Diabetes Mellitus

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Questions and Answers

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

  • It has no effect on satiety and weight
  • It increases satiety and weight
  • It decreases satiety and weight (correct)
  • It only decreases satiety

Which of the following is an indication for starting insulin therapy?

  • Type 2 patients with HbA1c 9% or less
  • Type 2 patients with HbA1c less than 6.5%
  • Recently diagnosed type 2 patients with HbA1c 10% or more (correct)
  • Type 1 patients with HbA1c less than 7%

What is the initial insulin dose for a 20 kg, 7-year-old child with type 1 DM?

  • 10 units daily
  • 1 unit/kg/day
  • 0.5 units/kg/day (correct)
  • 20 units daily

What is the recommended insulin regimen for a type 1 patient?

<p>Basal bolus regimen with rapid acting analogue (C)</p> Signup and view all the answers

What is the initial insulin dose for a 80 kg patient with type 2 DM?

<p>40 units daily (A)</p> Signup and view all the answers

What is the benefit of insulin therapy in type 1 patients?

<p>It decreases blood glucose levels (D)</p> Signup and view all the answers

What is the recommended starting dose of insulin for a prepubertal patient?

<p>0.5 units/kg/day (A)</p> Signup and view all the answers

What is the benefit of liraglutide in patients with atherosclerotic disease?

<p>It decreases cardiovascular risk (B)</p> Signup and view all the answers

What is the indication for starting insulin therapy in type 2 patients?

<p>HbA1c more than 8.5% on two or more oral drugs (C)</p> Signup and view all the answers

What is the benefit of glucagon-like peptide-1 (GLP-1) receptor agonists?

<p>It controls blood glucose in a glucose-dependent manner (A)</p> Signup and view all the answers

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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 secretion.

Pathogenesis

  • Type 1 diabetes is associated with an increased risk of other autoimmune diseases, including thyroid disease, celiac disease, and pernicious anemia.
  • 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: family history of type 2 diabetes, 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 less adverse outcomes.
  • Patient education should cover the disease, clinical manifestations of hypo/hyperglycemia, complications, medical treatment, insulin types, and injection techniques.
  • Dietary recommendations should be provided, and SMBG should be performed for better optimization of BG.

Antidiabetic Drugs

  • Metformin:
    • Considered the backbone of diabetes treatment, prescribed to every patient unless contraindicated or non-tolerated.
    • Forms: immediate release or extended-release.
    • Dose: starting dose 500 mg with main meals, optimal dose 1000 mg twice daily, maximum dose 2550 mg.
    • Practical issues: start with small doses and increase gradually to avoid GIT upset.
  • Sulphonylurea:
    • Classified into 3 generations: glibenclamide (1st generation), gliclazide (2nd generation), and glimepiride (late 2nd generation).
    • Glibenclamide: should not be used during Ramadan fasting, in elderly patients above 60 years, or in stage 3 chronic kidney disease.
    • Gliclazide: can be used in patients with renal impairment without dose adjustment, but not preferred in patients with impaired liver functions.
    • Glimepiride: use with caution in patients with EGFR < 60 ml/min, and contraindicated in EGFR < 30 ml/min.
  • Thiazolidinediones (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.
    • Examples: Actos, Actozone, Diabetonorm.
  • DPP-4 Inhibitors:
    • Leaders in management of type 2 diabetes.
    • Control blood glucose in a 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 proximal convoluted tubule.
    • Examples: Dapagliflozin, Empagliflozin.
  • GLP-1 Receptor Agonists:
    • One of the promising drugs in diabetes.
    • Control blood glucose in a glucose-dependent manner with less incidence of hypoglycemia and decreases satiety, resulting in 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% and blood glucose > 300 mg, especially with catabolic state or associated increased triglycerides level.
    • Hospital admission.
  • Insulin types:
    • Premixed insulin.
    • Basal-bolus regimen (MDI).
  • Starting insulin dose: 0.5 units/kg/day, divided into two-thirds as morning dose and one-third as night dose.
  • Adjustment: starting dose can be increased to 0.7-1 unit/kg/day in prepubertal and adolescent patients.

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