OnlineMedEd: Endocrine - "Outpatient Diabetes"

Question 1

List three groups of people who should be screened for type II diabetes?

Answer 1

• Those older than 45
• Those with HTN
• Those with BMI greater than 25

Because this includes such a broad swath of the population, basically everybody should be screened for diabetes.

Question 2

List the four ways you can diagnose diabetes.

Answer 2

• Random blood glucose greater than 200 with a symptom (e.g., polydipsia, polyuria, polyphagia, weight loss, neuropathy, renal impairment, retinopathy)
• Fasting glucose greater than 124
• Two-hour glucose challenge greater than 200
• A1c greater than or equal to 6.5

Question 3

Fasting glucose levels between ____________ is pre-diabetes.

Answer 3

100 and 124

Question 4

What is a normal (i.e., nondiabetic) two-hour glucose level?

Answer 4

Less than 140

Question 5

What are the three tiers of A1cs?

Answer 5

• 6.5 or greater: diabetes
• 5.7 - 6.4: pre-diabetes:
• Less than 5.7: non-diabetic

Question 6

Why might you get diabetes antibodies?

Answer 6

The antibodies, if positive, help confirm that the person has type I diabetes; in this case, oral medicines will not work.

Question 7

What are the two common antibodies in type I DM?

Answer 7

• GAD (the “better” one)

* IA-2

Question 8

How should pre-diabetes be managed?

Answer 8

Lifestyle modifications and metformin

Question 9

Go through the three treatment stages of TIIDM.

Answer 9

1) Lifestyle modifications and metformin
2) Add a second oral agent
3) Add insulin

In between each stage, you check to see if they’re meeting their target A1c. If they have, then you stop. If they haven’t, then you move to the next stage.

Question 10

List three contraindications to metformin.

Answer 10

• CHF
• CKD
• Liver disease

Each of these increases the risk of lactic acidosis with metformin use.

Question 11

How much can oral agents and insulin change the A1c?

Answer 11

• Orals: 3% max
• Insulin: 7% max

This means that if the person’s A1c is greater than 9%, then you need to start on insulin.

Question 12

Which oral agent can cause CHF?

Answer 12

Thiazolidinediones

Question 13

The -gliptin drugs act by what mechanism?

Answer 13

They are DDP-4 inhibitors. (DDP-4 is the enzyme that breaks down GLP.)

Question 14

_______________ can cause euglycemic DKA.

Answer 14

The SGLT-2 inhibitors

Question 15

How often should you do an A1c in a diabetic?

Answer 15

Every three months

Question 16

What is a good “goal” A1c?

Answer 16

Less than 7%

Question 17

What four annual exams should diabetics get?

Answer 17

• Retinal exam
• Monofilament screen for neuropathy
• UA with microalbumin to creatinine ratio
• Foot exam