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  • What is Diabetes mellitus?

    Metabolic disorder characterized by hyperglycemia - Abnormalities in carbohydrate, fat, and protein metabolism

    diabetes health

  • How many Americans have diabetes?

    25.8 million (8.3%) - 18.8 million diagnosed - 7 million undiagnosed

    diabetes statistics

  • What was the cost of diagnosed diabetes in the U.S. in 2007?

    $174 billion

    diabetes economics

  • What are the leading causes of diabetes complications?

    • Leading cause of blindness
    • Leading cause of kidney failure
    • 7th leading cause of death
    diabetes health

  • What is Type 1 Diabetes?

    • Immune mediated or idiopathic β-cell destruction
    • Absolute insulin deficiency
    • 5-10% of cases
    diabetes type1

  • What is Type 2 Diabetes?

    • Progressive insulin secretory defect
    • Background of insulin resistance
    • 90% of cases
    diabetes type2

  • What is Gestational Diabetes?

    • Diabetes diagnosed during pregnancy
    • Occurs in 7% of pregnancies
    • 30-50% develop Type 2 diabetes postpartum
    diabetes gestational

  • What is the role of insulin in glucose metabolism?

    • Suppresses hepatic glucose production
    • Stimulates glucose uptake by peripheral tissues
    diabetes insulin

  • What are the risk factors for diabetes screening?

    • BMI≥ 25 mg/m2
    • Physical inactivity
    • First degree relative with diabetes
    • High risk ethnicity
    diabetes riskfactors

  • What are the characteristics of Type 1 vs Type 2 Diabetes?

    Type 1: - Age <30 years - Abrupt onset - Lean body habitus Type 2: - Age >30 years - Gradual onset - Obese body habitus

    diabetes comparison

  • What is the A1c level for diabetes diagnosis?

    A1c ≥6.5%

    diagnosis diabetes

  • What does A1c measure?

    Average blood glucose over 2-3 months

    diagnosis a1c

  • What is the mean plasma glucose for A1c of 6?

    126 mg/dL

    a1c plasma_glucose

  • What is the FBG level for diabetes diagnosis?

    FBG ≥126 mg/dL

    diagnosis fbg

  • What is the 2 hr plasma glucose threshold for diabetes?

    ≥200 mg/dL during a 75 g OGTT

    diagnosis ogtt

  • What are the classic symptoms of hyperglycemia?

    • Polyuria
    • Polydipsia
    • Polyphagia
    symptoms hyperglycemia

  • What are the additional symptoms of hyperglycemia?

    • Lethargy
    • Nocturia
    • Blurred vision
    • Weight loss
    symptoms hyperglycemia

  • What is hypoglycemia defined as?

    Blood glucose <70 mg/dL

    hypoglycemia definition

  • What are the symptoms of hypoglycemia?

    • Dizziness
    • Shaky
    • Fatigue
    • Sweating
    • Anxious
    • Rapid heartbeat
    • Irritability
    • Headache
    • Pale skin
    • Seizure
    symptoms hypoglycemia

  • What is Level 1 hypoglycemia?

    Alert value ≤70 mg/dL; needs carbohydrates

    hypoglycemia classification

  • What is Level 2 hypoglycemia?

    Clinically significant hypoglycemia <54 mg/dL

    hypoglycemia classification

  • What is Level 3 hypoglycemia?

    Severe cognitive impairment, no threshold

    hypoglycemia classification

  • What are common causes of hypoglycemia?

    • Decreased caloric intake
    • Skipped meals
    • Too much insulin
    • Increased exercise
    hypoglycemia causes

  • What is the treatment for Level 1 hypoglycemia?

    Eat 15-20 grams of glucose, recheck SMBG in 15 min

    hypoglycemia treatment

  • What is the treatment for Level 2 and 3 hypoglycemia?

    Glucagon administration

    hypoglycemia treatment

  • What is nephropathy caused by?

    Persistent hyperglycemia leads to protein in urine

    complications nephropathy

  • What is retinopathy?

    Damage to retina's blood vessels from hyperglycemia

    complications retinopathy

  • What is neuropathy caused by?

    Hyperglycemia damages blood vessels to nerves

    complications neuropathy

  • What does diabetic foot infection result from?

    Decreased sensation, poor blood flow, structural changes

    complications foot_infection

  • What is the prevention for nephropathy?

    Glycemic control and blood pressure control

    prevention nephropathy

  • What is the prevention for retinopathy?

    Glycemic control and blood pressure control

    prevention retinopathy

  • What is the prevention for neuropathy?

    Glycemic control and annual screening

    prevention neuropathy

  • What is the prevention for diabetic foot infection?

    Glycemic control, annual foot exam, daily self-checks

    prevention foot_infection

  • What is a major complication of diabetes related to foot health?

    Foot ulcers complicated by impaired wound healing

    diabetes health

  • What is a key prevention method for foot ulcers in diabetes?

    • Glycemic control
    • Annual foot exam
    • Daily self-foot checks
    • Diabetic shoes
    diabetes prevention

  • What is the major cause of morbidity and mortality in diabetes?

    Cardiovascular disease

    diabetes complications

  • What blood pressure target is recommended for diabetes management?

    Blood pressure <130/80 mm Hg

    diabetes hypertension

  • What are the LDL and HDL targets for lipid management in diabetes?

    • LDL <100 mg/dL
    • HDL >50 mg/dL
    diabetes lipids

  • What is the ADA A1c target for glycemic control in diabetes?

    A1c <7%

    diabetes glycemic_control

  • What is a more stringent A1c target if achievable without hypoglycemia?

    A1c <6.5%

    diabetes glycemic_control

  • What is the preprandial plasma glucose target for diabetes management?

    80-130 mg/dL

    diabetes glycemic_control

  • What is the peak post-prandial glucose target for diabetes?

    <180 mg/dL

    diabetes glycemic_control

  • What is the recommended exercise duration for diabetes management?

    150 minutes/week of moderate aerobic activity

    diabetes exercise

  • What are two types of medications for diabetes management?

    • Insulin sensitizers
    • Insulin secretagogues
    diabetes medications

  • What is the mechanism of action of Metformin?

    • Decrease hepatic glucose production
    • Increased glucose uptake by liver and skeletal muscle
    diabetes medications

  • What is a common adverse effect of Metformin?

    GI upset

    diabetes medications

  • What is a contraindication for starting Metformin therapy?

    eGFR <30 ml/min

    diabetes medications

  • What is the eGFR threshold for starting therapy?

    Not recommended if eGFR is 30-45 ml/min

    kidney therapy

  • When should you check kidney function after IV contrast?

    Before and 48 hours after IV contrast

    kidney contrast

  • What should Metformin be taken with?

    Take with food

    medication metformin

  • What is the maximum dose of Metformin?

    2000 mg/day

    medication metformin

  • What are the agents in Thiazolidinediones (TZDs)?

    • Pioglitazone (Actos®)
    • Rosiglitazone (Avandia®)
    medication tzds

  • What is the mechanism of action for TZDs?

    Increases peripheral insulin sensitivity

    medication tzds

  • What is the efficacy of TZDs in decreasing A1c?

    Decreases A1c by 1.5%

    medication tzds

  • What is a major adverse effect of TZDs?

    Weight gain (fat and water)

    medication tzds

  • What are the contraindications for TZDs?

    • NYHA Class III/IV
    • Active hepatic disease
    • Pregnancy/Breastfeeding
    medication tzds

  • What type of agents are Sulfonylureas?

    • First Generation
    • Second Generation
    medication sulfonylureas

  • What is the mechanism of action for Sulfonylureas?

    Binds to a receptor on the pancreas to stimulate 2nd phase insulin release

    medication sulfonylureas

  • What is the efficacy of Sulfonylureas in decreasing A1c?

    Decreases A1c by 1.5 – 2%

    medication sulfonylureas

  • What are the adverse reactions of Sulfonylureas?

    • Hypoglycemia
    • Weight gain
    medication sulfonylureas

  • What are the agents in Meglitinides?

    • Repaglinide (Prandin®)
    • Nateglinide (Starlix®)
    medication meglitinides

  • What is the mechanism of action for Meglitinides?

    Stimulates glucose-dependent release of insulin

    medication meglitinides

  • What is the efficacy of Meglitinides in decreasing A1c?

    Decreases A1c by approximately 1%

    medication meglitinides

  • What is the mechanism of action for Alpha-glucosidase Inhibitors?

    Slows intestinal carbohydrate digestion and absorption

    medication alpha-glucosidase

  • What are the agents of Alpha-glucosidase Inhibitors?

    • Acarbose (Precose®)
    • Miglitol (Glyset®)
    medications alpha-glucosidase

  • What is the mechanism of action for Alpha-glucosidase Inhibitors?

    Slows intestinal carbohydrate digestion and absorption

    mechanism alpha-glucosidase

  • What is the efficacy of Alpha-glucosidase Inhibitors?

    A1C decreased by 0.3-1%

    efficacy alpha-glucosidase

  • What are the advantages of Alpha-glucosidase Inhibitors?

    • Focuses on postprandial glucose
    • Weight neutral
    • No hypoglycemia
    • Better timing with meals
    advantages alpha-glucosidase

  • What are the adverse reactions of Alpha-glucosidase Inhibitors?

    • GI side effects
    • Flatulence
    • Bloating
    • Diarrhea
    • Abdominal discomfort
    adverse_reactions alpha-glucosidase

  • What are the contraindications for Alpha-glucosidase Inhibitors?

    • Bowel digestive abnormalities
    • Cirrhosis
    • CrCl <25 ml/min
    contraindications alpha-glucosidase

  • What are the agents of Sodium Glucose Co-Transporter 2 Inhibitors?

    • Canagliflozin (Invokana®)
    • Dapagliflozin (Farxiga®)
    • Empagliflozin (Jardiance®)
    • Ertugliflozin (Steglatro®)
    medications sglt2

  • What is the mechanism of action for SGLT2 Inhibitors?

    Inhibits SGLT2 in proximal renal tubule, reducing glucose reabsorption

    mechanism sglt2

  • What is the efficacy of SGLT2 Inhibitors?

    0.5 – 1% reduction in A1C

    efficacy sglt2

  • What are the advantages of SGLT2 Inhibitors?

    • Reduced cardiovascular M&M
    • Low risk of hypoglycemia
    • Weight loss
    • Lowers blood pressure
    advantages sglt2

  • What are the adverse effects of SGLT2 Inhibitors?

    • UTI
    • Genital fungal infections
    adverse_effects sglt2

  • What are the contraindications for SGLT2 Inhibitors?

    • Renal impairment
    • GFR <30-60 ml/min
    contraindications sglt2

  • What are the agents of DPP-4 Inhibitors?

    • Sitagliptin (Januvia®)
    • Saxagliptin (Onglyza®)
    • Linagliptin (Tradjenta®)
    • Alogliptin (Nesina®)
    medications dpp-4

  • What is the mechanism of action for DPP-4 Inhibitors?

    Inhibits DPP-4 activity, increasing insulin secretion and decreasing glucagon secretion

    mechanism dpp-4

  • What is the efficacy of DPP-4 Inhibitors?

    Decreases A1C by 0.7-1%

    efficacy dpp-4

  • What are the adverse reactions of DPP-4 Inhibitors?

    • Headache
    • Nasopharyngitis
    • Pancreatitis
    • Urticaria
    adverse_reactions dpp-4

  • What are the clinical pearls for DPP-4 Inhibitors?

    Weight neutral; no hypoglycemia as monotherapy

    clinical_pearls dpp-4

  • What are some combination products for diabetes treatment?

    • Glucovance (glyburide/metformin)
    • Avandamet (rosiglitazone + metformin)
    • Janumet (sitagliptin/metformin)
    combination diabetes

  • What is the A1C reduction for Sulfonylureas?

    1.5-2%

    a1c_reduction sulfonylureas

  • What are the agents of GLP-1 Receptor Agonists?

    • Exenatide (Byetta®)
    • Liraglutide (Victoza®)
    • Dulaglutide (Trulicity®)
    medications glp-1

  • What is the mechanism of action for GLP-1 Receptor Agonists?

    Increase insulin secretion; decrease glucagon secretion; slow GI absorption

    mechanism glp-1

  • What is the efficacy of GLP-1 Agonists?

    • Decrease A1c by approximately 0.5-1%
    • Reduced cardiovascular M&M
    • Weight loss
    pharmacology glp-1 diabetes

  • What are common adverse reactions of GLP-1 Agonists?

    • Gastrointestinal: nausea, vomiting, diarrhea
    • Potential for hypoglycemia
    • Acute pancreatitis
    pharmacology glp-1 adverse_effects

  • What is the mechanism of action of Amylinomimetic?

    • Amylin analog
    • Delays gastric emptying
    • Causes satiety
    pharmacology amylinomimetic mechanism

  • What are the adverse effects of Amylinomimetic?

    • Gastrointestinal: nausea, vomiting, anorexia
    • Insulin-induced hypoglycemia
    pharmacology amylinomimetic adverse_effects

  • What should be done with short-acting insulin before starting Amylinomimetic?

    Decrease by 50% before starting

    pharmacology amylinomimetic insulin

  • What is the goal in managing high-risk individuals with Type 2 Diabetes?

    Cardiovascular and Kidney Risk Reduction

    diabetes management goals

  • What are the indications for SGLT2i?

    • Proven CVD benefit
    • CKD progression reduction
    pharmacology sglt2i indications

  • What is the role of insulin in metabolism?

    Anabolic and anticatabolic hormone, allows glucose entry into cells

    pharmacology insulin metabolism

  • What are common adverse effects of insulin?

    • Hypoglycemia
    • Weight gain
    pharmacology insulin adverse_effects

  • What is the difference between basal and bolus insulin?

    Basal insulin maintains baseline glucose levels; bolus insulin is given at mealtime to manage spikes.

    pharmacology insulin types

  • What is the purpose of exogenous insulin?

    To decrease hyperglycemia in patients with diabetes.

    diabetes insulin

  • What is basal insulin used for?

    Provides consistent insulin level to decrease blood glucose through night and between meals.

    diabetes insulin

  • What is bolus insulin used for?

    Administered to decrease glucose after meals.

    diabetes insulin

  • What is the onset of insulin?

    Length of time insulin enters blood stream and begins lowering blood glucose.

    diabetes insulin

  • What does peak refer to in insulin action?

    Time insulin is at maximum strength in terms of lowering blood glucose.

    diabetes insulin

  • What does duration indicate for insulin?

    How long insulin lowers blood glucose.

    diabetes insulin

  • What is the onset of Rapid Acting Insulin like Humalog?

    15-30 min.

    diabetes insulin rapid_acting

  • What is the duration of Long Acting Insulin like Lantus?

    22-24 hr.

    diabetes insulin long_acting

  • What is a common insulin regimen for mimicking normal secretion?

    Insulin pump: Basal delivery + Mealtime boluses of rapid-acting insulin.

    diabetes insulin regimen

  • What is the initiation dose for basal insulin?

    Start 10 units per day OR 0.1-0.2 units/kg per day.

    diabetes insulin dosing

  • How is the titration of basal insulin determined?

    Increase 2 units every 3 days to reach FPG target without hypoglycemia.

    diabetes insulin titration

  • What is the typical initiation dose for prandial insulin?

    4 units per day or 10% of basal insulin dose.

    diabetes insulin dosing

  • How is titration of prandial insulin managed?

    Increase dose by 1-2 units twice weekly.

    diabetes insulin titration

  • What is the insulin dosing for Type 1 Diabetes?

    0.5 units/kg/day - 50% basal insulin - 50% bolus insulin divided with meals

    diabetes insulin dosing

  • How many units of bolus insulin does a 70 kg patient require?

    18 units

    diabetes insulin bolus

  • What is the target A1c for diabetes management?

    <7%

    diabetes a1c management

  • What is the target fasting plasma glucose range?

    70-130 mg/dL

    diabetes glucose target

  • What is the target 2-hour post-prandial glucose?

    <180 mg/dL

    diabetes glucose target

  • What should you check for when reviewing glucose logs?

    1. Pattern of hypoglycemia
    2. Correct fasting blood glucose first
    3. Correct other values
    4. Identify insulin affecting abnormal values
    diabetes glucose review

  • What is the Somogyi Effect?

    Nocturnal hypoglycemia leading to high AM fasting blood glucose.

    diabetes somogyi hypoglycemia

  • What is the Dawn Phenomenon?

    Reduced sensitivity to insulin between 5AM-8AM.

    diabetes dawnphenomenon insulin

  • How much will increasing insulin by 1-2 units lower glucose?

    30-50 mg/dL

    diabetes insulin adjustment

  • What are the wellness prevention measures for diabetes?

    • Smoking cessation
    • Daily aspirin
    • Dental care
    • Podiatry
    • Ophthalmology
    • Immunizations
    diabetes prevention wellness

  • What is the adult obesity rate in Texas as of 2017?

    33.0%

    obesity texas statistics

  • What are the causes of obesity?

    Too much food, too little insulin or diabetes pills, illness, stress.

    obesity causes health

  • What symptoms may indicate a diabetes emergency?

    Blurry vision, drowsiness, slow healing.

    diabetes symptoms emergency

  • What are the causes of hyperglycemia?

    • Too much food
    • Too little insulin or diabetes pills
    • Illness
    • Stress
    diabetes hyperglycemia

  • What are the symptoms of hyperglycemia?

    • Blurry vision
    • Drowsiness
    • Slow-healing wounds
    diabetes symptoms

  • What can cause hypoglycemia?

    • Little food or skipping meals
    • Too much insulin or diabetes pills
    • More active than usual
    diabetes hypoglycemia

  • What is the target glucose range for diabetes management?

    70-180 mg/dL

    diabetes management

  • What percentage of readings should be in the target range?

    Greater than 70%

    diabetes management

  • What is the average glucose level in the report?

    173 mg/dL

    diabetes statistics

  • What is the Glycemic Management Indicator (GMI) in the report?

    7.6%

    diabetes statistics

  • What is the glucose variability percentage?

    49.5%

    diabetes statistics

  • What are the phases of insulin secretion?

    • 1st phase
    • 2nd phase
    diabetes insulin

  • What is the effect of SGLT2 inhibition in type 2 diabetes?

    • Reduces blood glucose levels
    • Less glucose reabsorption
    • Increased glucose excretion
    diabetes medication

  • What are the benefits of insulin?

    • Neuroprotection
    • Cardioprotection
    • Appetite regulation
    • Insulin sensitivity
    diabetes insulin

  • What is the goal in managing Type 2 Diabetes?

    • Cardiovascular risk reduction
    • Kidney risk reduction
    • Achievement and maintenance of weight and glycemic goals
    diabetes management

  • What indicators suggest high CVD risk in Type 2 Diabetes?

    • Current or prior eGFR <60 mL/min/1.73 m²
    • Symptoms of HF
    • Albuminuria (ACR >30 mg/g)
    diabetes cvd risk

  • What is the role of GLP-1 RA in diabetes treatment?

    • Proven CVD benefit
    • Can be combined with SGLT2i
    • Efficacy for glucose lowering
    diabetes medications glp-1

  • What is the initial dose for basal insulin?

    • 10 units per day
    • 0.1-0.2 units/kg per day
    diabetes insulin dosing

  • What should be done if hypoglycemia occurs during insulin therapy?

    • Determine cause
    • Lower dose by 10-20% if no clear reason
    diabetes insulin hypoglycemia

  • What are common short-acting insulins?

    • Aspart
    • Lispro
    • Glulisine
    diabetes insulin short-acting

  • What is the titration strategy for basal insulin?

    • Increase 2 units every 3 days
    • Aim for FPG target without hypoglycemia
    diabetes insulin titration

  • What is recommended for prandial insulin initiation?

    • 4 units per day
    • 10% of basal insulin dose
    diabetes insulin prandial

  • What is the total NPH dose adjustment for mixed insulin regimen?

    • Total NPH dose = 80% of current NPH dose
    • 2/3 before breakfast, 1/3 before dinner
    diabetes insulin nph

  • What is a key consideration when adding SGLT2i?

    • Proven CVD benefit
    • Can start with eGFR = 20 mL/min/1.73 m²
    diabetes sglt2i treatment

  • What is the titration method for short/rapid-acting insulin?

    • 1 each injection
    • 10% of reduced NPH dose
    insulin titration

  • What is a basal-bolus regimen?

    • Basal insulin
    • Prandial insulin with each meal
    insulin regimen

  • How should insulin titration be based?

    • Individualized needs
    insulin titration

  • What components should be titrated in a regimen?

    • Each component based on individualized needs
    insulin titration