Complications

Question 1

Main type of complications

Answer 1

Acute: hypo + hyper (DKA + HHS)
Chronic: micro + macro

Question 2

What is level 1 hyperglycemia

Answer 2

BG bw 3-3.9
- autonomic symptoms; no neuroglycopenic

Question 3

Level 2 hypoglycemia

Answer 3

BG bw< 3
- have neuroglycopenic symtpoms +/- autonomic; no changes in mental or physical state

Question 4

Level 3 hypoglycemia

Answer 4

neuroglycopenic symptoms + changes to mental/physical state
- may be unconscious

Question 5

Level 1+2 treatment

Answer 5

15g of carbs, retest in 15

Question 6

Level 3 treatment Conscious

Answer 6

20g of carbs OR 3mg of IN glucagon or 1mg glucagon SC/IM
- retest in 15

Question 7

Level 3 treatment (unconscious)

Answer 7

3mg of IN glucagon or 1mg SC/IM
- or 10-25g of glucose IV

Question 8

T or F: DKA is more common in T2DM who are younger

Answer 8

F- more common in young T1DM

HHS: more common in elderly T2DM (less common overall than DKA)

Question 9

Which hyperglycemic emergency has Kussman breathing ?

Answer 9

DKA: main features include acidosis, ketosis , and can have hyperglycemia (mild)
—- BG- 11.1
- + ketone

HHS: severe hyperglycemia —- start peeing out urine —- volume depletion

Question 10

S+S of Retinopathy

Answer 10

• seeing spots
  blurry vision
  blank spots in center of vision
• difficulty seeing at night
• fading colour

Question 11

Nephropathy S+S

Answer 11

normally asymptomatic
- increased ACR
- increased urination
- edema

Question 12

Neuropathy S+S

Answer 12

numbness, tingling of extremities
- burning or sharp pain

autonomic ones
- GI: gastroparesis, consitpation or diarrhea ( treat with pro kinetic as last restore)
CV: HR variability, tachy, postural hypo
Urinary: UTI, incontinence , EDs

Question 13

T or F: Diabetic retinopathy is more commonly seen in T2DM

Answer 13

F- T1DM and T2DM on insulin

Question 14

Forms of retinopathy

Answer 14

1) Macular Edema: vascular leakage into macula
2)Non-proliferative + proliferative
3) Retinal Capillary Closure

Question 15

How do we screen for retinopathy + how often

Answer 15

• dilated eye exam or retinal photography

T2DM: at diagnosis
T1DM: 5 years after diagnosis
—- if no R: screen every 1-2 yrs
— if R: screen every year
— if on semaglutide: every 6 mths

Question 16

What are the main factors that help prevent + slow progression of retinopathy

Answer 16

1) good A1c </= 7
2) BP 130/80
3) lipids: fenofibrate

Question 17

Treatment options for retinopathy

Answer 17

1) Pan-retinal photography/laser therapy: decrease swelling + stop BV leaking
2) VEGF anatagonists: Eylea
3) Vitrectomy/surgery: revolve scar tissue + blood

Question 18

How do we screen for neuropathy

Answer 18

monofilament or tuning fork

Question 19

What is the main way to prevent neuropathy

Answer 19

1glycemic control
—— prevent progression in T1DM with good glycemic control as well

Question 20

How common is diabetic neuropathy

Answer 20

40-50% of people with DM with get within 10 years of diagnosis

Question 21

Main treatment options for diabetic neuropathy

Answer 21

symptom management
- pregabalin 75mg BID (anticonvulsant)
- duloxetine 30mg once daily

other options: topical nitrates, opioids, TENS, capsaicin

** reduce pain by 30-50%

Question 22

What is the leading cause of ESRD

Answer 22

DM

Question 23

what is nephropathy

Answer 23

progressive increase in proteinuria in people with DM —- decrease in kidney fxn

Question 24

How to screen for nephropathy

Answer 24

random ACR + eGFR
— if ACR + eGFR are in range (>2 and then < 60 for eGFR)—— no CKD , rescreen in 1 yr

—- if one of them is abnormal : eGFR< 60 or ACR>/=2: look to see if ACR >/=20 —- if so—- CKD
—- if not and eGFR <60 OR ACR bw 2-20: repeat SCr in 3 mths + also complete 2 more ACR tests over the span of next 3 mths

—CKD diagnosis if patterns still remain: eGFR still below 60 or 2/3 past ACR tests >/=2

Question 25

What are the main things to help prevent nephropathy onset + progression

Answer 25

good A1c control + BP control + use of Acei/ARB (slow progression of CKD no matter what base BP is )

Question 26

What can cause a transient increase in albumin in urine

Answer 26

recent exercise, UTI, febrile illness, period,

Question 27

What are the 3 macrovascular complications

Answer 27

1) Cerebrovascular disease (CVD): brain problems such as stroke/TIA 2) Coronary Heart disease: HA, unstable angina or ACS 3) Peripheral vascular disease: ulcers, amputations, claudication

Question 28

What are the key ABCDES of CV protection

Answer 28

1) A1c 50% 3) drugs to protect hear: Acei/ARB, statin, SGLT2/GLP-1a 4) exercise and healthy eating 5) smoking cessation ** controlling all these things not only decreases risk of CVD, mortality or other CVEs, but also all the micro complications

Question 29

T or F: statins only work slow the progression of CVD and have no impact on primary prevention (stopping people from have macrovascular complications)

Answer 29

F- statins have prevent and slow progression of macrovascular complications

Question 30

Criteria for statin

Answer 30

One of the following - age >/=40 - clinical CVD - Microvascular complication (R, nephro, or neuro) - diabetic for over > 15 yrs and age > 30 - meet criteria for treatment based on dyslipidemia guidelines

Question 31

Criteria for ACEi or ARB therapy

Answer 31

1 of the following - age >/= 55 + additional CV RF (HTN, dyslipidemia, smoking, obese) - clinical CVD - microvascular complications (neuro, nephro, or retinopathy)

Question 32

Dosing for statins for CV protection

Answer 32

- atorvastatin 10mg - rosuvastatin 20 mg

Question 33

What ACEi/ARBs have evidence having CV protection

Answer 33

perindopril 8mg ramipril 10mg telmisartan 80mg

Question 34

T or F: Acei/ARBs offer primary prevention of CVD (stop you from getting macro complications) AND secondary prevention (slow progression of macrovascular complications if already have)

Answer 34

T

Question 35

T or F: ASA offers primary and secondary CV protection

Answer 35

F - only use as secondary prevention in these with history of CVD