Diabetes

Question 1

Type 1a DM is:

Answer 1

Immune mediated

Question 2

Type 1b DM is:

Answer 2

Idiopathic- autoimmune destruction of pancreas due to genetic susceptibility plus an environmental precipitation- insulitis or isletitis

Question 3

This is direct destruction of beta cells by virus or toxin > exposure of antigens to immune system or release of destructive cytokines that kill beta cells or programmed cell death may be induced.

Answer 3

Insulitis

Question 4

Symptoms of type 1 DM:

Answer 4

Polydipsia, polyuria, and polyphagia (with weight loss)
Blurred vision
Dizziness, weakness
N/V/impaired mental status (ketoacidosis)
Sudden weight loss and severe hyperglycemia

Question 5

Clinical presentation Type 1 DM:

Answer 5

Wasting
Visual impairment 
Orthostasis
Dry skin and mucous membranes
Impaired level of consciousness, fruity breath (ketoacidosis)

Question 6

When to perform the GTT in pregnancy?

Answer 6

High risk- early in second trimester

Normal risk- 24-28 weeks

Question 7

Diagnosis of GDM with any of the following:

Answer 7

Fasting greater or equal to 92
1hour greater than or equal to 180
2 hour greater than or equal to 153

Question 8

Women with GDM should be screened how often after pregnancy?

Answer 8

Rescreened 6-12 weeks postpartum and if negative should be checked annually; lifelong at least every 3 years

Question 9

Phase 1 development of T2DM?

Answer 9

Plasma glucose normal despite insulin resistance bc of hyperinsulinemia.

Question 10

Phase 2 of T2DM development?

Answer 10

Worsening insulin resistance; postprandial hyperglycemia despite hyperinsulinemia

Question 11

Phase 3 of T2DM development?

Answer 11

Declining insulin secretion with insulin resistance > fasting hyperglycemia and overt DM

Question 12

Clinical presentation T2DM:

Answer 12

Relatively asymptomatic
Symptoms of cardiac, skin, or neuro complications
Obese
Decreased peripheral sensation 
Fundoscopic changes
Recurrent fungal infections, vaginal yeast infections
Intertrigo 
Skin ulcers

Question 13

Screening for T2DM per ADA:

Answer 13

Annual for patients with BMI over 25 and 1 or more risk factors

Entire population over 45 every 3 years if normal

Question 14

Fasting blood glucose screening results:

Answer 14

Normal- less than or equal to 100
IFG- 100-125
Diabetes greater than or equal to 126

Question 15

HbA1C screening results:

Answer 15

Normal- less than 5.7
Prediabetes- 5.7-6.4%
Diabetes- greater than 6.5%

Question 16

What random glucose level is positive for diabetes?

Answer 16

Greater than 200

Question 17

Screening results for 2 hour GTT:

Answer 17

Impaired- 140-199

Diabetes greater than or equal to 200

Question 18

Diagnostic criteria for DM:

Answer 18

Symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) plus:
Random plasma glucose: over 200
FPG: greater than 126
HbA1C greater than or equal to 6.5
2-hour plasma glucose over 200

Question 19

Assessment of glycemic control in T1DM?

Answer 19

Self monitoring of blood glucose 3-4 times daily:
Prior to meals/snacks 
Occasionally postprandial
At bedtime 
Prior to exercise
When hypoglycemia is suspected 
After treating hypoglycemia
Prior to critical tasks

Question 20

Assessment of glycemic control on type 2 DM:

Answer 20

Check glucose as needed to achieve postprandial glucose targets

Question 21

When to test urine for ketones?

Answer 21

Patients with type 1
Pregnant patients with pre-existing DM
Patients with GDM
Diabetics with blood glucose over 300
Diabetics with N/V/ abdominal pain

Question 22

When to treat diabetic patients with HTN with pharmacologic therapy?

Answer 22

BP greater than or equal to 140/90

Question 23

Sodium restriction can decrease BP by:

Answer 23

2-8 mmHg

Question 24

Weight loss can decrease BP by:

Answer 24

5-20mmHg

Question 25

Moderately intense physical activity can decrease BP by:

Answer 25

4-9 mmHG

Question 26

Moderation of alcohol consumption can decrease BP by:

Answer 26

2-4 mmHG

Question 27

Antiplatelet therapy (ASA) recommended for primary prevention when:

Answer 27

``` 75-162 mg/ day of ASA in: Men over 50 and women over 60 Type 1/2 DM with increased CV risk and at least one of the following: Family hx of CAD Albuminuria Smoking HTN Lipid abnormalities ```

Question 28

When is ASA not recommended?

Answer 28

In diabetics at low risk for CVD ( 10-year risk less than 5%) and patients under 21

Question 29

Asa for secondary prevention with:

Answer 29

Diabetics with history of CVD | For diabetics with CVD and documented ASA allergy, plavix 75mg/day should be used

Question 30

What is cladication?

Answer 30

Symptom of macro vascular complications of DM that consist of calf pain, impotence, pain in distal foot when patient is supine.

Question 31

PVD signs:

Answer 31

``` Decreased or absent pulses Pallor on elevation of feet Rubor on dependency Thicken nails Loss of toe and foot hair Smooth, shiny, atrophic skin ```

Question 32

Advanced PVD signs:

Answer 32

Ulcers

Question 33

Stages of diabetic nephropathy:

Answer 33

``` Microalbuminuria Proteinuria Nephrotic syndrome Renal failure Single leading cause of ESRD ```

Question 34

Screening for nephropathy:

Answer 34

Annual Cr, microalbumin, albumin/cr ration

Question 35

Stage 1 of CKD:

Answer 35

EGFR is 90 and created with kidney damage and normal kidney function

Question 36

Stage 2 CKD:

Answer 36

GFR is 60-89 with kidney damage and mildly reduced function

Question 37

Stage 3 CKD:

Answer 37

GFR is 30-59 with moderate kidney damage and decreased GFR

Question 38

Stage 4 CKD:

Answer 38

GFR is 15-29 with severe damage and decreased GFR

Question 39

Drugs that increase insulin secretion?

Answer 39

SU, meglitinides

Question 40

Drugs that decrease glucagon levels?

Answer 40

DPP-4 inhibitors | Symlin

Question 41

Drugs that increase satiety?

Answer 41

Symlin | GLp-1 agonist

Question 42

Incretins and incretin mimetics?

Answer 42

DPP-4 inhibitors | GLP-1 agonists

Question 43

Insulin sensitizers?

Answer 43

Biguanides TZDs GLP-1 agonist

Question 44

Drugs that slow absorption of glucose by the gut?

Answer 44

Alpha- glucosidase inhibitors Symlin GLP-1 inhibitors

Question 45

Drugs that cause weight gain?

Answer 45

SU, TZDs, insulin

Question 46

Metformin is contraindicated in:

Answer 46

Renal insufficiency Treated CHF Binge alcohol use

Question 47

TZDs are contraindicated in:

Answer 47

Active liver disease Transaminase elevation 2.5 times ULN at baseline Class 3 and 4 CHF

Question 48

GLP-1 analogs contraindicated in:

Answer 48

Gastroparesis | Pancreatitis

Question 49

What is the preferred treatment for hypoglycemia in conscious individual?

Answer 49

Glucose 15-20 g Repeat if continued hypoglycemia Once BS normal consume meal or snack to prevent recurrence

Question 50

Agents targeted for postprandial hyperglycemia?

Answer 50

Meglitinides Acarbose GLP-1 agonists DPP-4 inhibitors