Endocrine

Question 1

What are the hallmark signs of type one diabetes?

Answer 1

Polyuria, polydipsia, polyphagia

Question 2

What occurs in type two diabetes?

Answer 2

Impaired insulin secretion, insulin resistance and/or abnormally elevated glucose production by liver

Question 3

Name eight risk factors for T2DM.

Answer 3

BMI >27, physical inactivity, first degree relative, PCOS, HTN, Indigenous/Hispanic/Asian/African American, CVD, hx of GDM

Question 4

Who should be screened for T2DM and how often?

Answer 4

Every 3 years in those > or equal to 40 years of age using fasting plasma glucose OR A1C or for those high risk (based on risk calculator)

Question 5

How often should patients with T2DM be screened for retinopathy?

Answer 5

At diagnosis and if none, every 1-2 years

Question 6

What are key aspects of a T2DM assessment?

Answer 6

Fundoscopic, monofilament, foot assessment, weight

Question 7

What is the diagnostic criteria for T2DM?

Answer 7

Fasting glucose of > or equal to 7 mmol, A1C > or equal to 6.5% (on two tests, at two separate times)

Question 8

What criteria qualifies pt as prediabetic?

Answer 8

A1C of 6-6.4%

Question 9

For children and adolescents with risk factors, how often should diabetes screening be done?

Answer 9

Every 2 years

Question 10

What are T2DM risk factors for children/adolescents?

Answer 10

Obesity, a part of high risk ethnic group, first degree relative, signs/symptoms of insulin resistance

Question 11

How often should those with risk factors for diabetes be screened?

Answer 11

Every 6-12 months

Question 12

What is the A1C target for someone with T2DM?

Answer 12

<6.5% if low risk for hypoglycemia and to reduce CVD/retinopathy risk, <7% for most others, higher in elderly/those at +hypoglycemia risk

Question 13

When should women with hx of GDM be screened for T2DM?

Answer 13

6 weeks-6 months postpartum with 2h 75g oral GTT, before future pregnancy, every 3 years

Question 14

Name two ways to screen for diabetic neuropathy.

Answer 14

Monofilament, on-off method with tuning fork

Question 15

How often should A1C testing be done in T2DM?

Answer 15

Q3months, q6months when stable/ A1C’s have been at target

Question 16

What are the ABCDES of reducing CVD events?

Answer 16

A- A1C <7%, B-blood pressure <130/80, C-cholesterol LDL <2 mmol/L, D-drugs to protect hearts, E-exercise/eating, S-stop smoking, limit stress

Question 17

How often should individuals be screened for CKD with a urine ACR?

Answer 17

Baseline/at diagnosis and then annually

Question 18

What qualifies pts for diagnosis of CKD?

Answer 18

Urine ACR >2 mg/mmol x2, and/or eGFR <60 ml/min x2

Question 19

If first urine ACR >2 mg/mmol or eGFR <60 ml/min, when should the next one be repeated?

Answer 19

Should have two more tests completed over three months

Question 20

What are some factors that may elevate urine ACR?

Answer 20

Infection, menstruation, marked HTN, marked hyperglycemia, CHF, vigorous exercise within 24 hours of test

Question 21

What is stocking distribution?

Answer 21

Symptom of peripheral neuropathy, usually bilateral and symptoms resemble stocking or glove

Question 22

What are microvascular complications of T2DM?

Answer 22

Nephropathy, neuropathy, retinopathy

Question 23

What are macrovascular complications of T2DM?

Answer 23

CAD, PAD, CVD

Question 24

What is the most common form of diabetic neuropathy?

Answer 24

Distal symmetric polyneuropathy

Question 25

How can autonomic neuropathy manifest?

Answer 25

Innervation of the heart, GI tract (gastroparesis), GU system, sexual dysfunction)

Question 26

What are some of the risk factors for developing a foot ulcer in those with T2DM?

Answer 26

Peripheral neuropathy, PAD, hx of ulcer/amputation, structural deformity, limited joint mobility, increased A1C, onychomycosis

Question 27

What is one thing to be aware of in men with T2DM?

Answer 27

May have decreased testosterone, should be screened for ED

Question 28

What is an appropriate A1C for elderly who frail and/or with dementia?

Answer 28

<8.5%

Question 29

What is an appropriate A1C for elderly who are functionally dependent?

Answer 29

<8%

Question 30

What is the best predictor of T2DM outcomes in the elderly?

Answer 30

Postprandial glucose

Question 31

What is the effect of hormones on diabetes?

Answer 31

Estrogen plays role in insulin secretion and sensitivity. When estrogen declines, these things are reduced and this places those who experience premature menopause @ greater risk

Question 32

What are the recommendations around screening for CVD in those with diabetes?

Answer 32

Suggested an ECG completed q3-5 years for those >40 years, duration of diabetes >15 years and >30 years, end organ damage, > or equal to 1 CVD risk factors

Question 33

What is the LDL-C goal for those with T2DM?

Answer 33

<2 or >50% reduction from baseline

Question 34

What is the recommendation for those with elevated triglycerides >4.5?

Answer 34

Fasting (>8 hours) lipid panel should be completed