dose of insulin in a 20 kg child?

    <p>0.5 unit per kg per day</p> Signup and view all the answers

    What is the schedule for premixed insulin doses in an 80 kg Type 2 patient?

    <p>25 units before breakfast and 15 units before dinner</p> Signup and view all the answers

    What is the benefit of GLP-1 receptor agonists in the treatment of diabetic patients?

    <p>Decreases satiety and weight</p> Signup and view all the answers

    What is the maximum daily dose of Amaryl beyond which there is no increase in efficacy but only an increased risk of hypoglycemia?

    <p>6mg</p> Signup and view all the answers

    What is the mechanism of action of TZDs in the treatment of type 2 diabetes?

    <p>Acting on PPAR gamma receptors in liver and adipose tissue</p> Signup and view all the answers

    What is the benefit of using DPP-4 inhibitors in the treatment of type 2 diabetes?

    <p>They have a glucose-dependent mechanism of action with less incidence of hypoglycemia</p> Signup and view all the answers

    What is the mechanism of action of SGLT-2 inhibitors in the treatment of type 2 diabetes?

    <p>They act by inhibiting 90% of glucose reabsorption in the first segment of the proximal convoluted tubule</p> Signup and view all the answers

    What is the proven benefit of Empagliflozin, an SGLT-2 inhibitor, in the treatment of type 2 diabetes?

    <p>It has a proven effect in reducing the risk of cardiovascular disease</p> Signup and view all the answers

    What is a common side effect of SGLT-2 inhibitors that can be prevented by keeping the genitals clean and dry?

    <p>Mycotic vaginal infection</p> Signup and view all the answers

    What is a contraindication for the use of TZDs in the treatment of type 2 diabetes?

    <p>Heart failure</p> Signup and view all the answers

    What is the precaution that should be taken when starting a patient on SGLT-2 inhibitors, especially in type 1 diabetes patients, to avoid euglycemic ketoacidosis?

    <p>Start with a low dose and increase gradually over 1-2 weeks</p> Signup and view all the answers

    Study Notes

    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.

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    Description

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

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