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LMCC Part II > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what are the 5 Rs to consider when organizing diabetes care in the office or clinic

A 
recognize
register
resource
relay
recall
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2
Q

what three tests can be used for diabetes screening and diagnosis

A
  1. HbA1c
  2. fasting plasma glucose
  3. 2 hour plasma glucose
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3
Q

how do you determine a patients glycemic targets

A

patients age

duration of diabetes

risk of hypoglycemia

CV disease presence

life expectancy

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4
Q

how often should you do blood work for diabetes follow up

A

every 3 months HbA1c

can do every 6 months if targets consistently met and treatment and lifestyle are stable

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5
Q

what causes type 1 diabetes

A

beta celld estruction

leading to total insulin deficiency

susceptible to ketoacidosis

either autoimmune or unknown etiology

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6
Q

what is latent autoimmune diabetes

A

a slow progressive form of autoimmune diabetes that shares clinical characteristics of T2DM

it is a form of T1DM

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7
Q

what causes T2DM

A

combination of insulin resistance and inadequate insulin secretory response

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8
Q

risk factors for T2DM

A

age over 40

first degree relative with T2DM

member of high risk population i.e aboriginal, hispanic, south asian, asian, african descent

history of prediabetes

history of gestational diabetes

presence of vascular risk factors

presence of associated diseases

use of medications associated with diabetes

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9
Q

what vascular risk factors increase risk of T2DM

A

obesity

DLD

HTN

abdo obesity

vascular disease

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10
Q

what other diseases are associated with T2DM

A

PCOS

acanthosis nigricans

HIV

psychiatric disorders

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11
Q

what medications are associated with diabetes

A

atypical antipsychotics

highly active ART

glucocorticoids

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12
Q

can T1DM be prevented

A

no

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13
Q

can T2DM be prevented

A

yes–onset and course can be ameliorated using lifestyle modification and pharmacologic intervention

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14
Q

would you consider pharmacologic treatment even in patients without diabetes but with impaired glucose tolerance

A

yes–can consider metformin or acarbose

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15
Q

screening guidelines for T2DM

A

q3 years at age 40 and above or those at high risk

screen more frequently in people with additional risk factors for DM

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16
Q

what is a screening tool you can use for DM

A

the CANRISK questionnaire

Canadian Diabetes Risk Assessment Questionnaire

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17
Q

what criteria can be used to diagnose DM

A

fasting plasma glucose of 7 or higher

HbA1c of 6.5% or higher

2 hour plasma glucose of 11.1 or higher after a 75g oral glucose tolerance test

a random plasma glucose of 11.1 or higher in a patient with the classic symptoms of hyperglycemia

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18
Q

what are the classic symptoms of hyperglycemia

A

polyuria
polydipsia
unexplained weight loss

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19
Q

in a patient with no symptoms of diabetes/hyperglycemia, what do you do if one screening lab test returns in diabetes range?

A

a repeat, confirmatory test (preferably the same test) must be done another day (in a timely fashion) –if the results of the two different tests are both above diagnostic cutoff, dx is confirmed

*a repeat test is not required if they have symptoms

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20
Q

if you suspect T1DM, should you delay treatment while waiting for the confirmatory test

A

no

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21
Q

what does the following “R” suggest in the 5Rs of diabetes management:
recognize

A

consider diabetes risk factors for all patients and screen appropriately

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22
Q

what does the following “R” suggest in the 5Rs of diabetes management:
register

A

develop a list of patients with diabetes to facilitate recall ad track changes in practice management

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23
Q

what does the following “R” suggest in the 5Rs of diabetes management:
resource

A

support self management through the use of interprofessional teams including a PCP, DM care educator, nurses, dietician, pharmacist and specialist

consider referral to Diabetes education clinic

24
Q

in which patients might a team specialized in diabetes be warranted?

A

patients with T1DM at diagnosis and at least annually

women with diabetes who require pregestational assessment and counselling

women with diabetes in pregancy

individuals with complex T2DM or who are not reaching target

25
Q

what does the following “R” suggest in the 5Rs of diabetes management:
relay

A

facilitate information sharing between patient with diabetes and the diabetes care team

26
Q

what does the following “R” suggest in the 5Rs of diabetes management:
recall

A

develop a system to remind patients of timely review and assessment

27
Q

what is the focus of glycemic goals

A

achieving target A1c levels and minimizing symptomatic hyper- and hypoglycemia

28
Q

what is the A1c target for most patients with diabetes

A

6.5-7%

29
Q

in which patients might you consider an A1c target at or below 6.5%

A

in some patients with T2DM to further lower risk of nephropathy and retinopathy

must be balanced with the risk of hypoglycemia

30
Q

in which patients might you consider an A1c target of 7.1-8.5%?

A

limited life expectancy

high functional dependency

extensive CAD at high risk of ischemic events

multiple co morbidities

hx of recurrent severe hypoglycemia

hypoglycemia unawareness

longstanding DM for whom it is difficult to achieve A1c 7 or below despite effective doses of multiple antihyperglycemic agents including insulin

31
Q

risk factors for hypoglycemia

A

prior episode of severe hypoglycemia

long term diabetes

current A1c below 6

autonomic neuropathy

hypoglycemia unawareness

current treatment with insulin

elderly

32
Q

what practical/reporting consideration is there in patients with diabetes/at high risk for hypoglycemia

A

a driver with a medical condition, like DM, that has the potential to affect their fitness to drive may be required to have a drivers medical exam report completed by their GP

33
Q

how do you reduce the risk of hypoglycemia

A

increase frequency of blood glucose checks–including episodic assessment during sleeping hours

make glycemic targets less stringent

consider multiple insulin injections

34
Q

in patients with T2DM and only using oral antihyperglycemics, how often should they check their blood glucose

A

1-2 times per week usually

35
Q

how much should people exercise

A

at least 150 minutes per week of aerobic exercise and two sessions per week of resistance training

36
Q

what insulin regimen should be suggested for people with T1DM

A

multiple (3-4) daily insulin injections or the use of continuous subcutaneous insulin infusion (insulin pump) should be considered as part of an intensive diabetes management program

37
Q

should you use a CV risk assessment calculator in people with T1DM

A

no

38
Q

how do you assess CV risk in the DM population

A

a CV risk assessment tool

medical history

physical exam

full fasting lipid profile

39
Q

how do you approach CV risk protection

A

lifestyle management
glycemic control
BP control
pharmacological interventions

40
Q

what is a mnemonic to help remember vascular protection strategies

A

ABCDEs

A1c and optimal glycemic control

Blood pressure

Cholesterol

Drugs for vascular protection

Exercise/eating

Smoking cessation

41
Q

what drug might you consider for vascular protection in people with DM

A

ACEi

consider this in any patient 55 or older, or with evidence of organ damage, even in absence of hypertension

in patients with DM and HTN, consider ACEi or ARB

42
Q

is the routine use of ASA in primary CV disease protection recommended

A

no–not even in people without DM

but especially in people with DM, the risk of bleeding is higher

43
Q

what is the first line strategy for vascular protection from a lipid lowering standpoint

A

first line is lifestyle

second line is statins
–use in people with clinical macrovascular disease, 40 or older, younger than 40 but with DM for more than 15 years, microvascular complications or other circumstances that warrant therapy

44
Q

should you use statins to treat to a specific lipid target?

A

no, not according to the BC guidelines, though the CCA and CDA recommend treating high risk and intermediate risk patients to a specific LDL-C target of 2.0 or less

45
Q

how often should DM patients get dilated retinal pupil exam

A

at diagnosis then every 1-2 years or as indicated

for T1DM, first follow up exam is 5 years after dx then every 1-2 years

46
Q

how can DM retinopathy change during pregnancy

A

can worsen–women with DM considering pregnancy or in early pregnancy should be assessed by ophtho

47
Q

what is the best way to prevent diabetic neuropathy

A

achieve long term glycemic control

48
Q

how do you screen for DM neuropathy

A

with 10g monofilament or 128 Hz tuning for during foot exam

49
Q

signs of autonomic neuropathy

A

erectile dysfunction
GI disturbance
orthostatic hypotension

50
Q

what psychiatric conditions should be screened for in DM

A

depression
anxiety
eating disorders

51
Q

how do you manage a patient with DM initially

A

lifestyle intervention, consider metformin right away (but dont have to)

if A1c is less than 8.5, let them try lifestyle alone (or lifestyle with metformin) for 2-3 months

if A1c is above 8.5, initiate metformin immediately and consider combination with another antihyperglycemic agent

52
Q

what happens if your patient cant achieve glycemic targets with just lifestyle alone

A

start (or increase) metformin

if still not at target after a trial of metformin or increased dose of metformin, then add an antihyperglycemic agent best suited to the individual based on patient characteristics, risks and benefits, and cost

53
Q

if, after lifestyle changes, metformin, and a second anithyperglycemic agent, your patient is still not achieving glycemic targets, what do you do

A 
add another agent from a different class
or
add/intensify insulin regimen
54
Q

in a patient who started with an A1c above 8.5, and started metformin immediately, what do they do if you cant achieve glycemic goals

A

if still not at target after a trial of metformin or increased dose of metformin, then add an antihyperglycemic agent best suited to the individual based on patient characteristics, risks and benefits, and cost

if still not at target, ass another agent from a different class, or add/intensify insulin regimen

55
Q

in which patients should you start insulin

A

those with symptomatic hyperglycemia with metabolic decompensation

(even with lifestyle changes and/or metformin )

LMCC Part II (52 decks)

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