Gcp Endocrinology Diabetes

Front 1

_______ is the leading cause for diabetes related death.

Back 1

Heart Disease

Front 2

Diabetics rate of CVD is __ to __ times higher.

Back 2

2 to 4 times

Front 3

Risk of Stroke in diabetics is ___ to __ times higher

Back 3

2 to 4 times

Front 4

____ percent for diabetics have HBP higher + or > ( ___/ 80 mm Hg)

Back 4

73 % ; ( 130/ 80mm Hg)

Front 5

________ is the leading cause of blindness newly diagnosed in persons 20 to 74 years.

Back 5

Diabetes

Front 6

______ ______ causes 12 to 24 thousand new cases of blindness each year.

Back 6

Diabetic Retinopathy

Front 7

________ is the leading cause of end-stage renal disease. ____ % of new cases each year.

Back 7

Diabetes ; 44 percent

Front 8

Diabetes accounts for ___ % of non-traumatic lower limb amputation.

Back 8

60 %

Front 9

____ % of diabetics have periodontal disease.

Back 9

33 % ( 1/3)

Front 10

Poorly controlled diabetes in pregnancy, especially in the 1st trimester, can result in _______ ______ _____ and _________ _________.

Back 10

Major birth defects and spontaneous abortion

Front 11

Diabetic Keto-acidosis **

Back 11

Diabetic Keto-acidosis is

Front 12

hyper-osmolar ( nonketotic) coma**

Back 12

hyper-osmolar ( nonketotic) coma is

Front 13

____ % of new diabetic cases occur in people > ___ years

Back 13

50 % ; 55 years

Front 14

___ to ____% of diabetics are insulin dependent

Back 14

5 - 10 %

Front 15

____ TO ____% of diabetics are NOT insulin dependent.

Back 15

90 - 95 %

Front 16

Diabetes diagnosis = __________ new cases each year.

Back 16

625,000

Front 17

Why are IDDM and NIDDM no longer used ?

Back 17

Many non-insulin dependent diabetics need some insulin to achieve normoglycemia.

Front 18

Glycogenesis*

Back 18

Glycogenesis

Front 19

Glycolysis**

Back 19

Glycolysis**

Front 20

Glycogenolysis**

Back 20

Glycogenolysis**

Front 21

Plasma glucose (normal range)

Back 21

70 - 110 mg/ dL

Front 22

glucagon**

Back 22

glucagon**

Front 23

____% of glucose provided by glycogenolysis.

Back 23

75%

Front 24

____% of glucose provided by

Back 24

25%

Front 25

gluconeogenesis**

Back 25

gluconeogenesis**

Front 26

__________ results when glucose is not available

Back 26

Lipolysis

Front 27

Lipolysis**

Back 27

Lipolysis**

Front 28

Fats->___ ____ ____->____ _____

Back 28

Fats->free fatty acids-> Keto acids

Front 29

Insulin is secreted by the __________ beta cells in the _______ of __________.

Back 29

pancreatic ; Islets of langerhans

Front 30

Pre-diabetes**

Back 30

Pre-diabetes**

Front 31

Prediabetes is sometimes called _____ _____ _____ (IFG) or ________ _______ ________ (IGT).

Back 31

Prediabetes is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).

Front 32

( IFG )

Back 32

impaired fasting glucose (IFG)

Front 33

( IGT ).

Back 33

impaired glucose tolerance (IGT).

Front 34

Glucose range for IFG = ____ - _____ mg / dL, _________ after test

Back 34

Glucose range for IFG = 100 -125 mg / dL, overnight after test

Front 35

Glucose range for IGT = ____- ____ mg / dL, at ___ hours after test

Back 35

Glucose range for IGT = 140 - 199 mg / dL, 2 hours after test

Front 36

In Adults 40 to 74; _____ % have prediabetes .

Back 36

40 %

Front 37

________and ______ _____ can return prediabetics to normal

Back 37

Exercise and weight loss can return prediabetics to normal

Front 38

Troglitazone \G

Back 38

Rezulin \B

Front 39

Diabetic patients experience _________ fasting plasma insulin.

Back 39

Diabetic patients experience Increased fasting plasma insulin.

Front 40

Diabetic patients experience Fasting blood glucose (FBG) _____ -______mg/dL

Back 40

Diabetic patients experience Fasting blood glucose (FBG) 140-180 mg/dL

Front 41

Diagnosis of diabetes is a (FBG) range = _____ to ______mg/dL

Back 41

Diagnosis of diabetes is a (FBG) range = 140-180 mg/dL

Front 42

Hyperinsulinemia**

Back 42

Hyperinsulinemia is a down regulation of insulin receptor with post-receptor binding defects

Front 43

With disrupted regulation of insulin receptors and post-receptor binding defects, __________________ may result.

Back 43

However, with disrupted regulation of insulin receptors and post-receptor binding defects, hyperinsulinemia may result

Front 44

Post- ________ hyperglycemic state stimulates ______ _________ in order to normalize plasma glucose

Back 44

Post-prandial hyperglycemic state stimulates insulin secretion in order to normalize plasma glucose

Front 45

Patients with Type 2 diabetes have elevated ______ ______ ______ secondary to _______ _______ _______ secretion due to insulin ____________.

Back 45

Patients with Type 2 diabetes have elevated fasting plasma insulin secondary to augmented basal insulin secretion due to insulin resistance.

Front 46

Another name for Metabolic Syndrome is Syndrome X .

Back 46

Another name for ______ _______is Syndrome X .

Front 47

Another name for Metabolic Syndrome is ________ ____.

Back 47

Another name for Metabolic Syndrome is Syndrome X .

Front 48

Metabolic Syndrome or Syndrome X is characterized by: ( 5 things)

Back 48

Metabolic Syndrome or Syndrome X is characterized by:
Central Obesity
HBP
Elevated triglycerides
Low HDL-cholesterol
Insulin Resistance

Front 49

________ __________ is often considered a central component of metabolic syndrome, significantly increases the risk of ____________ morbidity / mortality.

Back 49

Insulin resistance is often considered a central component of metabolic syndrome, significantly increases the risk of cardiovascular morbidity and mortality.

Front 50

Diabetic dyslipidemia**

Back 50

Dyslipidemia (increased TG, decreased HDL - aka diabetic dyslipidemia)

Front 51

# Frequent urination(poly_____)
# Excessive thirst (poly______)
# Extreme hunger (poly_______)

Back 51

# Frequent urination(polyuria)
# Excessive thirst (polydipsia)
# Extreme hunger (polyphagia)

Front 52

Altered mental status in diabetics (owing to _________ blood sugar levels)

Back 52

Altered mental status (owing to FLUCTUATING blood sugar levels)

Front 53

The following are what type of complications in the diabetic patient??_________ _________

* Coronary artery disease
* Cerebrovascular disease (stroke)
* Peripheral vascular disease (PVD)

Back 53

Macrovascular- complications:

* Coronary artery disease
* Cerebrovascular disease (stroke)
* Peripheral vascular disease (PVD)

Front 54

The following are termed ____________ complications:
* Retinopathy, * Nephropathy, * Neuropathy

Back 54

Microvascular complications
* Retinopathy, * Nephropathy, * Neuropathy

Front 55

Initially presentation of Patients with diabetes , ( not limited to) : unexplained weight loss, fatigue, blurred vision, or neuropathy.

Back 55

Patients with diabetes may initially present with
unexplained weight loss, fatigue, blurred vision, or neuropathy.

Front 56

Are example of ________ ________ _______(____)

* silent ischemia
* angina
* myocardial infarction

Back 56

# Coronary Artery Disease (CAD)

* silent ischemia
* angina
* myocardial infarction

Front 57

# Are example of ____________ ____________(____) :----
Stroke (CVA) , Transischemic attack (TIA)

Back 57

# Cerebrovascular Disease (CVD)

* Stroke (CVA)
* TIA (Transischemic attack)

Front 58

Are example of ________ _________ _________ (____)

* diabetic foot
* intermittent claudication

Back 58

# Peripheral Vascular Disease (PVD)

* diabetic foot
* intermittent claudication

Front 59

__________complications that result in the greatest impact on quality of life and degree of __________. Up to _____% of people with diabetes will experience nervous system damage in their lifetime.

Back 59

microvascular complications that result in the greatest impact on the person's quality of life and degree of disability. Up to 70% of people with diabetes will experience nervous system damage in their lifetime.

Front 60

They include 3 common categories of microvascular problems in the diabetic include ?

Back 60

They include 3 common categories:
Retin-opathy, Neph-ropathy
and Neur-opathy

Front 61

Paresthesias is _______ _____ or ______in the feet or hands---- may be experienced as ________ as ________, ______,or _________.

Back 61

Paresthesias, impaired sensation or pain in the feet or hands known or abnormal sensations such as burning, tingling, pricking

Front 62

Gastroparesis is ________ ______of food in the _________.

Back 62

Gastroparesis, slowed digestion of food in the stomach

Front 63

The following symptoms may be related to diabetes because of the disease multi-system effects ?

Back 63

# Carpal tunnel syndrome
# Muscle weakness
# Impotence
# Postural hypotension
# Diarrhea

Front 64

Retinopathy is divided into (#)___ categories. ___________ retinopathy and _____________ retinopathy

Back 64

Retinopathy is divided into two main categories. Non-proliferative retinopathy and proliferative retinopathy

Front 65

Non-proliferative retinopathy can be recognized by development of ______________, ______ ______, _________ ____________, hard and soft ____________.

Back 65

Non-proliferative retinopathy can be recognized by development of microaneurysms, venous loops, retinal hemorrhages, hard exudates and soft exudates

Front 66

Proliferative retinopathy is presence of ______blood vessels with or without _________hemorrhage.

Back 66

Proliferative retinopathy is defined as presence of new blood vessels with or without vitreous hemorrhage. Proliferative retinopathy represents a progression of non-proliferative retinopathy.

Front 67

Diabetic nephropathy is the presence of persistent ___________ , ie. >_____gms/___ hours and can eventually progress to ____ ______ ______ disease.

Back 67

Diabetic nephropathy is defined as the presence of persistent proteinuria >0.5 gms/24 hours. Overt nephropathy is characterized by progressive decline in renal function resulting in end stage renal disease.

Front 68

The ______(#) classifications of Neur-opathy are _______, _______, __________,_________ and ____________.

Back 68

The 5 classifications of NEUROpathy include: focal, diffuse, sensory, motor and autonomic..

Front 69

DKA**

Back 69

diabetic ketoacidosis

Front 70

HHNS**

Back 70

Hyperglycemic hyperosmolar nonketotic syndrome

Front 71

_________steroids are diabetogenic agents.

Back 71

Corticosteroids are diabetogenic agents

Front 72

___________ diuretics are diabetogenic agents

Back 72

Thiazide diuretics are diabetogenic agents

Front 73

________ _________ ( antihypertensives) are diabetogenic agents

Back 73

Beta blockers are diabetogenic agents

Front 74

Are 5 risk factors for diabetes:

Back 74

> 45 years , 1st deg. relative,
African-Am., Hispanic, or Nat. Am. descent, * HDL < 35 mg/dL OR Triglyceride > 250 mg/dl , HBP (> 140/90) , Obesity

Front 75

The following tests are used for diagnosis:

Back 75

The following tests are used for diagnosis:
* Fasting plasma glucose
* Oral glucose tolerance
* Random plasma glucose

Front 76

Fasting plasma glucose --- measures ________ ______ after patient has gone at least ____ hours without eating.

Back 76

Fasting plasma glucose --- measures blood glucose after patient has gone at least 8 hours without eating.

Front 77

Oral glucose tolerance ---- measures ______ glucose after at least ___ hrs w/o eating followed by ____ hrs after drinking a glucose-containing liquid.

Back 77

Oral glucose tolerance test measures blood glucose after 8 hrs w/o eating-- followed by-- 2 hrs after drinking a glucose beverage.

Front 78

________ plasma glucose test, blood glucose is sampled without regard to last meal. This , along with an assessment of symptoms, used to diagnose _________but not ___________.

Back 78

Random plasma glucose test, blood glucose is sampled without regard to last meal. This , along with an assessment of symptoms, used to diagnose diabetes but not pre-diabetes.

Front 79

Positive results to any of the 3 tests for diabetes should be confirmed with a _______ ________ ______test or _______ ________ test of a __________ day

Back 79

Positive results to any of the 3 tests for diabetes should be confirmed with a fasting plasma glucose test or glucose tolerance test of a differnet day

Front 80

FPG**

Back 80

Fast plasma glucose

Front 81

FPG is most reliable at what time of day?

Back 81

morning

Front 82

FPG is the preferred test because ?

Back 82

FPG is the preferred test because it is the most convenient and the most reliable.

Front 83

Normal value for FPG ?

Back 83

= or < than 99 mg/dL

Front 84

Pre-diabetes range for FPG ?

Back 84

100 - 125 mg/dL

Front 85

Diabetes confirmed range FPG ?

Back 85

= or > 126 mg/dL

Front 86

Normal value for OGTT ?

Back 86

= or < 139 mg/dL

Front 87

pre-diabetes range for OGTT ?

Back 87

140-199 mg/dL

Front 88

"Diabetes" value for OGTT ?

Back 88

200 mg/dL or >

Front 89

Contents of beverage for OGTT?

Back 89

75 mg of glucose dissolved in water

Front 90

1 mmol = _______ mg/dL

Back 90

1 mmol = 18 mg/dL

Front 91

7 mmol = _______ mg/dL
or a factor of _____.

Back 91

7 mmol = 126 mg/dL ( factor 18 ) 7 x 18 = 126

Front 92

? a drug used for PCP .ie. pneunocycistis that can cause either hyper or hypo glycemia ?

Back 92

pentamidine

Front 93

a class of medication used for HBP that can cause either hyper or hypo - glycemia ??

Back 93

Beta blockers

Front 94

__________ (esp sulfoylureas) can induce both hyper and hypoglycemia

Back 94

diuretics

Front 95

repaglinide \G

Back 95

Prandin \B

Front 96

repaglinide is part vof what class of agents ?

Back 96

meglitinides

Front 97

Meglitinides/ phenylalanine can induce ______glycemia but not _______glycemia.

Back 97

REPAGLINIDE AND NATEGLINIDE CAN INDUCE HYPOGLYCEMIA BUT NOT HYPER-GLYCEMIA

Front 98

Class of antihypertensive agents that may induce hypoglycemia , but not hyperglycemia??

Back 98

ACE inhibiters

Front 99

Recovery from alcoholism can unmask _______-glycemia. because alcohol induces _______-glycemia

Back 99

Recovery from alcoholism can unmask diabetes hyper-glycemia. because alcohol induces hypo-glycemia

Front 100

Preprandial Glucose
Normal < _____mg/dl
Goal ____-_____ mg/dl
if < ____, reduce therapy
if > _____, tighten control

Back 100

Preprandial Glucose :
Normal <115 mg/dl
Goal 80-120 mg/dl
if < 80, reduce therapy
if > 120, tighten control

Front 101

Bedtime Glucose : Normal<____mg/dl , GOAL ____-_____mg/dl
if < _____, reduce therapy
if > ______, tighten control

Back 101

Bedtime Glucose : Normal<120 mg/dl , GOAL 100-140 mg/dl
if < 100, reduce therapy
if > 140, tighten control

Front 102

Hemoglobin A1c : NORMAL< ___units , GOAL < ____units , if > ____, tighten controls

Back 102

Hemoglobin A1c : NORMAL< 6 units , GOAL < 7 units , if > 8, tighten controls

Front 103

Sulfoureas are more accurately called antihyperglycemics or hypoglycemics ?

Back 103

hypoglycemics

Front 104

the term Obese = Hyper___________

Back 104

HYPERLIPIDEMIC

Front 105

Metformin is a/an _______glycemic agent. Thiazolidiones are _______glycemic agents

Back 105

antihyperglycemic agents such as thiazolidinediones or metformin are good options

Front 106

Impaired insulin secretion in type 2 diabetes is a primary indication for what class?

Back 106

Sulfonylureas

Front 107

A primary indication for repaglinide is ?

Back 107

impaired insulin secretion

Front 108

the term Obese = Hyper___________

Back 108

HYPERLIPIDEMIC

Front 109

troglitazone _________ muscle Beta cell sensitivity to_________ produced

Back 109

troglitazone increases muscle Beta cell sensitivity to insulin produced

Front 110

METFORMIN ___________ Beta cell sensitivity to__________

Back 110

METFORMIN increases muscle Beta cell sensitivity to insulin produced

Front 111

Of the sulfonylureas ,____________ has the highest likelihood of inducing hypoglycemia.

Back 111

chlpropamide

Front 112

Sulfonylureas can cause a _________ _________ like Antabuse.

Back 112

disulferam reaction

Front 113

tolbutamide \g

Back 113

Orinase \b

Front 114

Chlorpropamide \g

Back 114

Diabenese \b

Front 115

Glyburide \g

Back 115

Diabeta , Micronase \b

Front 116

glyburide micronized \g

Back 116

Glynase \b

Front 117

Glipizide \g

Back 117

Glucotrol \b

Front 118

glipizide XL \g

Back 118

Glucotrol XL \b

Front 119

Glimiperide \g

Back 119

Amaryl \b

Front 120

The sulfonylureas inhibit the efflux of ____________ and leads to the opening of __________ __________ and the subsequent influx of ___________ with release of insulin

Back 120

The sulfonylureas inhibit the efflux of potassium and leads to the opening of calcium channels and the subsequent influx of calcium with the release of insulin

Front 121

Glimeperide is a ______ generation ___________and the only __________ approved by the FDA for use with __________.

Back 121

Glimeperide is a 2nd generation sulfonylurea and the only sulfonylurea approved by the FDA for use with insulin.

Front 122

____________ and _________ are safer in the elderly and in those with _________ ____________.

Back 122

glimepiride and glipizide are safer in the elderly and in those with renal impairment

Front 123

Glyburide should be used cautiously in the elderly due to the ________ ____ _________ and _________ _____________ that are excreted renally.

Back 123

Glyburide should be used cautiously in the elderly due to the duration of action and active metabolites that are excreted renally.

Front 124

___________ is the safest 2nd generation sulfonylurea for use in the elderly especially for those with _______ ___________.

Back 124

Glipizide is the safest 2nd generation sulfonylurea for use in the elderly especially for those with renal impairment.

Front 125

Repaglanide \g

Back 125

Prtandin \b

Front 126

Nateglinide \g

Back 126

Starlix \b

Front 127

Repaglinide should be given ( how long / time) before a meal and should not be given if _______ ________ ___ _______..

Back 127

Repaglinide should be given 30 minutes before a meal and should not be given if a meal is missed..

Front 128

__________ is a phenylalanine derivative and works similarly to _____________.

Back 128

Natgeglinide is a phenylalanine derivative and works similarly to repaglinide.

Front 129

Generic and brand names of Rapid acting insulins

Back 129

Insulin lispro (Humalog)
Insulinf aspartate (Novolog)

Front 130

Generic and Brands of "short-acting insulins

Back 130

Regular rDNA lilly (Humulin)
Regular rDNA Novo (Novolin)
Regular Pork (Illetin II )

Front 131

Generic and Brands of Intermediate acting insulins

Back 131

NPH rDNA Lilly (Humulin N )
NPH rDNA Novo (Novolin N)
NPH Pork Lilly (NPH Iletin II )

Front 132

Generic and brand names of LONG-acting insulin

Back 132

Insulin Glargine (Lantus)
Ultrlente Lilly (Humulin U)

Front 133

Generic and Brand Names of insulin combination of Intermediate with Rapid-acting

Back 133

75% Lispro protamine +/ 25% Lispro ( HUMALOG Mix 75/25) ;
70% Aspartate protamine + 30% Aspartate (Novolog Mix 70/30)

Front 134

Generic and Brand names of an intermediate combination with a short-acting insulin

Back 134

50%NPH / 50% R (Humulin 50/50)
70%NPH/30%R (Humulin 70/30)
70% NPH / 30% R (Novolin 70/30)

Front 135

Humulin (Lispro) is used with other insulins because

Back 135

its short action provides flexibility

Front 136

_______ action is similar to Humalog's but it has a slightly ________ _________

Back 136

Novolog's action is similar to Humalog's but it has a slightly longer duration

Front 137

Novolog's action is similar to _________ but it has a ________ ________ duration

Back 137

Novolog's action is similar to Humalog's but it has a slightly longer duration

Front 138

Glulisine insulin /g

Back 138

Apidra /b

Front 139

Glulisine insulin is similar to ________ and ________ (give genric short form)

Back 139

Lispro and Aspartate

Front 140

Insulin Glargine (Lantus®) - ______ acting human insulin analog (________ insulin)

Back 140

Insulin Glargine (Lantus®) - Long acting human insulin analog (basal insulin)

Front 141

Insulin Glargine (Lantus®)--
* Relatively _______ concentration/time profile over ____ hours

Back 141

Insulin Glargine (Lantus®)--
* Relatively constant concentration/time profile over 24 hours

Front 142

Insulin Glargine (Lantus®) ---
has NO ________ _____ .

Back 142

Insulin Glargine (Lantus®) ---
has NO pronounced peak

Front 143

Insulin Glargine (Lantus®)
( can or can not) ?"? be _____ or ______ with any other insulin or solution

Back 143

Insulin Glargine (Lantus®)
( can not) be mixed or diluted with other insulins or solution

Front 144

Insulin Glargine (Lantus®) ---- when converting patients from NPH adjustment is required if NPH used was more than _______ per day.

Back 144

Insulin Glargine (Lantus®) ---- when converting patients from NPH adjustment is required if NPH used was more than { 1 time ,once} per day.

Front 145

Insulin Detemir /g

Back 145

Levemir /b

Front 146

Levemir ( ? can or cannot?) be mixed with _______ ____ ______

Back 146

Levemir ( ? can or cannot?) be mixed with ANY OTHER INSULINS

Front 147

Levemir is a ______- acting insulin

Back 147

Levemir is a LONG-acting insulin

Front 148

Levemir when given to Type One diabetics may require __________ dosing

Back 148

Levemir when given to Type One diabetics may require 2x / twice a day dosing

Front 149

3 classes of "anti-hyper-glycemic agents:

Back 149

Biguanides , Alpha-glucosidase inhibiters , and (TZDs) Glitizones <-Tiazolidinediones

Front 150

acarbose /g

Back 150

Precose

Front 151

miglitol /g

Back 151

Glyset

Front 152

rosiglitizone /g

Back 152

Avandia

Front 153

pioglitiazone /g

Back 153

Actos /b

Front 154

3 Brand names that contain the biguanide called _____________ are:

Back 154

Glucophage , Glucophage XR , Glucovance

Front 155

Metformin / glyburide /g

Back 155

Glucovance /b

Front 156

Primary and secondary mechanisms of action for Metformin are:

Back 156

suppressed hepatic glucose , improved insulin sensitivity , delayed glucose absorption , enhasnced glucose utilization

Front 157

Metformin dose changes (titration) should be done no shorter than

Back 157

Metformin dose changes (titration) should be done no shorter than -- weekly...

Front 158

Metformin patiernt should have baseline and periodic checks for which renal test

Back 158

serum creatinine (SCr)

Front 159

Common name for anorexia dysgeusia

Back 159

altered taste sensation

Front 160

Metformin may alter (what) sensation

Back 160

altered taste sensation

Front 161

Biggest personnel complaints with metformin are of what type

Back 161

Gastro-intestinal

Front 162

With Metformin , ________ ________ is an extremely rare side effect but mortality is ______ %

Back 162

With Metformin , Lactic Acidosis is an extremely rare side effect but mortality is 50%

Front 163

Dysfunction of which organs indicate caution and contraindication for Metformin

Back 163

Heart, Kidney,Liver

Front 164

Metformin should not be started or cshould be discontinued in the face of _________ infection

Back 164

Severe infection

Front 165

True or False ---Metformin is contraindicate in _______ and _______ metabolic acidosis

Back 165

True ....acute or cdhronic metabolic acidosis

Front 166

midamor /b

Back 166

amiloride /g

Front 167

Which Organ functions shyould be monitored closely with Acarbose and Miglitol ; And how often

Back 167

Liver , hepatic function testing needs to be done at least quarterly during the 1st year.

Front 168

With Precose , what type of glucose testing should be done during titration ?

Back 168

1 hour post-prandial glucose

Front 169

Are sometimes called insulin sensitizers and can have what effect on insulin needs ?

Back 169

TZDs - Actos and Precose : may lower or iliminate the needs for insulin

Front 170

MUST be monitored with use of Actos and Avandia

Back 170

Liver function