33 Flashcards
1
Q
- Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type 1 diabetics have:
- Autoantibodies to two tyrosine phosphatases
- Mutation of the hepatic transcription factor on chromosome 12
- A defective glucokinase molecule due to a defective gene on chromosome 7p
- Mutation of the insulin promoter factor
A
- Autoantibodies to two tyrosine phosphatases
2
Q
Type 2 diabetes is a complex disorder involving:
- Absence of insulin production by the beta cells
- A suboptimal response of insulin-sensitive tissues in the liver
- Increased levels of glucagon-like peptide in the postprandial period
- Too much fat uptake in the intestine
A
- A suboptimal response of insulin-sensitive tissues in the liver
3
Q
- Diagnostic criteria for diabetes include:
- Fasting blood glucose greater than 140 mg/dl on two occasions
- Postprandial blood glucose greater than 140 mg/dl
- Fasting blood glucose 100 to 125 mg/dl on two occasions
- Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl
A
- Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl
4
Q
- Routine screening of asymptomatic adults for diabetes is appropriate for:
- Individuals who are older than 45 and have a BMI of less than 25 kg/m2
- Native Americans, African Americans, and Hispanics
- Persons with HDL cholesterol greater than 100 mg/dl
- Persons with prediabetes confirmed on at least two occasions
A
- Native Americans, African Americans, and Hispanics
5
Q
- Screening for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter:
- BMI above the 85th percentile for age and sex
- Family history of diabetes in first- or second-degree relative
- Hypertension based on criteria for children
- Any of the above
A
- Any of the above
6
Q
- Insulin is used to treat both types of diabetes. It acts by:
- Increasing beta cell response to low blood-glucose levels
- Stimulating hepatic glucose production
- Increasing peripheral glucose uptake by skeletal muscle and fat
- Improving the circulation of free fatty acids
A
- Increasing peripheral glucose uptake by skeletal muscle and fat
7
Q
- Adam has type 1 diabetes and plays tennis for his university. He exhibits a knowledge deficit about his insulin and his diagnosis. He should be taught that:
- He should increase his carbohydrate intake during times of exercise.
- Each brand of insulin is equal in bioavailability, so buy the least expensive.
- Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts.
- If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes.
A
- He should increase his carbohydrate intake during times of exercise.
8
Q
- Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action?
- Lispro
- Glulisine
- Glargine
- Detemir
A
- Glulisine
9
Q
- The drug of choice for type 2 diabetics is metformin. Metformin:
- Decreases glycogenolysis by the liver
- Increases the release of insulin from beta cells
- Increases intestinal uptake of glucose
- Prevents weight gain associated with hyperglycemia
A
- Decreases glycogenolysis by the liver
10
Q
- Before prescribing metformin, the provider should:
- Draw a serum creatinine level to assess renal function.
- Try the patient on insulin.
- Prescribe a thyroid preparation if the patient needs to lose weight.
- All of the above
A
- Draw a serum creatinine level to assess renal function.
11
Q
- Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:
- Increase endogenous insulin secretion
- Have a significant risk for hypoglycemia
- Address the insulin resistance found in type 2 diabetics
- Improve insulin binding to receptors
A
- Have a significant risk for hypoglycemia
12
Q
- Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include:
- Better reduction in glucose levels than other classes
- Less weight gain than sulfonylureas
- Low risk for hypoglycemia
- Can be given twice daily
A
- Low risk for hypoglycemia
13
Q
- Control targets for patients with diabetes include:
- HbA1C between 7 and 8
- Fasting blood glucose levels between 100 and 120 mg/dl
- Blood pressure less than 130/80 mm Hg
- LDL lipids less than 130 mg/dl
A
- Blood pressure less than 130/80 mm Hg
14
Q
- Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes:
- Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily.
- Tight control is acceptable for older adults if they are without complications.
- Plasma glucose levels are the same for children as adults.
- Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dl.
A
- Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dl.
15
Q
- Treatment with insulin for type 1 diabetics:
- Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight
- Divides the total doses into three injections based on meal size
- Uses a total daily dose of insulin glargine given once daily with no other insulin required
- Is based on the level of blood glucose
A
- Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight