DM pt 2 highlights

Question 1

What 3 things should occur at a follow-up visit for DM?

Answer 1

1) A1c should be measured every 3 months
2) Annual eye exam
3) Referral to podiatrist

Question 2

The Diabetes Control and Complications Trial (DCCT):
The intensively treated group also had reduced risk of _______________________ of 41%

Answer 2

macrovascular disease

Question 3

The UK Prospective Diabetes Study (UKPDS) used what 3 treatments?

Answer 3

Metformin, sulfonylureas, or insulin

Question 4

DM:
1) What is the BP goal?
2) What is the A1c goal?

Answer 4

1) < 130/80 mmHg in patients without contraindications
2) A1C < 7%

Question 5

List the targeted A1c goals for:
1) Nonpregnant healthy adults
2) Pregnant women
3) Older healthy adults

Answer 5

1) <7
2) 6-6.5
3) <7.5

Question 6

List the targeted A1c goals for:
1) Frail older adults with limited life expectancy
2) Pts with hx of severe hypoglycemia

Answer 6

1) <8.5
2) <8

Question 7

Glycemic targets in CKD are the ______ as those without it

Answer 7

same

Question 8

What 4 things do T1DM pts need to know?

Answer 8

1) Basal dose
2) Mealtime dose
3) Carb to insulin ratio
4) Correction factor

Question 9

T1DM Tx: Daily dose of insulin:
1) Half of this is the _______ dose
2) The other half is divided over _______________ doses

Answer 9

1) basal
2) three mealtime

Question 10

T1DM Tx: Mealtime doses get tweaked by the _____________ ratio

Answer 10

carb to insulin

Question 11

T1DM correction factor: They will also take this insulin at ______________ if it’s needed

Answer 11

mealtime

Question 12

Insulin dosing for T1DM: What 3 types of doses do they wind up taking?

Answer 12

1) Basal insulin dose
2) Insulin to carb dose based on the meal
3) Correction factor

Question 13

1) The Somogyi effect occurs when nocturnal hypoglycemia leads to a compensatory ______________ in the morning
2) What is done?

Answer 13

1) hyperglycemia
2) Lower the nighttime basal dose

Question 14

T2 DM Tx algorithm: What is step 1?

Answer 14

Weight Loss + Exercise + Metformin

Question 15

T2 DM Tx algorithm:
You do Weight Loss + Exercise + Metformin, what do you do if HbA1c not reached after ~3 months?

Answer 15

Metformin + another agent (noninsulin or insulin)

Question 16

T2 DM Tx algorithm:
You do Metformin + another agent (noninsulin or insulin) what do you do if HbA1c not reached after ~3 months?

Answer 16

Metformin + two other agents (noninsulin or insulin)

Question 17

T2 DM Tx algorithm:
You do Metformin + two other agents (noninsulin or insulin); what do you do if HbA1c not reached after ~3 months?

Answer 17

Metformin + insulin +/- another noninsulin agent

Question 18

List the entire T2 DM Tx algorithm

Answer 18

1) Weight Loss + Exercise + Metformin
-If HbA1c not reached after ~3 months
2) Metformin + another agent (noninsulin or insulin)
-If HbA1c not reached after ~3 months
3) Metformin + two other agents (noninsulin or insulin)
-If HbA1c not reached after ~3 months
4) Metformin + insulin +/- another noninsulin agent

Question 19

An initial consideration would be starting with an A1c > ____; These patients probably need insulin at the start

Answer 19

10

Question 20

List 3 therapeutic considerations for T2

Answer 20

1) Cardiovascular and renal effects
2) Efficacy
3) Hypoglycemic risk

Question 21

Insulin in type 2: Most of the time they still make some insulin. For this reason, they may just wind up on basal dosing as a supplement. What is a good dose for this?

Answer 21

0.2 units / kg

Question 22

What are 2 ocular DM complications?

Answer 22

Cataracts and retinopathy

Question 23

List the important points abt non-proliferative diabetic retinopathy pathogenesis

Answer 23

Microvascular changes are limited to the retina
-Mild: no vision loss
-Macular edema
-Severe

Question 24

List the 3 important points abt proliferative diabetic retinopathy pathogenesis

Answer 24

Neovascularization
Macular edema
Vitreous hemorrhage or retinal detachment

Question 25

Diabetic Nephropathy: What antihypertensive therapy should you use?

Answer 25

ACE inhibitors

Question 26

Diabetic Nephropathy: An ACE inhibitor in _______________ pts with DM impedes progression to proteinuria and prevents increase in albumin excretion rate

Answer 26

normotensive

Question 27

Peripheral Neuropathy: Does motor or sensory issues come first?

Answer 27

Sensory impaired first

Question 28

List 4 manifestations of diabetic neuropathy

Answer 28

1) Peripheral Neuropathy 2) Charcot Foot 3) Diabetic neuropathic cachexia 4) Autonomic Neuropathy: -GI system -GU

Question 29

Autonomic Neuropathy: GU -For incomplete bladder functioning, ____________ can sometimes help

Answer 29

bethanechol

Question 30

Autonomic Neuropathy: GU -Orthostatic hypotension: fitted stockings, tilting head of bed, rising slowly, sometimes _________________ can be considered (but watch for supine hypertension and potassium derangement)

Answer 30

fludrocortisone

Question 31

List 2 Cardiovascular Complications of DM

Answer 31

1) Heart disease 2) Peripheral vascular disease

Question 32

List 2 Skin and Mucous Membrane Complications of DM

Answer 32

chronic pyogenic infection, candidal infection

Question 33

List some emergent conditions that can result from DM

Answer 33

1) DKA 2) HHS