Diabetes Pharmacotherapy

A 54-year-old female registered nurse comes to the emergency department with symptoms of confusion, drowsiness, and hyperhidrosis. She has a known history of diabetes and takes glyburide, a sulfonylurea (SU). What about the physiology of SU overdose caused her to become hypoglycemic? 

A 21-year-old male with a known history of type 1 DM comes to the ED with symptoms of nausea, vomiting, abdominal pain, and drowsiness. His labs on admission show an AG of 22, bicarbonate of 10 and, potassium of 3.7, and a pH of 6.9. He is started on IV insulin given the diagnosis of DKA. His BMP is checked 4 hours later and is found with a potassium of 2.9. What is the cause of hypokalemia?

A 65-year-old male patient with recently diagnosed type 2 diabetes mellitus is started on metformin 1,000 mg PO twice a day given his A1c was elevated at 7%. Three months later, he develops progressively worsening symptoms of abdominal pain, nausea, vomiting, muscle cramps, and confusion over the course of 3 days. He is admitted to the hospital. His labs reveal an AG of 24, HCO3 of 18, and creatinine of 3.0 from a baseline GFR of 30. What is the pathophysiology of his current condition? 

A 50-year-old woman has a history of type 2 diabetes mellitus and is on metformin 1,000 mg PO BID and glargine 10 unit subcutaneously in the evening. She comes to a follow-up appointment with her endocrinologist and her A1c is found to be at 8% despite lifestyle modifications and compliance with the above medications. Which medication will increase an incretin release from the small intestine which aids in glucose-dependent insulin release? 

Which drug promotes glucosuria via inhibition of sodium-glucose cotransporter 2 in the kidney?

Which of the following drugs would be contraindicated as treatment for type 2 diabetes mellitus for a patient with a known history of Ulcerative Colitis?

A 23-year-oldwoman presents to an endocrinologist’s office with an official diagnosis of gestational diabetes made by her gynecologist. She is 29 weeks pregnant and she has been checking her blood sugars in fasting and 2 hours after she eats. She is already on Glargine 7 units subcutaneously at night. As you review her blood sugar levels, you find that her blood sugars after she eats are consistently above 120, which is the target in pregnancy. You tell the patient she requires Aspart or Lispro to be given before each meal. How long does it take for this insulin to reach it’s peak concentration in the blood?