A 65-year-old man with type 2 diabetes maintained on metformin needs to monitor his vitamin B12 level due to long-term metformin use. A 50-year-old woman with risk factors for type 2 diabetes including family history should start lifestyle modifications and metformin. Metformin is contraindicated in patients with acute or chronic renal insufficiency and should be stopped 48 hours before and after contrast procedures to avoid lactic acidosis.

1. 1
DIABETES
metformin
24. Metformin classification and contraindication
Metformin [met-FOR-min], the only biguanide, is classified as an insulin sensitizer (What Is Class Of Metformin ?Biguanide)
65. First line in treatment of diabetic patient ?
Metformin
18. When patient take Metformin ?
With meal as divide dose
19. Metformin of label use ?
Ovarian cystic in woman
34. Off label use metformin ?
polycystic ovary syndrome , weight lose
61. Metformin off label use
weight loss (Antidiabetic agent use as off label use for reduce weight ?Metformin)
42. What first line agent may be considered for an obese type 2? (What are, best first management for DM type 2 ) ?
Metformin
Q- Oral anti-diabetic drug can be used for type 1 DM ?
Metformin
Q- Newly diagnosed with diabetes? Metformin
43. which of the following diabetic drugs approved by fda for pediatric use ?
Metformin
94- Ptn take 4 drugs,high SrCr.HighBUN,,K ?
Should STOP Metformin
38. drug avoided in acute kidney insufficiency ?
Metformin
Q- Metformin contraindication ? lactic acidosis
48. which of the following cause metallic taste ?
Metformin
25-Patient use metformin have side effect GIT what best time to take it ?( Patient develop side effect with metformin)
Take with with meal
886- Metformin Off label use ?
Answer : Ovarian cystic in woman. metformin is effective in the treatment of polycystic ovary syndrome. It lowers insulin
resistance seen in this disorder and can result in ovulation and, therefore, possibly pregnancy. It’s also use for weight loss
Q- Which blood test you do before initiation of metformin ?
A1C - Blood glucose - renal function - Also may check vit B12
Q- Metformin monitoring ? BG - Renal function - Vitamin B12 level (Schilling test)
2. Plate diet used for ?
Diabetic
(10)Which of the following conditions use " the plate method" as lifestyle modification?
diabetes mellitus
30. what first line of treatment hypoglycemia?
Glucose is preferred treatment
32. desmopressin used in treatment of ?
nocturnal enuresis and diabetes insipidus
64. What s the treatment of Diabetic insipidus?
Desmopresson
. Acetohexamide is : Sulphonylurea :hypoglycemic
. Sulphonylurea side effect: hypoglycemia
4. What is the timeline in which symptoms of type 1 diabetes occur?

2. 2
75% b cells destruction
22. patient A1C >= 9% consider start?
dual therapy
3- Based on the latest guidelines, how to diagnose DM?
A1C > 6.5 or FPG > 126
6- DM patients should examine their eyes every?
At least every 6 to 12 month (Annually)
9- Colonoscopy screening in patient with HTN +DM every how many years?!
Colonoscopy every 10 years
14- Which inhibit conversion of micoalbumin to macroalbumin in diabetes? ACEI or ARB
352- Which inhibit conversion of micoalbumin to macroalbumin in diabetes?
Answer: Prevention: attaining and maintaining glycemic and blood pressure control, dietary protein restriction, and the use
of ACEI or ARB
Treatment for microalbuminuria or macroalbuminuria should be with an ACE-I or ARB to slow the progression of renal
disease. Arbs have data to support their use in individuals with T2DM and macroalbuminuria.
Q- Which is the best drug for pat have DM, HTN, Proteinuria ? ACE
10- What is vaccine us in DM? Flu vaccine- Td
Q- Vaccine in diabetic pt ? Pneumonia vaccine
Q- Which vaccine in diabetic foot ? TD ONLY
272 Vaccine for DM?
Answer Patients with diabetes should receive an annual influenza vaccine (if > 6 months of age), Pneumococcal vaccines
[PPSV23 (Pneumovax 23 x 1 between age 2 - 64 years and, at age > 65 years, PCV13 (,Prevnar) and Pneumovax 23, spaced at
least 12 months apart and with Pneumovax 23 spaced at least > 5 years after any previous administra tions],
And hepatitis B vaccine (FDA-approved for use in adults aged 19-59 years, but per ACIP recommendations can be used in
those > 60 years).
Tdap Zoster
26. what type of oral hypoglycemic agents can’t use with insulin? Why?
Meglitinides and sulfonylureas
Risk of hypoglycemia
43- Patient has diabetics what drug is contraindicated ?
Beta blockers because it mask hypoglycemia
Q- Drug exaggerated insulin ? masking hypoglycemia ? Beta blockers
46. Drug exaggrated blood glucose ?
Hydrochlorothiazide
Q- The synthesis of glycogen from glucose called?
Glycogenesis
Q- Drug exaggerated blood glucose? Cause hyperglycemia ?
Thiazides- Corticosteroids – Thiazides - Olanzapine – Clozapine
13 - DM + have allergic of sulfa what drug contraindication? Sulfonamide (sulphonyl urea)
18-Patient Have Allergy To Trimethoprim/Sulfamethoxazole Which Of The Following Oral Anti-Diabetes Is Contraindicated?
Glipizide
19- Which One Need Renal Adjustment ? Sitagliptin,
31- What drug contraindicated in HF ? Pioglitazone (Q- Pioglitazone contraindication in ? HF)
Pioglitazone is Thiazolidinediones is black boxed warnings cause or exacerbate heart failure
And contraindication class III/IV heart failure
.32 - Which medications increase heart failure mortality? NSAID , Pioglitazone
68- What is drug no take DM have acute renal ? DAPAGLIFLOZIN
53- Which of the following describes the mechanism of action of sitagliptin?
Inhibit dipeptidyl peptidase 4 enzyme

3. 3
6-Which of the following is the mechanism of action of liraglutide?
Glucagon like peptide-1receptor agonist (GLP-1)
37 - What Is The Class Of Canagliflozin (Invokana)?
SGLT 2 Inhibitors
Q-oral anti diabetic drug used in type 1 (no metformin in choice) ?
SGLT2 inhibitors (may help DM1 patients achieve their HbA1c goals by decreasing their insulin requirements)
21. When DM type 1, symptoms appears ? 70% destroy of Langerhans cell
169- What is the timeline in which symptoms of type 1 diabetes occur?
Answer once destruction occur
(8) Which of the following is the timeline when symptoms start to occur in type-1 diabetes mellitus?
when 70% of the islets of langerhans of the pancreas are destroyed
Q- The diagnosis of DM according to the newest guideline ?
A1C >= 6.5 and FBG >126
Q- Database system used by insurance companies ?
“Index System” 1 (or “Index Database”) and is used by most insurance companies to secure
the claims history of every claimant
Q- A drug that can be used to lose weight ? orlistat
INSULIN
.Insulin preserved at 2-8 C
34 - Which of the following is considered as a high alert medication?
Insulin/hypoglycemics
72- basel insulin calculation ?

4. 4
DIVIDE THE TOTAL DOSAGE INTO 40-50% N.B// FOR BOLUS: DIVIDE INTO 50-60%
31. tyrosine kinas class II receptors are ?
insulin receptors
110- Which one of insulin have long acting effect? (. Insulin use in long time ?
Answer: Glargine and detemir are long acting insulins
150- Insulin take once daily ?
Answer Glargine
62. G6p enzyme activated when ?
Incrased insulin
60. Which type of insulin that have very long duration of action ?
Glargine 12 hour
Detemir 12hour
Degludic insulin 24hr
83- Tyrosine Kinase class II receptors are ? Insulin receptor
92 - treat e Insulin , should monitor ?
K… as it cause hypokalemia
227- Which metal is needed for insulin function?
Cr
35 -Which type of insulin that can be used IV?
Regular insulin NPH
38- Best rout of insulin ? SC
427 Best place to inject insulin SC? Answer: Abdomen
Q- What is the best route of administration for insulin ?
S.C
IV in hospitalized emergency
39 -What is fastest route for administration in insulin? Iv
47. Drug exaggrated insulin ? metoprolol(masking hypoglycemic symptoms)
20. High risk of hypoglycemia
Insulin
844- patient is 16years old female, Wt:55kg and Ht: 158, patient known case of diabetic type 1 .How much unite “basal insulin glargine
(lantus)” patient takes?
Answer Basal insulin is started at 0.1-0.2 units/kg/days
6 units-11 units
Q- A patient needs insulin, as he will give it while he has Central Line ?
Regular insulin
91- 12 year diabetic type 1 ?
metformin
Insulin
61-which of the following diabetic drugs approved by fda for pediatric use ? insulin DM1
844- patient is 16years old female, Wt:55kg and Ht: 158, patient known case of diabetic type 1 .How much unite “basal
insulin glargine (lantus)” patient takes?
Answer Basal insulin is started at 0.1-0.2 units/kg/days
6 units-11 units
Q- pt complains about insulin inc his weight what should u do ?
Tell him yes it's true
801- Patient with DM take inulin Lispro and aspart after monitoring all thing good but the morning fasting blood glucose
was increase for 2 weeks ago what will do?
Answer
Increase the unit of night dose
Increase the unit morning dose
Increase the unit afternoon dose

5. 5
170- drug of choice for gestational diabetes? (first line agent gestational diabetes?)?
insulin
90- Antidiabetic drug used in pregnancy ?
Insulin if not in option then metformin
15-which of the following insulins has the longest duration of action?
Degludec (42hr)
SE
397 Drugs that causes hypoglycemia mask?( Drug mask hypoglycemia)?
Beta blockers
457 Patient has diabetics what drug is contraindicated
Beta blockers because it mask hypoglycemia
13. Drug mask hypoglycemia
Carvedilol
14. Side effect of oral hypoglycemic agent
Hypoglycemia
9. Side effect of metformin
Lactic acidosis
10. Patient develop side effect with metformin
Take with meal
41. metformin and metronidazol cause ?
metallic taste
848 which Oral hypoglycemic causes Acute pancreatitis?
Answer Dipeptidyl peptidase 4 (DPP-4) inhibitors Such as: sitagliptin
11 - What is drug no take DM have acute renal? Dapagliflozin –
985- which drug contraindicated in CHF
Answer Pioglitazone
Q- Pioglitazone contraindication ? HF
56. Pioglitazon side effect ? Hypoglycemia
CASES
METFORMIN
14-A 65-year-old man was diagnosed with type 2 diabetes five year ago, maintained on metformin
Which of the following need to be monitored?
Vitamin B12 level
59- A patient with DM type 2, with uncontrolled (high) blood glucose for years. The patient complains of burning and stabbing pain in his
extremities started for years. Which of the following types of pain this patient is experiencing?
Neuropathic pain
97- A 50-year-old Saudi woman with hypertension and dyslipidemia. She presented today to her follow up visit with family medicine clinic. Her
sister has a type 1 diabetes mellitus. No alcohol or ciggarrate use is reported. She is physically active for 2 minutes a week.
Weight 51 kg
Height 160 cm
Which of the following is a risk factor for developing diabetes type 2 in this patient? ‫مكرر‬
Family History
52-A patient with high blood glucose and his weight is 103 kg and ha1c is 9, he will take
N.B: Answer is Metformin ... , SGLT- inhibitor AND GLP-1 as overweight is an indication for type 2 diabetes
59. case in which glucose is high and its weight 103 kg and is Glycated hemoglobin Hb1 is 9, he will take . ?
Metformin
23. patient 48 years old male known case of hypertension, newly diagnosis diabetic type 2, A1C 6.8%, what the best option to start treatment
of patient?
Life style modification + Metformin
50. 12 years old boy has diabetes type1 which drug can take?
Metformin

6. 6
66. Case Patient take metformin and A1c = 6.8 , what is your recommendation ?
no change on metformin
44 - A patient suffers from polyurination and dizziness so he does lab tests and his results are as following:
- glycosuria +ve, -capillary blood glucose = 15 normal up to 6,-lbw = 28.what is the best medication for this patient ?
Metformin
55 -A 54 years woman with polyuria for 3 months before analysis...
A. Give Metformin 3 times a daily
50-An elderly man around 60 years old, complain from polyuria, dry mouth...There is no family history of diabetes... He has done a lab tests
and the results were positive for diabetes...Initial treatment should be: Metformin
404 Patient refused to take an insulin that says cause overweight what to do?
If patient has type 2 diabetes, patient's diabetes can be managed with hypoglycemic agent like metformin which do not
cause weight gain but rather causes weight loss. My prof answer
58-A 48 woman suffers from fatigue, weakness and polyurination and lab tests proved that she is diabetic... A Doctor prescribed her 850 mg
metformin twice a day and so blood sugar become normal... but after sometime she did another lab tests and the result was hemoglubinated
sugar increased by 1% than the last result and HbA1c was 7.5 ... what will you advise her?
a-increase metformin dose
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12 - Drug DM contraindication contrast? Metformin
(To avoid this complication, metformin must be withheld after the administration of the contrast agent for 48 hours, during which the
contrast-induced renal failure becomes clinically apparent. If renal function is normal at 48 hours, the metformin can be restarted.)
35. patient was in C.T with contrast procedure what is the drug should to be stopped for the next 48 hour
Metformin
52. patient take 4 drugs . he did kidney function test and the result was high serum cr and high BUN ( blood urea nitrogen)and high potassium
serum level so which drug should be stopped ?
Should STOP Metformin
N.B: Metformin is contraindicated with renal failure
53. 22 years woman wants to become a pregnant, she is taking metformin and pioglitazone. she has a history of hypoglycemia and she
prefers oral therapy . What will be the best approach in her case?
stop pioglitazone and titrate metformin
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51- A 83 years old man suffers from fatigue, weakness and dizziness, there is no family history of diabetes... he went to the doctor and had
done a lab tests and the results were positive for diabetes and BMI = 28 .. Initial treatment should be?
A-Gliclazide
N.B:
An adult who has :
BMI = 25 to 29.9 is considered overweight
BMI = 30 or higher is considered obese
For elderly patients...
- If younger than 80 years old ... metformin
- if older than 80 years old ...glyclizide "as usually elderly patients have kidney dysfunction which contraindicated with metformin"
55. CASE WOMAN Hyprttention diabetic and sensitive of sulph. which is contraindicated with sulpha ?
Glyburide
846 -as pharmacist and patient came with prescription for DM Containing ( metformin, glimepiride, thyroxine, Omeprazole,
aspirin and atorvastatin) patient has sulfa allergy, what you do?
Glimepiride is sulfonylureas class, contraindication with sulfa allergy, type 1 diabetes, DKA
So D/C Glimepiride and referral the patient to doctor with recommendation
554- Patient Have Allergy To Trimethoprim/Sulfamethoxazole Which Of The Following Oral Anti-Diabetes Is ontraindicated?

7. 7
Answer
Glipizide
67- pt has heart failure what is the contraindicated oral anti diabetic for him?
THIAZOLIDINEDIONES( PIOGLITAZONE, ROSIGLITAZONE(DPP-4 inhibitors)
77-Oral hypoglycemic used with type 1
- Empagliflozin , SGLT inhibitor only class DM1 as oral agent
8- 50 Years Old Woman Has BMI At Normal Average And Her Hypertension and Hyperlipidemia is well controlled .She Has A Sister With DM
Type 1.So What Is The High Risk To Get DM?
Geography. Age. Family history, genetics.
While in DM 2: family history, age, or ethnicity, depression, HT.
INSULIN
538- An 18-year-old boy was diagnosed with diabetes type 1 the doctor wanted to give him poles/basic insulin thereby to
reach normal glycemic control ?
Answer 30 mg insulin glargine once a day
25. patient is 16years old female, Wt:55kg and Ht: 158, patient known case of diabetic type 1
How much unite “basal insulin glargine (lantus)” patient takes?
Basal insulin is started at 0.1-0.2 units/kg/days
6 units-11 units
33. blood glucose of patient 210 mg/dl and target 120, the correction factor is 30. What the correction dose for this patient
Correction dose= (blood glucose now-target blood glucose) / correction factors
(210-120) /30
=90/30
=3 units
Add to patient dose
INSULIN
-A girl 16 year has DM type 1 and she takes insulin in specific medical schedule She take pioglitazone with insulin according to instructions of
her doctor from 2 months ago ... She complain nausea and vomiting from two days as she escaped from the schedule... she made Lab tests
and you have shown her
results in details some of her results:
Heart rate110
Blood pressure 80/50
Initially you give her.. ??
0.9 normal saline in 500 ml solution
57 -A 12 years child has diabetes type1 which drug can take?
Metformin
N.B:Insulin is the drug of choice for Type 1 diabetes
59- A summary of a case that a diabetic girl her lab results were mostly normal except glucose ....27, potassium is higher than normal by 1
what do you recommend for her?
insulin infusion 10 unit
45- Diabetic patient uses insulin daily, he forgot to take his insulin dose someday... he did lab tests and his results was normal except, high
glucose, high potassium (hyperkalemia). what do you recommend for this case ?
a-restart his daily insulin dose
N.B:
-hyperkalemia most commonly occurs in uncontrolled hyperglycemia (diabetic
ketoacidosis)
due to lake of insulin

8. 8
- The acidosis and high glucose levels in the blood work together to cause fluid
and potassium to move out of the cells into the blood circulation
46- hyperglycemic patient his blood glucose level given by moles and his HBA1C was high ((more than 10%)What is the best medication for
him?
-insulin 70/30
hyperglycemic patient his blood glucose level given by moles and his
HBA1C was high ((more than 10%)
N.B: (HBA1C or HGBA1C): is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over
prolonged periods of time...
type 2 diabetes start with metformin
If HBA1C is getting higher even if 1% we increase metformin
If HbA1c increased for more than 10% we give insulin Hba1c is the same as a1c normal HbA1c less than 6.5 – 7
74 - basal insulin calculation : ?
Basal/Background Insulin Dose:
Basal/Background Insulin Dose = 40-50% Of Total Daily Insulin Dose
Example
Assume You Weigh 160 Pounds
Your Total Daily Insulin Dose (TDI) = 160 Lbs ÷ 4 = 40 Units.
In This Example:
Basal/Background Insulin Dose = 50% Of TDI (40 Units) = 20 Units Of Either Long
Acting Insulin,(Such As Glargine Or Detemir) Or Rapid Acting Insulin If You Are Using
An Insulin Pump (Continuous Subcutaneous Insulin Infusion Device).
Total Daily Insulin
Weight (Ib)/4 Or Weight (Kg)*0.55
80- Calculate CHADS2 score in patient with DM, HTN, 60year , history of HF?
DM=1, HTN=1, CHF=1
The total is = 3
MONITORING
547- on treatment of insulin , which should be monitored ?
Potassium as it cause hypokalemia
939- Drug need renal adjustment
Answer Sitagliptin
75- Drug need renal adjustment : Dpp-4
679- Renal adjustment needed
Answer All need adjustment sitagliptin- voriconazole- fluconazole- Insulin glargine
587-Drug for diabetics need adjustment
Answer: Alogliptin, saxagliptin, and sitagliptin are orally active dipeptidyl peptidase-4 that need dose adjustment
29- Patient on metformin, lisnopril, sitagliptin What is the most important thing to monitor ?
Renal function
Q- Patient is use Metformin + Glibenclamid, what is the most appropriate monitoring for him?
Liver function test
Q- CASE if the patient take metformin and pioglitazone we should monitor ?
Metformin: Monitor Kidney
Sitagliptin: Monitor Kidney
Pioglitazone: Monitor liver
23- An ACE inhibitor or ARB should be used for initial monotherapy in patients who have diabetic nephropathy or nondiabetic chronic kidney
disease complicated by proteinuria.
MOA
15-- What is MOA of sitagliptin ?

9. 9
DPP-4 inhibitor, which is believed to exert its actions in patients with type 2 diabetes by slowing the inactivation of incretin hormones
80 What is MOA of glipized ?
Answer Sulfonylureas likely bind to ATP-sensitive potassium-channel receptors on the pancreatic cell surface, reducing
potassium conductance and causing depolarization of the membrane. Depolarization stimulates calcium ion influx through
voltage-sensitive calcium channels, raising intracellular concentrations of calcium ions, which induces the secretion, or
exocytosis, of insulin
70-What is MOA of glipized ?
INCREASE INSULIN SECRETION FROM PANCREATIC BETA CELLS
563- What Is The Class Of Liraglutide?
Answer: Liraglutide Injection (Saxenda) Is Not Used to Treat Type 2 Diabetes. Liraglutide Injection Is in A Class of Medications
Called Incretin Mimetics. It Works By Helping The Pancreas To Release The Right Amount Of Insulin When Blood Sugar
Levels Are High.
512 What is Mechanism of action for Canagliflozin
Answer (inhibitor of subtype 2 sodium-glucose transport proteins (SGLT2), which is responsible for at least 90% of renal
glucose reabsorption)work by increasing the amount of glucose that gets passed out in the urine
564What Is The Class Of Canagliflozin (Invokana)?
SGLT 2 Inhibitors Sodium-Glucose Transport Proteins (SGLT2
617- What Is MOA Canagliflozin
Answer
Canagliflozin
Inhibitor Of Subtype 2 Sodium-Glucose Transport Proteins (SGLT2), Which Is Responsible For At Least 90% Of Renal Glucose
Reabsorption)Work By Increasing The Amount Of Glucose That Gets Passed Out In The Urine
Sitagliptin
DPP-4 Inhibitors. It Works By Increasing The Amount Of Incretin Released By The Intestine. Incretin Is A Hormone That Raises
Insulin Levels When Blood Sugar Is High And Decreases The Amount Of Sugar Made By The Body.(REDUCE GLUCAGON
SECRETION FROM PANCREATIC ALPHA CELLS)
Liraglutide
Injection (Saxenda) Is Not Used To Treat Type 2 Diabetes. Liraglutide Injection Is In A Class Of Medications Called
Incretin Mimetics. It Works By Helping The Pancreas To Release The Right Amount Of Insulin When Blood Sugar Levels Are
High.
90 What is MOA of sitagliptin ?
Answer DPP-4 inhibitor, which is believed to exert its actions in patients with type 2 diabetes by slowing the inactivation of
incretin hormone