221223 PS Diabetes

Question 1

Alcoholism is a risk factor of diabetes?

Answer 1

No
Acute consumption: decrease BG
Chronic consumption: increase insulin resistance

Question 2

How to screen gestational diabetes?

Answer 2

Glucose tolerance 1 hour after ingestion of 50gr of glucose
If =>11.1: diabetes
7.8-11: f/u with 75gr
After 1h: =>10.6
After 2h: => 9
FBG next morning: => 5.3

Question 3

A1C <1.5 above target (ex: 7.5, 7.8…)

Answer 3

TLC +/- Metformin

Question 4

A1C => 1.5 above target

Answer 4

TLC + metformin +/- another agent

Question 5

Not at target + CVD

Answer 5

+ Liraglutide, canagliflozin (decrease MACE)
empagliflozin (decrease MACE + mortality)

Question 6

Not at target + Not CVD

Answer 6

+ another agent based on pt.’s profile (CKD, pregnancy, risk of hypoglycemia…)

Question 7

Start insulin when?

Answer 7

at anytime if the pt. cannot achieve target or develops DKA

Question 8

Pt is on insulin

Answer 8

Optimize insulin therapy
Add an oral agent

Question 9

Pt is on medication

Answer 9

Add basal insulin (1st choice)
or add 3rd oral agent
(Combine agents from different classes)

Question 10

Disulfiram-like reaction ~ hypoglycemia (flushing, sensation of warmth, nausea, tachycardia) when?

Answer 10

alcohol + SU

Question 11

Bolus insulin, think what?

Answer 11

Bolus = Meal
Control BG after meal
Skip meal, skip bolus

Question 12

Test ketone bodies when?

Answer 12

T1DM
PPBG > 14
symptom of DKA

Question 13

Target A1C

Answer 13

2h PPG 5-10
FBG 4-7
T1DM <= 18: FBG 4-8

Question 14

Target of glycemic control during pregnancy

Answer 14

FBG < 5.3
1h PPG < 7.8
2h PPG < 6.7

Question 15

Symptoms of hypoglycemia

Answer 15

Autonomic (early): shakiness, sweating, palpitation, hunger, nausea, anxiety, numbness
Neuroglycopenic (hypoglycemia continues): trouble speaking, vision changes, confusion, dizziness/drowsiness, weakness, lack of concentration, headache

Question 16

Drugs withheld by diabetic pt. during sick days if they have N&V and cannot keep hydrated

Answer 16

SAD MANS

SU
Acei
Diuretics

Metformin
ARB
NSAIDs
SGLT2i

Question 17

In addition to caloric restriction and moderate physical activity, primary literature suggests that all the following medications can reduce the development of diabetes in high-risk pt (prediabetic) except:
A. Repaglinide
B. Metformin
C. Thiazolidinediones
D. Orlistat
E. Acarbose

Answer 17

Repaglinide causes your pancreas to release more insulin into the blood stream.

Question 18

All the following are complications of diabetes except:
A. Constipation
B. Erectile dysfunction
C. Depression
D. Vaginal candidiasis
E. None of the above

Answer 18

E. None of the above
Microvascular
Macrovascular: CAD, cerebrovascular, CHF, peripheral artery diseases, impaired wound healing
Uncontrolled BG: impaired immunity

Question 19

Diabetic food

Answer 19

affected by neuropathy (numbness, tingling, weakness, reduced sweating, reduced pain sensation)

Question 20

Fetid foot

Answer 20

malodourous food = unpleasant/stinky smell

Question 21

Diabetes + Heart failure: avoid?

Answer 21

thiazolidinediones (pioglitazone, rosiglitazone)