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Questions and Answers
Why should sulfonylureas be discontinued at least two weeks before the expected delivery date?
Why should sulfonylureas be discontinued at least two weeks before the expected delivery date?
What is essential for successful lactation in patients with diabetes?
What is essential for successful lactation in patients with diabetes?
Which of the following insulins is considered safe while breastfeeding?
Which of the following insulins is considered safe while breastfeeding?
What may newborn exposure to insulin in breast milk potentially help prevent?
What may newborn exposure to insulin in breast milk potentially help prevent?
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Why is caution advised when using newer biosynthetic insulins during breastfeeding?
Why is caution advised when using newer biosynthetic insulins during breastfeeding?
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What is the primary cause of type 1 diabetes mellitus?
What is the primary cause of type 1 diabetes mellitus?
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What age group is most commonly affected by type 1 diabetes mellitus?
What age group is most commonly affected by type 1 diabetes mellitus?
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Which symptom is NOT commonly associated with type 1 diabetes mellitus?
Which symptom is NOT commonly associated with type 1 diabetes mellitus?
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What treatment is essential for managing type 1 diabetes?
What treatment is essential for managing type 1 diabetes?
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Why can't insulin be taken orally for treatment?
Why can't insulin be taken orally for treatment?
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What phenomenon describes the relationship between genetics and environment in type 2 diabetes?
What phenomenon describes the relationship between genetics and environment in type 2 diabetes?
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What is a common factor that leads to impaired pancreatic beta cells in type 2 diabetes?
What is a common factor that leads to impaired pancreatic beta cells in type 2 diabetes?
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Which method of insulin administration is typically recommended for improved absorption?
Which method of insulin administration is typically recommended for improved absorption?
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What condition is associated with an increased risk when using SGLT2 inhibitors?
What condition is associated with an increased risk when using SGLT2 inhibitors?
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Which class of drugs is now used for managing Type 2 diabetes with a focus on incretin mimetics?
Which class of drugs is now used for managing Type 2 diabetes with a focus on incretin mimetics?
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What warning was previously associated with GLP-1 agonists but is based on animal studies?
What warning was previously associated with GLP-1 agonists but is based on animal studies?
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Which medication is considered the gold standard for managing gestational diabetes?
Which medication is considered the gold standard for managing gestational diabetes?
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What is the primary concern for patients taking canagliflozin despite changes in its Black Box Warning?
What is the primary concern for patients taking canagliflozin despite changes in its Black Box Warning?
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In managing gestational diabetes, which condition is NOT a potential risk related to hyperglycemia?
In managing gestational diabetes, which condition is NOT a potential risk related to hyperglycemia?
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What lifestyle modifications are essential for managing gestational diabetes before considering medication?
What lifestyle modifications are essential for managing gestational diabetes before considering medication?
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How does metformin prove to be beneficial during pregnancy?
How does metformin prove to be beneficial during pregnancy?
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What is a potential long-term health outcome in mothers with gestational diabetes?
What is a potential long-term health outcome in mothers with gestational diabetes?
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Which oral medication is contraindicated during pregnancy due to its effects on the fetus?
Which oral medication is contraindicated during pregnancy due to its effects on the fetus?
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What change in a woman's physiology can lead to gestational diabetes during pregnancy?
What change in a woman's physiology can lead to gestational diabetes during pregnancy?
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Which of the following is NOT a recommended initial management strategy for gestational diabetes?
Which of the following is NOT a recommended initial management strategy for gestational diabetes?
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What is a targeted measure to establish euglycemia before conception in women with diabetes?
What is a targeted measure to establish euglycemia before conception in women with diabetes?
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What effect does controlled blood glucose have on fetal risks associated with diabetes?
What effect does controlled blood glucose have on fetal risks associated with diabetes?
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What primary mechanism does metformin use to lower blood glucose levels?
What primary mechanism does metformin use to lower blood glucose levels?
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Which of the following is NOT a side effect of metformin?
Which of the following is NOT a side effect of metformin?
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What is the maximum recommended daily dose of metformin?
What is the maximum recommended daily dose of metformin?
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When should metformin be held in preparation for a radiological procedure requiring IV contrast?
When should metformin be held in preparation for a radiological procedure requiring IV contrast?
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What serious condition is a rare but possible side effect of metformin?
What serious condition is a rare but possible side effect of metformin?
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What is a significant advantage of metformin compared to sulfonylureas?
What is a significant advantage of metformin compared to sulfonylureas?
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Which of the following classes of medication primarily acts as insulin sensitizers?
Which of the following classes of medication primarily acts as insulin sensitizers?
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What is the mechanism by which SGLT2 inhibitors function?
What is the mechanism by which SGLT2 inhibitors function?
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Which of the following represents a common side effect of alpha-glucosidase inhibitors?
Which of the following represents a common side effect of alpha-glucosidase inhibitors?
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What is one of the primary concerns with the use of thiazolidinediones?
What is one of the primary concerns with the use of thiazolidinediones?
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Meglitinides are primarily effective in which of the following situations?
Meglitinides are primarily effective in which of the following situations?
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What is a common gastrointestinal side effect related to metformin?
What is a common gastrointestinal side effect related to metformin?
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Which vitamin levels should be monitored in patients taking metformin?
Which vitamin levels should be monitored in patients taking metformin?
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How do alpha-glucosidase inhibitors primarily achieve their effect on blood glucose levels?
How do alpha-glucosidase inhibitors primarily achieve their effect on blood glucose levels?
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Which area is the most common for insulin injection?
Which area is the most common for insulin injection?
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What is a characteristic feature of rapid-acting insulin?
What is a characteristic feature of rapid-acting insulin?
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Which insulin type should NOT be mixed with other insulins in the same syringe?
Which insulin type should NOT be mixed with other insulins in the same syringe?
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What is the primary advantage of using an insulin pump?
What is the primary advantage of using an insulin pump?
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Which of the following complications is most commonly associated with insulin use?
Which of the following complications is most commonly associated with insulin use?
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What should be performed prior to initiating inhaled insulin?
What should be performed prior to initiating inhaled insulin?
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Which class of drugs can mask hypoglycemia symptoms?
Which class of drugs can mask hypoglycemia symptoms?
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What is the preferred drug of choice for initial monotherapy in type 2 diabetes?
What is the preferred drug of choice for initial monotherapy in type 2 diabetes?
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Which insulin type is typically used for basal and mealtime coverage in the pump?
Which insulin type is typically used for basal and mealtime coverage in the pump?
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What effect do thiazides and glucocorticosteroids have on blood glucose levels?
What effect do thiazides and glucocorticosteroids have on blood glucose levels?
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In type 1 diabetes, patients produce which of the following?
In type 1 diabetes, patients produce which of the following?
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Hypokalemia, a risk associated with insulin, refers to the condition of having:
Hypokalemia, a risk associated with insulin, refers to the condition of having:
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What type of insulin includes combinations like Novolog Mix 70/30?
What type of insulin includes combinations like Novolog Mix 70/30?
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What is a common cause of lipohypertrophy in diabetic patients?
What is a common cause of lipohypertrophy in diabetic patients?
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Study Notes
Types of Diabetes
- Two main types: Type 1 and Type 2
- Type 1: Autoimmune destruction of pancreatic beta cells, leading to no insulin production. Typically develops before 30, with a prevalence of about 5%. Symptoms include weight loss, frequent urination (polyuria), increased thirst (polydipsia), and increased hunger (polyphagia). Can present with diabetic ketoacidosis (DKA), including dehydration, abdominal pain, vomiting, and decreased consciousness. Management is lifelong insulin therapy.
- Type 2: Genetic predisposition combined with environmental factors (e.g., poor diet, lack of exercise, stress). Reduced tissue sensitivity to insulin causes high blood sugar (hyperglycemia). The pancreas initially produces more insulin, but over time, beta cells become impaired and die, failing to keep up with the body's needs. Management includes lifestyle changes such as healthy diet, regular exercise, stress management to prevent further insulin resistance.
Insulin Therapy
- Insulin is a protein, requiring injection or IV administration.
- Various types based on duration of action:
- Rapid-acting (e.g., lispro, aspart): Used immediately before meals or with insulin pumps.
- Short-acting (e.g., Regular): Used before meals.
- Intermediate-acting (e.g., NPH): Used to control blood sugar between meals.
- Long-acting (e.g., glargine, detemir): Provides basal insulin levels.
- Premixed insulins (e.g., 70/30): Combinations of intermediate and short-acting insulins.
- Insulin pump: Delivers basal and bolus insulin continuously, mimicking natural insulin release. Advantages include more accurate glucose control, reduced injections, and improved HbA1c levels. Disadvantages associated with the pump are weight gain, the risk of DKA if catheter dislodges, and the cost.
- Insulin inhaler: Delivers powdered insulin via inhalation, with faster absorption than injected insulin. Contraindicated in patients with asthma or COPD due to risk of acute bronchospasm; thorough medical history, exam and spirometry are crucial before starting inhaled insulin.
- Insulin administration sites: Abdomen, outer arms, outer thighs, and buttocks, with consistent rotation crucial.
- Insulin adjustments should be cautious in Type 1 diabetes, given the absence of endogenous insulin production.
Complications of Insulin Therapy
- Hypoglycemia: Most significant risk, requires careful monitoring, especially when combining insulin with other medications.
- Hypokalemia: Possible complication.
- Lipohypertrophy: Abnormal fat accumulation at injection sites due to repeated injections.
Other Diabetic Medications (Type 2)
- Agents to manage Type 2 diabetes aim to increase insulin action, stimulate insulin release, or reduce glucose production.
- Sulfonylureas and Meglitinides: Stimulate insulin secretion from the pancreas.
-
Biguanides (Metformin): Inhibit glucose production by the liver, increase insulin sensitivity in target tissues, and do not lead to weight gain.
- Risks: Lactic acidosis, gastrointestinal issues (diarrhea), and decreased vitamin B12/folic acid.
- Monitoring: Periodic kidney function tests (eGFR).
- Thiazolidinediones: Increase insulin sensitivity in muscle, fat, and liver; fat redistribution may assist in reducing insulin resistance.
- Alpha-glucosidase Inhibitors: Slow carbohydrate digestion & absorption in the gut. Side effects include flatulence, diarrhea.
- Sodium-glucose co-transporter 2 (SGLT2) inhibitors: Increase glucose excretion in urine, potentially lower blood pressure, and reduce cardiovascular and kidney risk. Potential risks: lower limb amputation, DKA and urinary tract infections. (Note: the warnings re. limb amputation are no longer a black box warning).
-
Non-insulin injectables:
- GLP-1 agonists: Mimic incretin hormones, stimulating insulin release, inhibiting glucagon release, and slowing gastric emptying. Potential risks including thyroid cancer.
Metformin (Biguanide)
- Initial drug of choice for type 2 diabetes, unless contraindicated or poorly tolerated.
- Works by lowering glucose production in the liver, reducing gut absorption, and enhancing insulin sensitivity without inducing hypoglycemia.
- Benefits include no weight gain, effective in lowering blood glucose, helps reduce cardiovascular risk, and can improve gut microbiome composition.
- Risks: Lactic acidosis, gastrointestinal side effects (e.g., diarrhea), and vitamin deficiencies (e.g., B12).
- Important to avoid alcohol, and hold metformin for 48 hours before IV contrast procedures.
Thiazolidinediones (Glitazones)
- Increase insulin sensitivity in muscle, fat, and to a lesser extent, the liver.
- May redistribute fat from the visceral to subcutaneous compartment.
- Risks: Risk or exacerbation of heart failure, and liver injury
Meglitinides (e.g. Repaglinide)
- Stimulate insulin release. Used for erratic meal schedules.
- Side effects include digestive issues (bloating, cramping, diarrhea).
Alpha-glucosidase Inhibitors (e.g., Acarbose)
- Slow carbohydrate digestion and absorption in the gut, primarily affecting postprandial blood glucose.
- Side effects include gastrointestinal issues (flatulence, diarrhea); most commonly mild and tolerable.
- Often used in combination with other medications.
Sodium-glucose co-transporter 2 (SGLT2) Inhibitors ("Gliflozins")
- Inhibits kidney re-absorption of glucose.
- Protection of heart and kidneys, noted in type 2 diabetes.
- Increased risk of lower limb amputation and DKA, although the Black Box Warning on amputation is no longer a black box warning.
Non-Insulin Injectable Hypoglycemic Agents
- GLP-1 agonists: Mimic incretin hormones, stimulating insulin release, inhibiting glucagon release, and slowing gastric emptying. Potential risks for thyroid cancer.
- Amylin analogs: Slow gastric emptying, suppress glucagon secretion, and promote satiety,
Pregnancy & Diabetes
- Pregestational Diabetes: Managing blood glucose levels before conception reduces risks for congenital anomalies or miscarriages in the fetus. Consider medication safety during pregnancy.
- Gestational Diabetes: Increased risk of complications for the fetus. Close blood glucose control is crucial to reduce perinatal outcomes (e.g., large for gestational age, congenital heart defects). Medications, such as insulin and metformin, may be necessary.
Lactation & Diabetes
- Successful breastfeeding is achievable with diabetes.
- Euglycemia crucial for lactation and normal insulin levels.
- Insulin NPH and regular human insulin are typically considered safe with breastfeeding; cautious approach needed for newer insulins.
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Description
This quiz explores the two main types of diabetes: Type 1 and Type 2. It delves into their causes, symptoms, and management strategies, including insulin therapy. Understanding these concepts is crucial for effective diabetes care and prevention.
