Exam 2

Question 1

Name 3 common features of Type 1 DM at diagnosis

Answer 1

• Polyuria and thirst
• Weight loss and polyphagia
• Weakness/fatigue
• Nocturnal enuresis

Question 2

Name 3 common features of type 2 DM at diagnosis

Answer 2

• Recurrent blurred vision
• Vulvovaginitis
• Peripheral neuropathy
• Mostly asymptomatic

Question 3

Criteria for the diagnosis of DM

Answer 3

1. FPG greater than 126
2. Random glucose greater than 200 with signs of hyperglycemia or hyperglycemic crisis
3. A1C greater than 6.5
4. 2 hour OGTT FPG greater than 200

Question 4

Microvascular complications of DM

Answer 4

• Retinopathy
• Neuropathy (autonomic/peripheral)
• Nephropathy

Question 5

Microvascular complications of DM

Answer 5

Atherosclerosis (CAD, PAD, cerebrovascular dz)

Question 6

What is the leading cause of death in T1DM?

Answer 6

ESRD

Question 7

What is the leading cause of death in T2DM?

Answer 7

Macrovascular diseases leading to AMI, CVA

Question 8

What causes blindness in T1DM? T2DM?

Answer 8

T1DM = Severe proliferative retinopathy
T2DM = Macular edema/ischemia

Question 9

When do you refer a T1DM patient to an ophthalmologist? What percent of diabetic patients will have retinopathy at 30years?

Answer 9

5 years after diagnosis, 100%

Question 10

When do you refer a T2DM to an ophthalmologist? What percent will have retinopathy after 16 years?

Answer 10

At diagnosis, 60%

Question 11

What is the most common complication of DM in both type 1 and type 2?

Answer 11

Diabetic neuropathy

Question 12

How can you prevent/delay the progression of diabetic neuropathy?

Answer 12

Normalization of blood glucose

Question 13

Name 3 disorders caused by autonomic neuropathy in long-standing DM

Answer 13

1. Diabetic gastroparesis
2. Fecal incontinence
3. Orthostatic HTN
4. N/V/C/D

Question 14

How do you examine diabetic patients feet for peripheral neuropathy? What happens when they fail this test?

Answer 14

Microfilament - failure increases risk for unperceived neuropathic injury

Question 15

What does untreated charcot arthropathy lead to?

Answer 15

Rocker bottom deformity and ulceration

Question 16

How do you manage a diabetic foot ulcer?

Answer 16

• Decrease pressure with mechanical unloading

- Debridement and antibiotic

Question 17

How do you manage a diabetic patient who has lost feeling in their feet?

Answer 17

• Check feet daily for reddened areas, blisters, abrasions or lacerations
• Podiatry referral

Question 18

Name 3 features of the diabetic foot exam

Answer 18

1. Inspection for skin cracking, hair growth, ulcers, calluses, etc.
2. Check vascular supply (temperature and distal pulses)
3. Check neurologic function (sensation, ankle reflex, gait)

Question 19

What tests should you do to check neurologic function of a diabetic foot?

Answer 19

Vibratory sense
Proprioception
Microfilament

Question 20

How do you prevent cardiovascular complications in diabetics?

Answer 20

1. Lower BP to less than 140/90
2. Lower LDL to less than 100 (less than 70 if multiple risk factors)
3. ACE-I if CVD or microalbuminuria present
4. Aspirin

Question 21

Leading cause of death in patties with T2DM?

Answer 21

Coronary atherosclerosis

Question 22

Name 3 complications of diabetes

Answer 22

Candidal infections
Eruptive xanthomas
Carpal tunnel syndrome

Question 23

Name 4 cormorbid conditions associated with diabetes

Answer 23

Obstructive sleep apnea
Fractures
Cancer
Periodontal disease
Fatty liver disease
Hearing impairment

Question 24

What are 2 questions you should ask during a diabetic medical history?

Answer 24

• Patients blood glucose log
• History of DKA
• Hypoglycemic episodes (awareness)
• History of macro/micro complicatons

Question 25

Name 3 components of the physical exam

Answer 25

1. Height, weight, BMI 2. Fundoycopic exam 3. Foot examination 4. Skin examination 5. Thyroid examination

Question 26

What should you be looking for on the skin exam of a diabetic patient?

Answer 26

Acanthosis nigricans | Superficial candidal infections

Question 27

When should you get a lab evaluation of A1C?

Answer 27

If results not available within last 3 months

Question 28

Name 3 lab values you should get on a diabetic if not available within the last year?

Answer 28

1. Lipids 2. LFTs 3. TSH 4. GFR and serum creatinine 5. Urine albumin excretion with spot urine albumin:creatinine ratio

Question 29

What is the A1C recommendation for non-pregant adults with diabetes?

Answer 29

less than 7

Question 30

What is the preprandial capillary plasma glucose recommendation for non pregnant patients with diabetes?

Answer 30

80-130

Question 31

What is the peak postprandial capillary plasma glucose recommendation for non pregnant patients with diabetes?

Answer 31

Less than 180

Question 32

Name 3 referrals you should make for your diabetic paitietn

Answer 32

1. Ophthalmologist 2. Dentist 3. Family planning for women of reproductive age 4. Diabetes self-management education and diabetes self-management support 5. Dietitian

Question 33

Name 3 aspects of patient education in diabetics

Answer 33

1. Medical nutrition therapy 2. Weight management 3. Physical activity 4. Tobacco cessation 5. Immunizations

Question 34

How much of the diabetic diet should be carbs? fat? protein?

Answer 34

``` Carbs = 45-65% Fat = 25-35% Protein = 10-35% ```

Question 35

How often should you do a foot exam on a diabetic patient?

Answer 35

Yearly, if abnormal at every visit

Question 36

How often should you get a urine albumin:creatinine ratio?

Answer 36

Yearly

Question 37

What vaccinations should diabetic patients get?

Answer 37

Pneumococcal Influenza Hep B

Question 38

What should be done at EVERY VISIT?

Answer 38

Smoking cessation and BP