06 - 57 yo female diabetes care

Question 1

in the absence of risk factors, screening for diabetes should begin at age ____ and if results are normal testing should be repeated at least every ____ years

Answer 1

• 45

- 3

Question 2

what are the diagnostic criteria for DM?

Answer 2

• random glucose 200 or more plus symptoms (polyuria, unexplained weight loss, hyperglycemic crisis)
• fasting plasma glucose of 126 mg/dL or more
• HbA1C 6.5% or greater

Question 3

eye symptom: dark blot with indistinct borders that indicate partial obstruction and infarction

Answer 3

retinal hemorrhages

Question 4

eye symptom: white spots with fuzzy borders indicating areas of previous infarction (usually accompany hemorrhages)

Answer 4

cotton wool spots

Question 5

eye symptom: punctate dark lesions that indicate vascular dilation

Answer 5

microaneurysms

Question 6

what is the hallmark of diabetic proliferative retinopathy?

Answer 6

neovascularization

Question 7

the optimal post-prandial blood glucose between 1-2 hours after a meal should be:

Answer 7

180 mg/dL or less

Question 8

is hyperosmolar hyperglycemic state a metabolic acidosis?

Answer 8

no - serum pH is generally over 7.3 with a bicarb over 15

Question 9

what are the physical findings in hyperosmolar hyperglycemic state?

Answer 9

• severe dehydration
• profound fluid deficit (in excess of 9L)
• serum osmolality usually exceeds 320 mOsm/kg

Question 10

metformin can lead to what vitamin deficiency?

Answer 10

B12

Question 11

according to JNC 8 what is the BP goal for patients over 18 with diabetes?

Answer 11

less than 140/90

Question 12

according to JNC 8 what are the medication options to treat HTN in diabetic patients?

Answer 12

• ACEi
• ARB
• CCB
• thiazide diuretic
• JNC 8 dropped the JNC 7 recommendation about preferentially picking an ACEi or ARB for patients with diabetes
• *for the general black population, including those with diabetes, a thiazide diuretic or CCB should be started

Question 13

what is the recommendation for screening asymptomatic diabetic patients for CHD?

Answer 13

not recommended (when ECG is normal)

Question 14

lowering the A1C to what level has been shown to prevent microvascular disease?

Answer 14

under 7%

Question 15

what vaccines are recommended for patients with diabetes?

Answer 15

• influenza (yearly)
• PPSV23 (one time for patients over 64 if the vaccine was first received greater than 5 years ago)
• hepatitis B

Question 16

when should type 1 diabetics get their first annual eye exam? type 2 diabetics?

Answer 16

• type 1: 5 years

- type 2: first diagnosed