6- diabetes

Question 1

The leading cause of death in patients with diabetes

Answer 1

cardiovascular disease- including both coronary heart disease and cerebrovascular disease

Question 2

the most common cause of new cases of blindness among adults of working age

Answer 2

diabetes

Question 3

how long does it take to get retinopathy in DM?

Answer 3

after 5 years:

controlled: 24%
uncontrolled: 40%

after 15 years:
DM1: almost all
DM2: 67%

Question 4

what % of people with diabetes develop diabetic nephropathy

Answer 4

20-40%

Question 5

can someone with DM2 develop DKA?

Answer 5

yes If the insulin deficiency is severe enough

Question 6

Hyperosmolar Hyperglycemic State

Answer 6

acute episode for DM2

mortality- 15%

severe dehydration
Plasma glucose levels are usually >600 mg/dL.

Question 7

underlying causes of HHS

Answer 7

most common- infection + decreased fluids

others: stroke, MI, PE

Question 8

typical mortality rate for DKA

Answer 8

2% for patients under 65 years old,

but as high as 22% for patients over 65 years old.

Question 9

typical plasma glucose level for DKA

Answer 9

250 mg/dL.

Question 10

In the absence of the above risk factors, screening should begin at what age for DM? according to ADA

Answer 10

45, then every 3 years if nl

Question 11

diagnosis criteria for DM

Answer 11

1. A random glucose > 200 mg/dL plus symptoms of hyperglycemia: polyuria or unexplained weight loss, or hyperglycemic crisis.
2. A fasting plasma glucose > 126 mg/dL.
3. HgBA1C >6.5%.
4. Oral Glucose Tolerance Test (OGTT) is more sensitive and a little more specific than a fasting glucose, but it is difficult to do and poorly reproducible, so it is not recommended for routine clinical use.

Question 12

findings on fundoscopic exam in severe, non-proliferative retinopathy

Answer 12

• Retinal hemorrhages
• Cotton wool spots
• Microaneurysms
• Neovascularization

Question 13

• Retinal hemorrhages

Answer 13

are dark blots with indistinct borders that indicate partial obstruction and infarction.

Question 14

Cotton wool spots

Answer 14

are white spots with fuzzy borders and they indicate areas of previous infarction. They accompany hemorrhages.

Question 15

Microaneurysms

Answer 15

are more punctate dark lesions that indicate vascular dilatation.

Question 16

how often should diabetics get foot exam

Answer 16

annual

Question 17

foot exam in diabetics entails

Answer 17

1. testing for loss of protective sensation
   - vibration using 128-Hz tuning fork
   - pinprick sensation
   - ankle reflexes (Achilles necessary, but patellar not needed)
2. Assessment of pedal pulses (dorsalis pedis and posterior tibial arteries
3. inspection- breaks in the skin, pressure calluses that precede ulceration, existing ulceration and infection, and bony abnormalities

Question 18

Recommended Diabetes Follow-Up Laboratory Studies

Answer 18

A. Hemoglobin A1c

C. Spot urine albumin/creatinine ratio

E. Serum creatinine and calculated GFR

F. Serum B12 levels (metformin s/e, neuropathy r/o)

G. Thyroid-stimulating hormone (TSH)

H. Fasting lipid profile (total cholesterol, LDL- and HDL-cholesterol and triglycerides)

Question 19

when should you measure HgbA1c

Answer 19

initial A1C testing at diagnosis,

follow-up testing at least two times a year in patients who are stable and meeting goal of A1C < 7;

quarterly when therapy is changing or they are not meeting goal.

Question 20

which HTN medication should be started for diabetic preferentially?

Answer 20

ACEI or ARB

Question 21

when should a diabetic get a moderate-intensity statin?

Answer 21

patients 40-75 yrs old with LDL-c >70 mg/dl

Question 22

when should a diabetic get a high-intensity statin?

Answer 22

patients 40-75 yrs old with LDL-c >70 mg/dL and ≥ 7.5% estimated 10-year ASCVD risk

Question 23

Consider aspirin therapy (75-162 mg/day) as a primary prevention strategy when…

Answer 23

those with type 1 or type 2 diabetes who are at increased cardiovascular risk (10-year risk >10%).

This includes most men or women with diabetes aged ≥50 years who have at least one additional major risk factor

Question 24

if aspirin allergy, what should you use?

Answer 24

clopidogrel

Question 25

what should the A1C goal be to prevent microvascular disease?

Answer 25

close to or less than 7%,

but doesnt help macrovascular (can even increase mortality if too intense)

Question 26

If HbA1C 6.5%-8%, what is treatment

Answer 26

Lifestyle changes plus Metformin

Question 27

If HbA1C > 8

Answer 27

Continue lifestyle changes and Metformin
+ Add either a sulfonylurea (Glyburide, Glipizide (both second generation)
or Glimepiride (third generation))
or basal insulin (Insulin Glargine (Lantus)
or Insulin Detemir (Levemir) on intermediate-acting insulin (NPH).

Question 28

Vaccines Recommended for Patients with Diabetes

Answer 28

influenza
pneumo23
hep B

Question 29

when should patients be revaccinated with pneumo23?

Answer 29

for patients over 64 years of age if the vaccine was first received greater than five years ago.

or if they have nephrotic syndrome, chronic renal disease or are immunocompromised.

Question 30

how often are dilated ophthalmoscopic exams needed

Answer 30

annual

Question 31

Optimal range for blood glucose:

Answer 31

fasting blood glucose 80 -120 mg/dl

1-2 hours postprandial < 180 mg/dl

Question 32

what can you not take with ACEIs?

Answer 32

ARBS (risk of renal failure, hyperkalemia)

Question 33

what is goal of HTN for diabetics and if above, must start meds?

Answer 33

140/90