Diabetes - Jaber Flashcards
(181 cards)
1
Q
Insulin is a hormone produced by the ____ cells of the pancreas.
A
Beta
2
Q
True or False: The main job of insulin is to help the cells of the body utilize glucose.
A
True
3
Q
True or False: Without insulin, glucose cannot go into the cells.
A
True
4
Q
Diabetes is a chronic, complex, and heterogenous disease. What does heterogenous mean in reference to diabetes?
A
It means there are different forms, including type 1, type 2, and gestational diabetes.
5
Q
The most common type of diabetes is type _____
A
2
6
Q
What types of treatments are available for type 1 diabetes?
A
Can only use insulin
7
Q
What is the one thing that is associated with all types of diabetes and the hallmark of the disease?
A
Hyperglycemia
8
Q
Diabetes results in abnormal metabolism of carbohydrates, lipids, and ____, and affects the vasculature as well.
A
Proteins
9
Q
True or False: Diabetes is the most prevalent chronic disease on earth.
A
True
10
Q
Why does type 2 diabetes often go undiagnosed?
A
Because it has no symptoms until it becomes severe.
11
Q
True or False: The risk of diabetes goes down with every decade of life.
A
False! It goes up!
12
Q
True or False: Type 2 diabetes favors minorities.
A
True
13
Q
The highest prevalence of type 2 diabetes is in this minority.
A
Indians
14
Q
The major cause of death in patients with diabetes is _____.
A
Cardiovascular disease
15
Q
Early diagnosis and proper treatment of diabetes can reduce complications, and will thus reduce morbidity and ______.
A
Mortality
16
Q
True or False: Diabetes carries CV risk greater than patients with established heart disease.
A
False! It is equivalent
17
Q
People with diabetes have the highest incidence of 3 things:
- Adult blindness
- Chronic renal failure
- _______
A
Non-traumatic amputations
18
Q
People with diabetes have the highest incidence of 3 things:
- ________
- Chronic renal failure
- Non-traumatic amputations
A
Adult blindness
19
Q
People with diabetes have the highest incidence of 3 things:
- Adult blindness
- _______
- Non-traumatic amputations
A
Chronic renal failure
20
Q
The screening recommendations is to screen for diabetes every _ years in individuals age 45+.
A
Every 3 years
21
Q
Screening recommendations for diabetes are to screen every 3 years for age 45 and older. However, they should be screened more often if _____.
A
BMI is 25 or higher (23 or higher in asian americans) and who have 1 additional risk factor.
22
Q
Which of the following is NOT a risk factor for screening individuals earlier than 45 and more frequently for diabetes?
A. Have a 1st degree relative with diabetes
B. Physically active
C. Member of high risk ethnic group
D. Woman with GDM
A
B. Physically active
23
Q
Which of the following is NOT a risk factor for screening individuals earlier than 45 and more frequently for diabetes? A. Delivering a baby < 9 lbs B. Women with polycystic ovary syndrome C. Having a history of A1C ≥ 5.7% D. Having a history of IGT or IFG
A
A. Delivering a baby < 9 lbs
24
Q
Individuals with pre-diabetes should be tested every ___.
A
Every year
25
Patients should be screen earlier than 45 YO and more frequently if they have hypertension (___/___ mmHg), or dyslipidemia (high triglycerides > ___, and/or low HDL < ____, or cardiovascular disease.
Hypertension = 140/90
High triglycerides > 250
Low HDL < 35
26
List the 4 classifications of diabetes.
Type 1 DM
Type 2 DM
Other types of diabetes
Gestational DM
27
IGT stands for ____.
Impaired glucose tolerance
28
IFG stands for ____.
Impaired fasting glucose
29
A1C normal level is ____.
< 5.7%
30
Pre-diabetes range for A1C is ____.
5.7-6.4%
31
Diabetes level for A1C is ___.
≥ 6.5%
32
What are the 3 categories for pre-diabetes?
IGT, IFG, and A1C 5.7-6.4%
33
What is the normal level of fasting blood glucose?
< 100
34
What is the normal level of 2h-postprandial blood glucose?
<140
35
IFG is correlated with an abnormal level of ___ blood glucose, which is ≥ 100 but <126
Fasting
36
IGT is correlated with an abnormal level of ___ blood glucose, which is ≥ 140 but <200
2h-postprandial
37
The diabetic level of fasting blood glucose is ____.
> 126
38
The diabetic level of 2h-postprandial blood glucose is ______.
≥ 200
39
Fasting blood glucose → Means you tested the blood after a minimum of __ hours of fasting.
8
40
A patient has fasting blood glucose of 124 and 2h-postprandial of 130, it means they have ____.
IFG
41
If a patient has fasting blood glucose of 90 but a 2h-postprandial of 150, it means they have ____.
IGT
42
True or False: IFG and IGT are considered 2 distinct readings.
True
43
All of the following can used to diagnose type 2 diabetes EXCEPT:
A. Symptoms of diabetes (3Ps) + random plasma glucose ≥ 200 mg/dl
B. Fasting plasma glucose ≥ 126 mg/dl
C. 2-hr plasma glucose during 2h 75g-OGTT ≥ 200 mg/dl
D. A1C ≥ 6.5% (standardized to the DCCT assay)
A. Symptoms of diabetes (3Ps) + random plasma glucose ≥ 200 mg/dl
44
The symptoms of diabetes include the 3 Ps, which are ______, _______, and ________.
Polyuria, polydipsia, and polyphagia
45
If a pregnant woman presents with diabetes during her first trimester, it is classified as:
A. Type 1 DM
B. Type 2 DM
C. Gestational DM
B. Type 2 DM
46
```
If a pregnant woman presents with diabetes during her 2nd trimester, she is categorized as having:
A. Type 1 DM
B. Type 2 DM
C. Gestational DM
D. Other types of diabetes
```
C. Gestational DM
47
True or False: With gestational diabetes, oral agents and insulin can be used as treatment.
False! Only insulin can be used!
48
```
A patient has fasting blood glucose of 124 and 2h-postprandial of 130. This means they have:
A. IFG
B. IGT
C. Diabetes
D. None of the above
```
A. IFG
49
```
A patient has fasting blood glucose of 90 and a 2h-postprandial of 150. This means they have:
A. IFG
B. IGT
C. Diabetes
D. None of the above
```
B. IGT
50
The threshold for glucose uptake by the kidney is ____, so when blood sugar is above that, it exceeds capability of kidney to conserve glucose, so that glucose goes into the urine, so you get polyuria.
180 mg/dl
51
Gestational diabetes is diagnosed during which trimesters?
2nd and 3rd
52
If diabetes is diagnosed during the first trimester of pregnancy, it is called ______.
Type 2 DM
53
A risk factor for diabetes is a woman giving birth to a baby larger than ___ lbs.
9
54
True or False: GDM is a risk factor for type 2 diabetes.
True
55
At first prenatal visit, women who are planning to get pregnant should be assessed for risk of diabetes. If they are high risk, they will be tested with standard diagnostic testing. List the standard diagnostic testings that can be used here.
1. Test A1C if it's ≥ 6.5%
2. OGTT ≥ 200
3. Fasting glucose ≥ 126
56
When is the ideal time to screen for GDM?
24-28 weeks gestation
57
When screening for GDM during 24-28 weeks gestation, who should be screened?
All pregnant women not known to have diabetes.
58
List the 3 common short-term complications of diabetes.
1. hypoglycemia
2. Diabetic ketoacidosis
3. Hyperosmolar hyperglycemic state (HHS)
59
List the 3 microvascular long-term complications of diabetes.
Retinopathy, nephropathy (diabetic kidney disease), neuropathy
60
List the 3 macrovascular long-term complications of diabetes.
Peripheral vascular disease
Coronary artery disease
Cerebrovascular disease
61
Women with GDM should be screened for diabetes ____ weeks postpartum using OGTT and non-pregnancy diagnostic criteria.
6-12 weeks postpartum to ensure they didn't develop type 2 DM
62
Women with a history of GDM should be tested for diabetes or prediabetes every __ years.
3
63
Women with a history of GDM should receive lifestyle intervention or ____ to prevent diabetes.
Metformin
64
True or False: Prediabetics have insulin resistance and hyperinsulinemia.
True because beta cells try to compensate for the insulin resistance by producing more insulin.
65
The combination of insulin resistance and hyperinsulinemia in prediabetics increases their risk for ____ complications, such as MI or stroke.
Macrovascular complications
66
For prediabetic patients, weight loss by ___% and weekly activity of ___ minutes can reduce the progression to diabetes.
5-10% weight loss and 150 mins/week exercise.
67
In addition to lifestyle modifications, consider metformin for prevention of T2DM in patients with pre diabetes, especially for those with BMI > ___, age < ___, and women with prior GDM.
BMI > 35
| Age < 60 years
68
In patients with prediabetes, they should be monitored for diabetes every __ year(s).
1
69
In prediabetic patients, they should be screened and treated for modifiable risk factors for CVD. These would include ____, ___, and ____.
HTN
Hyperlipidemia
Smoking
70
Other names for type 1 DM include ____ and _____.
Juvenile diabetes
| Insulin dependent diabetes
71
Many type 1 diabetics present with ___ as the first sign of type 1 diabetes.
Diabetic ketoacidosis (DKA)
72
Type 1 diabetics are ketosis prone under basal conditions. During this process, lipolysis occurs and there is breakdown of triglycerides from adipose tissue, and ____ are released, which go to the liver and produce ketones. These ketones can give people acidosis and lead to the development of diabetic ketoacidosis (DKA).
Free fatty acids
73
Why are type 1 diabetics usually thin?
Because they break down their fat stores.
74
True or False: Type 2 diabetics are often symptomatic with the classic signs of diabetes (3 Ps) and/or DKA.
FALSE!! Type 1 diabetics are the ones that symptomatic and present like this.
75
True or False: Type 1 diabetes is an autoimmune disease.
True
76
Type 1 diabetics should be tested for autoantibodies at time of diagnosis. If autoantibodies are present, they are categorized as having diabetes type ___.
1A
77
Type 1 diabetics should be tested for autoantibodies at time of diagnosis. If autoantibodies are NOT present, they are categorized as having diabetes type ___.
1B
78
Which of the following is MORE common?
A. Diabetes type 1A
B. Diabetes type 1B
A. Diabetes type 1A (accounts for ~90% of type 1 diabetic cases.
79
True or False: All type 1 diabetes have autoimmunity.
FALSE! ~90% have autoimmunity (Type 1A) and ~10% do not (Type 1B).
80
True or False: There is a strong genetic predisposition for type 1 and type 2 diabetes.
True (more in type 2 than type 1)
81
True or False: For type 1 diabetes, having a genetic predisposition is enough to cause type 1 diabetes.
FALSE! Must have genetic predisposition PLUS an environmental trigger.
82
In regards to type 1 diabetes, , which 2 viruses are the most common environmental triggers?
Rubella
| Coxsackie
83
True or False: The antibodies formed against rubella and coxsackie also have an affinity for beta cells, so they can attack the beta cells and destroy them.
True
84
True or False: Every child born in the US is screened for type 1 diabetes.
FALSE! because type 1 diabetes requires genetic predisposition plus an environmental trigger.
85
Other names for type 2 diabetes include ____ and ____.
Non-insulin dependent diabetes and adult onset diabetes
86
True or False: There is an absolute insulin deficiency in type 2 diabetics.
FALSE! There is relative deficiency because there is still insulin, but not enough for the blood glucose levels.
87
These type of diabetics are ketosis prone under basal conditions.
Type 1 diabetics.
88
True or False: Type 2 diabetics are ketosis prone under basal conditions.
FALSE! They are NOT ketosis prone under basal conditions.
89
True or False: Obesity is an insulin resistant state.
True
90
True or False: Majority of type 2 diabetics are obese.
True
91
In terms of pathogenesis for type 2 diabetes, these 2 defects are the primary contributors.
1. Relative insulin secretion impairment
| 2. Insulin resistance
92
The pathogenesis effect of type 2 diabetes on this organ is mainly responsible for the fasting hyperglycemia of the patient.
Liver
93
The pathogenesis effect of type 2 diabetes on _____ is mainly responsible for the postprandial hyperglycemia of the patient.
Skeletal muscle
94
Hypoglycemia is defined as blood sugar level less than ___.
70 mg/dl
95
Severe hypoglycemia (neuroglycopenic stage) is categorized as having glucose level less than ___.
40 mg/dl
96
During the early stage of hypoglycemia, you see an early adrenergic response. List some of the symptoms.
Shakiness, sweating, palpitations, nervousness (mimic effects of when you're scared)
97
List some of the symptoms of the severe stage of hypoglycemia (late neuroglycopenic response).
Altered mentation, altered behavior (such as violence/agitation), slurred speech or not making sense.
98
How would you treat hypoglycemia?
Rule of 15 --> take 15 grams of carbohydrates (glucose tablet or other sugar source). Once sugar goes up, patient should eat a snack to sustain their blood sugar until next meal.
99
If the patient has severe hypoglycemia and the patient is unconscious, how can we treat them?
IM glucagon
| IV glucose
100
The earliest microvascular complication that can appear with diabetes is ___.
Diabetic retinopathy
101
It takes about __ years of diabetes to develop diabetic retinopathy.
5
102
True or False: Some individuals with type 2 DM can have diabetic retinopathy at time of diagnosis.
True
103
_____ is the leading cause of new cases of blindness in adults.
Retinopathy
104
True or False: People with diabetes are at increased risk of having cataracts, glaucoma, and other eye disorders.
True
105
There are 2 classifications of diabetic retinopathy: proliferative and non-proliferative. Which is more severe?
Proliferative
106
The presence of micro-aneurysms is the hallmark of this type of diabetic retinopathy.
A. Proliferative
B. Non-proliferative
B. Non-proliferative
107
Dilation of the capillary of the eye is called:
A. Micro-aneurysms
B. Cotton white spots
C. Dot hemorrhages
A. Micro-aneurysms
108
Leakage of serum in the eye that gives the appearance of white spots is called:
A. Micro-aneurysms
B. Cotton white spots
C. Dot hemorrhages
B. Cotton white spots
109
What is the main thing that occurs with proliferative diabetic retinopathy?
New vessel formation
110
True or False: Macular edema can occur at any stage of diabetic retinopathy.
True
111
True or False: Severe and very severe non-proliferative diabetic retinopathy are precursors for proliferative retinopathy.
True
112
Explain how polyol accumulation contributes to diabetic retinopathy.
Glucose gets converted to sorbitol, which then gets converted to fructose in the eye, which causes damage and results in retinopathy.
113
Protein kinase C can cause diabetic retinopathy by damaging the endothelium through 2 processes:
1. Promoting growth factors
2. __________
Increasing oxidative stress
114
```
All of the following can contribute to development of diabetic retinopathy EXCEPT:
A. Oxidative damage
B. Polyol accumulation
C. Growth Factors
D. High HDL
E. Protein kinase C
```
D. High HDL
115
All of the following can contribute to development of diabetic retinopathy EXCEPT:
A. Advanced glycation end-products (AGES)
B. Increased retinal blood flow
C. Hyperglycemia
D. Hypotension
E. Growth Factors
D. Hypotension
116
Why can increase in growth factors lead to diabetic retinopathy?
Because increased growth factors promote new vessel formation.
117
True or False: Oxidative stress can lead to the formation of reactive oxygen species and lead to the development of diabetic retinopathy.
True
118
True or False: Every type 2 diabetic should go initially for an eye exam upon diagnosis and once annually thereafter.
True
119
What type of eye exam should be done for diabetics to prevent vision loss?
Dilated and comprehensive eye exam.
120
True or False: Every type 1 diabetic should go initially for an eye exam upon diagnosis and once annually thereafter.
FALSE! For type 1 diabetics, go 5 year post diagnosis, then yearly thereafter.
121
This type of eye exam is able to detect most clinically significant micro-aneurysms, but should not replace the dilated and comprehensive eye exam in diabetic patients.
Fundus photographs
122
Diabetic macular edema can lead to loss of reading vision. Anti-vascular endothelial growth factor (VEGF) therapy is used to target _______ because these promote new vessel formation.
Growth factors
123
```
Which of the following is not FDA approved for the treatment of diabetic macular edema (DME), but is still used in practice:
A. Ranizumab
B. Aflibercept
C. Bevacizumab
D. Fluocinolone acetonide
E. Dexamethasone
```
C. Bevacizumab
124
What are the 2 steroids are approved for use in diabetic macular edema (DME) to reduce inflammation?
Fluocinolone and dexamethasone
125
```
This is a steroid used for the treatment of diabetic macular edema (DME) in patients previously treated with a course of corticosteroids and did not have a clinically significant rise in intraocular pressure.
A. Ranizumab
B. Aflibercept
C. Bevacizumab
D. Fluocinolone acetonide
E. Dexamethasone
```
D. Fluocinolone acetonide
126
True or False: Presence of retinopathy is a contraindication to aspirin therapy as this therapy increases risk of retinal hemorrhage.
FALSE!!! Retinopathy + aspirin use is fine because it doesn't increase risk of retinal hemorrhage.
127
True or False: There is a genetic predisposition for Diabetic Kidney Disease (DKD).
True
128
In stage 1 of diabetic kidney disease, the GFR is:
A. Decreased
B. Normal
C. Increased
C. Increased
129
In the 2nd stage of DKD, you see an increased urinary albumin to creatinine ratio, defined as UACR ≥ __ mg/g.
30
130
DKD is also called ____.
Diabetic nephropathy
131
Microalbuminuria is defined as UACR _____ mg/g creatinine.
UACR 30-299 mg/g creatinine
132
Proteinuria or macroalbuminuria is defined as UACR ≥ ___ mg/g creatinine.
300
133
When using an ACE or ARB or diuretic, these labs should be monitored.
Creatinine and potassium.
134
This class of medications should be used to treat patients with DKD and HTN.
ACE-Is/ARBs
135
```
This study showed that ACE inhibitors reduce cardiovascular events and therefore, are cardio-protective.
A. HOPE study
B. HPS study
C. IMPROVE-IT study
D. ACCORD study
E. AIM-HIGH study
```
A. HOPE study
136
Which of the following complications is most common and affects the most number of patients in DM types 1 and 2?
A. Diabetic retinopathy
B. Diabetic Kidney Disease (aka nephropathy)
C. Diabetic neuropathy
C. Diabetic neuropathy
137
What are the 2 types of diabetic neuropathy?
Peripheral neuropathy
| Autonomic neuropathy
138
Most common form of neuropathy in diabetics is ______, which is a type of peripheral neuropathy.
Painful distal symmetrical polyneuropathy
139
The hallmark of peripheral neuropathy is _____.
Loss of protective sensation
140
True or False: With peripheral neuropathy, patients frequently complain of consistent numbness, tingling of extremities, and painful extremities, especially during the night.
True
141
True or False: The symptoms of peripheral neuropathy can affect a patient's quality of life and lead to depression.
True
142
About __% of patients with diabetes have depression.
40%
143
Is there a test to diagnosed peripheral neuropathy?
A. Yes
B. No
B. No (so diagnosed clinically through symptoms)
144
```
All of the following are FDA approved for the treatment of painful diabetic neuropathy EXCEPT:
A. Pregabalin
B. Tramadol
C. Duloxetine
D. Tapentadol ER
```
B. Tramadol
145
True or False: TCAs can be used in the treatment of painful diabetic neuropathy.
True
146
Hypoglycemic unawareness falls under this type of neuropathy:
A. Peripheral
B. Autonomic
B. Autonomic
147
This type of neuropathy falls under autonomic neuropathy, affects specifically the heart, can result in systolic dysfunction, reduced ejection fraction, and impaired CV reflexes, and results in increased mortality in people with diabetes.
Cardiac autonomic neuropathy
148
Name a hallmark of cardiac autonomic neuropathy
```
Resting tachycardia
Variability in HR
Exercise intolerance
Silent MI
Postural hypotension
```
149
Postural hypotension is defined as more than __ mmHg drop in systolic BP and/or more than ___ mmHg drop in diastolic when you stand.
20 drop in systolic
| 10 drop in diastolic
150
The only FDA approved drug that is used for postural hypotension in cardiac autonomic neuropathy is called ____.
Midodrine
151
Metoclopramide, used to treat gastroporesis in autonomic neuropathy, has a black box warning for ____.
Irreversible tardive dyskinesia
152
Foot amputations can be a result of which type of neuropathy?
A. Peripheral
B. Autonomic
A. Peripheral
153
The 10 gram monofilament test is used for what?
To test for sensation in feet/toes of diabetics
154
True or False: Diabetes eliminates gender protection for women for CVD.
True
155
Stage ___ in DKD is a marker of CV disease and a CV risk factor.
Stage 2
156
True or False: Platelets in diabetic patients are stickier and aggregate more as a result of increased thromboxane A2, resulting in prothrombotic state that can lead to atherosclerosis.
True
157
The pathogenesis of atherosclerosis in diabetic patients can be due to impaired fibrinolysis as a result of decreased:
A. Thromboxane A2
B. Tissue plasminogen activator (tPA)
C. Plasminogen Activator Inhibitor (PAI-1)
B. Tissue plasminogen activator (tPA)
158
True or False: Large, buoyant LDL particles are more atherogenic than small, dense LDL particles.
FALSE! Small, dense LDL particles are more atherogenic.
159
```
In all patients with diabetes, CV risk factors should be assessed at least ______.
A. Annually
B. Biannually
C. Every 3 years
D. Every 5 years
```
A. Annually
160
In patients with prior MI, ___ should be continued for at least 2 years after the even to reduce mortality.
Beta-Blockers
161
True or False: The goal of treatment with statin drugs is to reduce LDL.
FALSE! It is to reduce CV risk profile
162
```
This study randomized patients into simvastatin 40 mg vs. placebo and showed that people in the statin group had reduced CV risk compared to placebo, regardless of LDL level.
A. HOPE study
B. HPS study
C. IMPROVE-IT study
D. ACCORD study
E. AIM-HIGH study
```
B. HPS study
163
For severe hypertriglycerides (> 1,000 mg/dL), which medications can be used?
Fabric acid derivatives
| Fish oil
164
Which classes of drugs can increase low HDL?
Fibrate
| Niacin
165
This anti-hyperlipidemia drug is localized in the small intestine and works by inhibiting the absorption of cholesterol.
Ezetimibe (Zetia)
166
PCSK9 inhibitors is a class of drugs that inhibit PCSK9, which is an enzyme that binds to LDL receptors to prevent removal of LDL from circulation. 2 Medications in this class are ______ and ____.
Evolocumab and Alirocumab
167
Most effective at increasing HDL, but it is not used much in diabetes due to cause of increase in blood glucose and uric acid. However, studies have shown that if you use lower doses (less than __ grams per day), effect on HDL is good with minor glucose effects. Always monitor blood sugar more often when using it in diabetic patients.
2
168
In order to initiate statin therapy, list the CVD risk factors that would be considered.
```
LDL ≥ 100
Smoking
HTN
Overweight
Obesity
```
169
True or False: People with cardiovascular disease, regardless of age, should be put on high intensity statin.
True
170
Individuals ≥ 40 with no CV risk = _____ intensity statin
moderate
171
List the high intensity statins and their doses.
Rosuvastatin 20-40 mg
| Atorvastatin 40-80 mg
172
You have a 50 YO patient with diabetes, his LDL level is 90 and has HTN. Which intensity statin would you use?
You would use high intensity statin due to HTN being a risk factor.
173
```
The addition of ezetimibe (Zetia) to a moderate-intensity statin has been shown to provide additional CV benefit vs. moderate-intensity statin alone. This was shown through this study.
A. HOPE study
B. HPS study
C. IMPROVE-IT study
D. ACCORD study
E. AIM-HIGH study
```
C. IMPROVE-IT study
174
True or False: The risk of rhabdomyolysis is lower if you combine statin with gemfibrozil than if you combine statin with fenofibrate.
FALSE. The risk is HIGHER
175
```
Combination therapy of statin and fibrate has not been shown to improve CV outcomes and is generally not recommended. However, therapy with statin and fenofibrate may be considered for men with both triglyceride levels ≥ 200 mg/dl and HDL ≤ 34 mg/dl. This information is based on the following study.
A. HOPE study
B. HPS study
C. IMPROVE-IT study
D. ACCORD study
E. AIM-HIGH study
```
D. ACCORD study
176
```
Combination therapy statin and niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone, may increase the risk of stroke, and is not generally recommended. The study that showed this had to be terminated early due to the increased risk of stroke.
A. HOPE study
B. HPS study
C. IMPROVE-IT study
D. ACCORD study
E. AIM-HIGH study
```
E. AIM-HIGH study
177
The blood pressure goal for patients with HTN and diabetes is _______.
BP < 140/90 mm Hg
178
In terms of weight loss → for each kg lost, it reduces BP by __mmHg.
1
179
True or False: Sodium restriction will only have an effect on systolic BP.
FALSE! It will have an effect on systolic AND diastolic.
180
```
Which of the following classes of antihypertensives can increase blood glucose levels, can mask the symptoms of hypotension, and can delay recovery from hypoglycemia?
A. ACE-Is
B. ARBs
C. Diuretics
D. Beta-blockers
E. Calcium channel blockers
```
D. Beta-blockers
181
True or False: You should consider administering one or more antihypertensive agents at bedtime because studies have shown there is a correlation between a CV event and BP during sleep.
True
