pre-IC11

Question 1

How many stages are there in T1DM? Which stage starts to become symptomatic?

Answer 1

3; Stage 3

Question 2

Describe the pathophysiology of Type 1 DM

Answer 2

An absolute deficiency of pancreatic β-cell function

Question 3

Describe the pathophysiology of Type 2 DM

Answer 3

Progressive loss of adequate β-cell insulin secretion on the background of insulin resistance

Question 4

Signs and symptoms of hyperglycemia

Answer 4

• extreme thirst (polydipsia)
• hunger (polyphagia)
• decreased healing
• drowsiness
• dry skin
• frequent urination (polyuria)
• blurred vision

Question 5

Signs and symptoms of hypoglycemia

Answer 5

• fast heartbeat
• shaking
• hunger
• irritable
• headache
• dizziness
• weakness fatigue
• sweating
• impaired vision

Question 6

Diagnosis of DM

Answer 6

HbA1c 7% and above

Question 7

Types of positive antibodies found in T1DM patients

Answer 7

• islet cell autoantibodies and autoantibodies to GAD (GAD65)
• insulin
• tyrosine phosphatases IA-2 and IA-2b
• zinc transporter 8 (ZnT8)

Question 8

What substance is measured to prove absence of insulin in the body, and why is this measured instead of insulin?

Answer 8

C-peptide; insulin has a short half life

Question 9

Explain insulin resistance

Answer 9

In the presence of insulin, glucose utilization is impaired and hepatic glucose output increased

Question 10

Levels of glucose and insulin at an early stage of T2DM

Answer 10

Both elevated (hyperglycemia triggers insulin secretion)

Question 11

Primary cause of Type 1 Vs Type 2 DM

Answer 11

T1: Autoimmune-mediated pancreatic beta-cell destruction; positive antibodies

T2: Insulin resistance, impaired insulin secretion, negative antibodies

Question 12

Insulin production (C-peptide level) for Type 1 Vs Type 2 DM

Answer 12

T1: Absent
T2: Normal or abnormal

Question 13

Age of onset for Type 1 Vs Type 2 DM

Answer 13

T1: Usually <30 years
T2: Often >40 years, although increasing prevalent in obese
children and younger adults

Question 14

Onset of clinical presentation for Type 1 Vs Type 2 DM

Answer 14

T1: Abrupt
T2: Gradual

Question 15

Physical appearance for Type 1 Vs Type 2 DM

Answer 15

T1: Often thin
T2: Often overweight

Question 16

Proneness to ketosis for Type 1 Vs Type 2 DM

Answer 16

T1: Frequent
T2: Uncommon

Question 17

Onset and progress of hyperglycemia VS hypoglycemia

Answer 17

Hyper: gradual, may progress to diabetic coma
Hypo: sudden, may progress to insulin shock

Question 18

Measurement of fasting plasma glucose (FPG)

Answer 18

No calorie intake for ≥ 8hrs

Question 19

Measurement of Postprandial plasma glucose (PPG)

Answer 19

Glucose level measured after meal; usually after 2 hours

Can also be measured using a standardized 75-g oral glucose tolerance test (OGTT)

Question 20

Measurement of HbA1c

Answer 20

Measures the average amount of glucose in a person’s blood over the past 3 months.

HbA1c = Past 3 months Average of (FPG + PPG)

• Glucose stays attached to hemoglobin for the lifespan of a red blood cell (~120 days)

Question 21

Contributor to high HbA1c

Answer 21

Greater extent contributed by fasting/ basal hyperglycemia

Question 22

Contributor to lower HbA1c

Answer 22

Greater extent contributed by postprandial hyperglycemia

Question 23

Frequency of glucometer use for T1DM, pregnant women, or insulin pump users

Answer 23

• ≥ 4 times daily
• Before meals/snacks, at bedtime, at 3 a.m.

Question 24

Frequency of glucometer use for T2DM

Answer 24

• ≥ 3 times daily for patients on multiple injections of insulin
• For patients using less frequent insulin injections, noninsulin therapies, or medical nutrition therapy alone, self monitoring of blood glucose (SMBG) may be useful as a guide to the success of therapy

Question 25

Frequency of glucometer use for practice setting

Answer 25

Patients are to check before breakfast (to see fasting glucose lvl) and 2hr after largest meal (2 times) (to see postprandial glucose)

Question 26

In the absence of diabetes risk factors, at what age should screening begin and how often should the screening be repeated?

Answer 26

40 y/o; every 3 years

Question 27

Significance of HbA1c of 6% and below

Answer 27

No diabetes

Question 28

Cutoff for 2h OGTT for diabetes

Answer 28

11.1 mmol/L and above

Question 29

Prevention of foot wound of diabetic patients

Answer 29

Maximizing Blood Glucose Control / Reduce risk factors
Self-Examination of the Foot
Foot Protection
Nail and Foot Care and Hygiene
Annual Foot Examination

Question 30

General DM medication adjustments during Ramadan

Answer 30

TDS to BD
* Reduce medications with high hypoglycemia potential
* Evening dose potency to be higher than morning

Question 31

Steps to Understanding patient views

Answer 31

Listen, Explain, Acknowledge, Recommend, Negotiate

Question 32

Most common causes of mild-to-moderate infections in diabetes

Answer 32

Gram positive cocci esp staphylococcus/ streptococcus

Question 33

Most common causes of chronic/severe infections

Answer 33

Mixed gram-positive cocci and gram-negative bacilli with or without anaerobic organisms

Question 34

TIME management for diabetic foot/ wound care

Answer 34

• Tissue: Assessing for non-viable or necrotic tissue
• Infection: Chronic wounds get “stuck” in inflammation due to bacteria
• Moisture: Assessment and management of wound exudate
• Edge of Wound: Assessment of non-advancing wound edges and condition of the periwound

Question 35

Risk factors for foot wounds in diabetes

Answer 35

Poor glycemic control
Peripheral artery disease
Peripheral neuropathy
Visual impairment
Smoking

Question 35

Risk factors for foot wounds in diabetes

Answer 35

Poor glycemic control
Peripheral artery disease
Peripheral neuropathy
Visual impairment
Smoking

Question 36

Can moisturiser be used btw toes?

Answer 36

No; may cause fungal infx

Question 37

Foot examination for PAD

Answer 37

Vascular assessment of pedal pulses

Question 38

Foot examination for peripheral neuropathy

Answer 38

Neurologic exam with monofilament