Diabetes Mellitus: Type 1 vs Type 2
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Questions and Answers

What percentage of patients may develop type 2 diabetes within 10 to 15 years after subsiding?

  • 20%
  • 40%
  • 30% (correct)
  • 50%

    • What is the HbA1C goal of treatment for diabetic patients?

  • Less than 9%
  • Less than 6.5%
  • Less than 8%
  • Less than 7% (correct)

    • What is the fasting blood glucose goal for diabetic patients?

  • 90 to 140 mg/dL
  • 80 to 130 mg/dL (correct)
  • 100 to 150 mg/dL
  • 70 to 100 mg/dL

    • What is the duration of action for rapid-acting insulin aspart?

    <p>3 to 5 hours</p> Signup and view all the answers

    What is the peak of action for inhaled insulin Afrezza?

    <p>12 to 15 minutes</p> Signup and view all the answers

    What is the duration of action for short-acting insulin regular?

    <p>6 to 10 hours</p> Signup and view all the answers

    What is the duration of action for intermediate-acting insulin isophane suspension?

    <p>10 to 18 hours</p> Signup and view all the answers

    What is the characteristic of insulin glargine (Lantus)?

    <p>Constant level of insulin in the body</p> Signup and view all the answers

    What is the primary cause of Type 1 Diabetes Mellitus?

    <p>Lack of insulin production or production of defective insulin</p> Signup and view all the answers

    Which of the following is a characteristic of Diabetic Ketoacidosis (DKA)?

    <p>Ketones in the serum, acidosis, and dehydration</p> Signup and view all the answers

    What is the typical percentage of patients with newly diagnosed Type 1 Diabetes Mellitus who present with Diabetic Ketoacidosis (DKA)?

    <p>25% to 30%</p> Signup and view all the answers

    Which of the following comorbid conditions is commonly associated with Type 2 Diabetes Mellitus?

    <p>Microalbuminemia and thrombotic events</p> Signup and view all the answers

    What is the term used to describe the collective comorbidities associated with Type 2 Diabetes Mellitus?

    <p>All of the above</p> Signup and view all the answers

    What is the primary concern in Gestational Diabetes?

    <p>Preventing birth defects</p> Signup and view all the answers

    What is the hallmark of Hyperosmolar Hyperglycemic Syndrome (HHS)?

    <p>Hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis</p> Signup and view all the answers

    What is the common long-term complication of both Type 1 and Type 2 Diabetes Mellitus that affects the capillaries?

    <p>Microvascular disease</p> Signup and view all the answers

    Which of the following situations would increase concerns for a patient with DM?

    <p>The patient is under stress</p> Signup and view all the answers

    What is essential for thorough patient education regarding DM?

    <p>Disease process, diet and exercise recommendations, self-administration of insulin or oral drugs, and potential complications</p> Signup and view all the answers

    When administrating insulin, what should be checked before giving the insulin?

    <p>Blood glucose level before giving insulin</p> Signup and view all the answers

    When drawing up two types of insulin in one syringe, what should be done?

    <p>Always withdraw the regular or rapid-acting insulin first</p> Signup and view all the answers

    Why should metformin be discontinued if the patient is to undergo studies with contrast dye?

    <p>Because of possible renal effects</p> Signup and view all the answers

    What should be administered to a conscious patient with hypoglycemia?

    <p>Oral form of glucose</p> Signup and view all the answers

    What should be monitored to assess therapeutic response to insulin?

    <p>Decrease in blood glucose levels to the level prescribed by physician</p> Signup and view all the answers

    What is used to monitor long-term compliance with diet and drug therapy?

    <p>HbA1C</p> Signup and view all the answers

    What is the mechanism of action of GLP-1 injectable medications in patients with type 2 diabetes?

    <p>Enhance glucose-dependent insulin secretion, suppress elevated glucagon secretion</p> Signup and view all the answers

    What is the primary adverse effect of SGLT2 inhibitors that led to a 2018 FDA warning?

    <p>Necrotizing fasciitis of the perineum (Fournier's gangrene)</p> Signup and view all the answers

    What is the primary indication for GLP-1 injectable medications in patients with type 2 diabetes?

    <p>Indicated for patients with type 2 diabetes who have not been able to achieve blood glucose control with metformin, a sulfonylurea and/or a glitazone</p> Signup and view all the answers

    What is the primary action of SGLT2 inhibitors on glucose levels in patients with type 2 diabetes?

    <p>Inhibit glucose reabsorption from the glomerular filtrate, resulting in a reduced renal threshold for glucose and glycosuria</p> Signup and view all the answers

    What is the primary contra-indication for SGLT2 inhibitors in patients with type 2 diabetes?

    <p>Moderate to severe kidney impairment</p> Signup and view all the answers

    What is the primary nursing implication for patients taking antidiabetic medications and undergoing a test or procedure?

    <p>Consult the primary care provider to clarify orders for antidiabetic drug therapy</p> Signup and view all the answers

    What is the primary treatment for mild hypoglycemia in patients with type 2 diabetes?

    <p>Dietary changes to increase protein intake and lower carbohydrate intake</p> Signup and view all the answers

    What is the primary adverse effect of DPP-4 inhibitors that can occur when used in conjunction with a sulfonylurea?

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

    What is the main disadvantage of delaying insulin administration until hyperglycemia occurs?

    <p>It results in large swings in glucose control.</p> Signup and view all the answers

    Which type of insulin is used as a basal insulin in Basal-Bolus Insulin Dosing?

    <p>Insulin glargine</p> Signup and view all the answers

    What is the first-line drug and most commonly used oral drug for the treatment of type 2 DM?

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

    Which of the following is a common adverse effect of Sulfonylureas?

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

    What is the mechanism of action of Thiazolidinediones?

    <p>Decrease insulin resistance</p> Signup and view all the answers

    Which of the following is a contraindication for Alpha-glucosidase inhibitors?

    <p>Certain bowel disorders</p> Signup and view all the answers

    What is the mechanism of action of Incretin mimetics?

    <p>Mimic naturally secreted incretin hormones</p> Signup and view all the answers

    What is the preferred method of treatment for hospitalized patients with DM?

    <p>Basal-Bolus Insulin Dosing</p> Signup and view all the answers

    Study Notes

    Diabetes Mellitus

    • Type 1 Diabetes Mellitus:
      • Lack of insulin production or production of defective insulin
      • Affected patients need exogenous insulin
      • Complications include diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)
    • Type 2 Diabetes Mellitus:
      • Most common type (90% of all cases)
      • Caused by insulin deficiency and insulin resistance
      • Many tissues are resistant to insulin, including reduced number of insulin receptors and less responsive insulin receptors

    Signs and Symptoms of Diabetes

    • Elevated fasting blood glucose (higher than 126 mg/dL) or a hemoglobin A1C (HbA1C) level greater than or equal to 6.5%
    • Polyuria
    • Polydipsia
    • Polyphagia
    • Glycosuria
    • Unexplained weight loss
    • Fatigue
    • Blurred vision

    Type 2 Diabetes Mellitus Comorbid Conditions

    • Obesity
    • Coronary heart disease
    • Dyslipidemia
    • Hypertension
    • Microalbuminemia (protein in the urine)
    • Increased risk for thrombotic (blood clotting) events
    • These comorbidities are collectively referred to as metabolic syndrome, insulin-resistance syndrome, or syndrome X

    Major Long-Term Complications of Both Types of Diabetes

    • Macrovascular (atherosclerotic plaque):
      • Coronary arteries
      • Cerebral arteries
      • Peripheral vessels
    • Microvascular (capillary damage):
      • Retinopathy
      • Neuropathy
      • Nephropathy

    Gestational Diabetes

    • Hyperglycemia that develops during pregnancy
    • Insulin must be given to prevent birth defects
    • Usually subsides after delivery
    • 30% of patients may develop type 2 DM within 10 to 15 years

    Nonpharmacologic Treatment Interventions

    • Type 1: Always requires insulin therapy
    • Type 2:
      • Weight loss
      • Improved dietary habits
      • Smoking cessation
      • Reduced alcohol consumption
      • Regular physical exercise

    Glycemic Goal of Treatment

    • HbA1C of less than 7%
    • Fasting blood glucose goal for diabetic patients: 80 to 130 mg/dL

    Treatment Options for Diabetes

    • Type 1: Insulin therapy
    • Type 2:
      • Lifestyle changes
      • Oral drug therapy
      • Insulin when the above no longer provide glycemic control

    Insulin

    • Function as a substitute for the endogenous hormone
    • Effects are the same as normal endogenous insulin
    • Restores the diabetic patient's ability to:
      • Metabolize carbohydrates, fats, and proteins
      • Store glucose in the liver
      • Convert glycogen to fat stores

    Types of Insulin

    • Rapid-acting:
      • Onset of action: 5 to 15 minutes
      • Peak: 1 to 2 hours
      • Duration: 3 to 5 hours
      • Examples: insulin lispro (Humalog), insulin aspart (NovoLog), insulin glulisine (Apidra)
    • Short-acting:
      • Onset: 30 to 60 minutes
      • Peak: 2.5 hours
      • Duration: 6 to 10 hours
      • Examples: regular insulin (Humulin R)
    • Intermediate-acting:
      • Onset: 1 to 2 hours
      • Peak: 4 to 8 hours
      • Duration: 10 to 18 hours
      • Examples: insulin isophane suspension (NPH)
    • Long-acting:
      • Onset: 1 to 2 hours
      • Peak: none
      • Duration: 24 hours
      • Examples: insulin glargine (Lantus), insulin detemir (Levemir)

    Sliding Scale vs Bolus Insulin Dosing

    • Sliding-scale insulin dosing:
      • SUBQ rapid-acting or short-acting insulins are adjusted according to blood glucose test results
      • Typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings
    • Basal-bolus insulin dosing:
      • Preferred method of treatment for hospitalized patients with DM
      • Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus
      • Basal insulin is a long-acting insulin (insulin glargine), and bolus insulin is a rapid-acting insulin (insulin lispro or insulin aspart)

    Non-Insulin Antidiabetic Drugs

    • Biguanides:
      • Mechanism of action: decrease production of glucose by the liver, decrease intestinal absorption of glucose, and increase uptake of glucose by tissues
      • Adverse effects: primarily affects gastrointestinal (GI) tract, may also cause metallic taste, reduced vitamin B12 levels
      • Contraindications: renal or hepatic disease
      • Example: metformin (Glucophage)
    • Sulfonylureas:
      • Mechanism of action: stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels
      • Adverse effects: hypoglycemia, hematologic effects, nausea, epigastric fullness, heartburn
      • Contraindications: hypersensitivity to Sulphur, pregnancy
      • Examples: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta)
    • Glinides:
      • Mechanism of action: similar to sulfonylureas, increase insulin secretion from the pancreas
      • Adverse effects: hypoglycemia, weight gain
      • Examples: repaglinide (Prandin), nateglinide (Starlix)
    • Thiazolidinediones (glitazones):
      • Mechanism of action: decrease insulin resistance, increase glucose uptake and use in skeletal muscle
      • Adverse effects: can cause or exacerbate heart failure, peripheral edema, weight gain, decreased bone marrow density
      • Contraindications: heart failure
      • Example: pioglitazone (Actos)
    • Alpha-glucosidase inhibitors:
      • Mechanism of action: decrease intestinal absorption of glucose
      • Adverse effects: flatulence, diarrhea, abdominal pain
      • Contraindications: certain bowel disorders
      • Examples: acarbose (Precose), miglitol (Glyset)
    • Incretin mimetics:
      • Mechanism of action: mimic naturally secreted incretin hormones, increase insulin synthesis and lower glucagon secretion
      • Adverse effects: upper respiratory tract infection, headache, diarrhea
      • Contraindications: pancreatitis
      • Examples: sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina)
    • SGLT2 inhibitors:
      • Mechanism of action: inhibit SGLT2, leading to a decrease in blood glucose caused by an increase in renal glucose excretion
      • Adverse effects: genital yeast infections, urinary tract infections, increased urination
      • Contraindications: diabetic ketoacidosis, moderate to severe kidney impairment
      • Examples: canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), ertugliflozin (Steglatro)

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    Description

    This quiz covers the differences between Type 1 and Type 2 Diabetes Mellitus, including symptoms and complications such as diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome.

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