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CDE stuff Flashcards

1
Q

how often do you screen for diabetes if someone is <40 years old with no risk factors for DM?

A

no screen indicated

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2
Q

what is high risk of developing diabetes?

A

33% chance of developing diabetes within 10 years

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3
Q

what is VERY high risk of developing diabetes?

A

50% chance developing diabetes within 10 years

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4
Q

how often do you screen for diabetes in someone who is at least 40 years old with no risk factors?

A

every 3 years

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5
Q

how often do you screen for diabetes in someone with the presence of multiple risk factors?

A

every 6 to 12 months

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6
Q

what is the blood glucose range for impaired fasting glucose?

A

6.1 to 6.9mmol/L

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7
Q

at what blood glucose is fasting blood glucose considered diabetes?

A

7.0mmol/L

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8
Q

A1C range for pre-diabetes

A

6.1 to 6.4

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9
Q

A1C begins at ___ for diabetes

A

6.5

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10
Q

if symptomatic and a1c/fgb/2hPG/random PG) are in glucose range, do you need to repeat confirmatory test?

A

no

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11
Q

what microvascular complications do an A1C at 6.5 and below prevent?

A

chronic kidney disease and retinopathy

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12
Q

a1c target for functionally dependent?

A

7.1 to 8%

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13
Q

a1c target for frail elderly?

A

7.1 to 8.5

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14
Q

a1c target for limited life expectancy?

A

7.1 to 8.5

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15
Q

a1c target for severe recurrent hypoglycemia and/or hypoglycemia unawarenss

A

7.1 to 8.5

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16
Q

what does metabolic decompensation look like?

A

dehydration, HHS, DKA

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17
Q

first treatment option for a1c <1.5% above target?

A

physical activity, weight management. if not at target within 3 months, start/increase metformin

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18
Q

first treatment option for a1c> 1.5% above target?

A

physical acitivity, weight management, metformin +/- additional diabetes agent

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19
Q

first treatment option for symptomatic hyperglycemia and/or metabolic decompensatoin

A

insulin +/- metfomrin

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20
Q

diabetes agent with CV benefit?

A

empaglifozin, cannagliflozin, liraglutide

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21
Q

diabetes agent that has this contraindication: medullary thyroid cancer/MEN2

A

glp-1 agonist (liraglutide, exenatide, lixilgutide,

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22
Q

which class of medication can cause gallstone disease?

A

glp-1 agonists (liraglutide, exenatide, lixilgutide)

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23
Q

which class of medication can cause rare diabetic ketoacidosis (may occur with no hyperglycemia)?

A

sglt2-inhibitors

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24
Q

which medication can cause increased risk of fractures and amputations?

A

cannaglifozin

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25
Q

which class of medications can cause dose-related changes/increases of LDL-C?

A

sglt2inhibitors

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26
Q

bladder cancer is a contraindication for which drug - empaglifozin, dapa, or canna?

A

dapa

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27
Q

in those with clinical CVD, these 2 drugs can reduce CHF hospitalizations and progression of nephropathy?

A

empaglifozin and cannagliflozin

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28
Q

which drug may worsen heart failure?

A

saxagliptin (onglyza, komboglyze), TZD

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29
Q

which drugs are weight neutral?

A

acarbose, DPP4-inhibitors

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30
Q

TZD risks?

A

CHF, edema, fractures

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31
Q

rare bladder cancer is a risk of which drug?

A

pioglitazone

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32
Q

timeframe for getting to A1c targets?

A

3-6 months

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33
Q

rare joint pain is a side effect of which class of medications?

A

dpp-4 inhibitors

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34
Q

what’s included in cardiovascular disease?

A

cardiac ischemia (silent or overt), cerebrovascular/carotid disease, peripheral arterial disease

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35
Q

what is cardiac ischemia?

A

blocked blood flow to heart muscle

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36
Q

what is cerebrovascular disease?

A

reduced blood flow to the brain; can include stroke

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37
Q

what is carotid disease?

A

reduced blood flow in carotid arteries; 1 supplies blood to brain, the other to face/scalp/neck

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38
Q

what is peripheral arterial disease?

A

reduced blood flow to limbs, head, organs; may cause claudication (leg pain when walking)

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39
Q

if someone has CVD, what cardiovascular protection drugs do you need?

A

Statin + ACEI/R + ASA

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40
Q

if CVD, and already on Statin + ACEI/R + ASA but not at glycemic target, what other drug to use? (type 2 diabetes only)

A

start drug with CV benefit; liraglutide or empaglifozin or cannaglifozin

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41
Q

what is microvascular disease?

A

kidney disease (ACR at least 2), retinopathy, neuropathy

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42
Q

What CV protective drugs to start if someone has microvascular disease?

A

Statin + ACEI/R

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43
Q

What CV protective drugs to start if someone has retinopathy?

A

statin + ACEI/R

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44
Q

What CV protective drugs to start if someone has neuropathy?

A

statin + ACEI/R

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45
Q

What CV protective drugs to start if someone has kidney disease?

A

statin + ACEI/R

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46
Q

what risk factors other than microsvascular disease would be an indication to start Statin + ACEI/R (CV protection)

A

at least 55 yo + CV risk factors

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47
Q

when do you start a statin in the absence of CV and microvascular disease?

A

at least 40yo OR at least 30yo + >15 years duration of DM

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48
Q

ACEI/R doses with demonstrated vascular protection

A

perindopril 8mg daily, telmisartan 80mg daily, ramipril 10mg daily

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49
Q

How long can it take for brain function to be fully restored after hypoglycemia?

A

40 minutes

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50
Q

how often to check BG during long drives

A

before driving, then every 4 hours (unless unaware of hypoglycemia symptoms, then every 2 hours) or real-time continuous glucose monitor

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51
Q

BG needs to be at least ____ before driving?

A

5mmol/L

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52
Q

SADMANS stands for

A

sulfonylureas, ACEI, diuretics (or other direct renin inhibitor- aliskiren), Metformin, ARB, NSAIDs, sglt2-inhibitors

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53
Q

A1c target before pregnancy?

A

7% or less, but strive for 6.5

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54
Q

what drugs to stop prior to pregnancy?

A

non-insulin agents (except glyburide, metformin); ACEI/R unless overt nephropathy, in which case to continue until detection of pregnancy

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55
Q

blood pressure medications that can be used in pregnancy?

A

labetolol and nifedipine XL

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56
Q

if planning a pregnancy, what to start?

A

folic acid 1mg daily 3 months prior, insulin if a1c not at target with metformin/glyburide

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57
Q

what are SMART goals?

A

specific, measureable, achievable, realistic, timely

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58
Q

what is the cholesterol target in DM?

A

<2mmol/L or LDL-C 50% reduction from baseline

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59
Q

when to do an ECG?

A

every 3-5 y; if over 40yo , if >30 years and duration of diabetes >15 years, end-organ damage (micro, macrovascular), at least 1 CVD risk factor, age over 40 and planning to do vigorous activity

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60
Q

when to do a monofilament/vibration screening?

A

yearly or more if abnormal

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61
Q

when to do kidney eGFR , ACR?

A

yearly or more if abnormal

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62
Q

when to screen for retinopathy?

A

yearly if Type 1 (5 years after diagnosis, at least 15 years old), every1-2 years if type 2 (at diagnosis)

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63
Q

what is monogenic diabetes?

A

rare disorder caused by a genetic defect of beta cell function

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64
Q

what is latent autoimmune diabetes in adults (LADA)

A

apparent type 2 diabetes with immune mediated loss of of pancreatic beta cells

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65
Q

Type 1 usually occurs before what age and not usually before which age?

A

before 25yo but not before 6months

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66
Q

monogenic diabetes usually occurs in __?

A

less than 25 or less than 6 months

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67
Q

Baby <6 months has diabetes most likely has which kind?

A

monogenic/neonatal diabetes

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68
Q

monogenic or insulin or non-insulin dependent?

A

non-insulin dependent

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69
Q

what is an autosomal dominant disorder?

A

the mutated gene is a dominant gene located on one of the nonsex chromosomes (autosomes). You need only one mutated gene to be affected by this type of disorder.

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70
Q

what is C peptide

A

byproduct of formation of insulin ; usually absent in type 1, present in type 2 and monogenic diabetes

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71
Q

genetic testing is required to confirm which form of diabetes?

A

monogenic

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72
Q

diagnosis of diabetes is FBG ___

A

at least 7mmol/l

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73
Q

diagnosis of diabetes is A1C ___

A

at least 6.5%

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74
Q

diagnosis of diabetes is 2hPG 75g oral glucose tolerance test

A

at least 11.1mmo/l

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75
Q

diagnosis of diabetes is random BG

A

at least 11.1mmol/L

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76
Q

which test (a1c, FBG, 75OGTT) is the best predictor of CVD?

A

a1c

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77
Q

a1c, FBG, 75OGTT are all predictors of microvascular complications

A

true

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78
Q

A1c may be affected by ethnicity and age

A

true

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79
Q

a1c can be used for diagnostic purposes for children and adolescents?

A

no

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80
Q

a1c can be used for diagnostic purposes for screening gestational diabetes?

A

no

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81
Q

a1c can be used for diagnostic purposes for cystic fibrosis?

A

no

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82
Q

a1c can be used for diagnostic purposes for those suspected with type 1?

A

no

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83
Q

autoimmune markers that may be present in type 1 diabetes are :

A

GAD (anti-glutamic acid decarboxylase) and ICA (anti-islet cell auto-antibodies)

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84
Q

impaired glucose tolerance range (2hPG in a 75g OGTT)is

A

7.8 to 11.0 mmol/L

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85
Q

waist circumference cut off point for USA And Canada in Men

A

102cm

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86
Q

waist circumference cut off point for USA And Canada in women

A

88cm

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87
Q

waist circumference cut off point for asians, japanese, south & central americans in Men

A

90cm

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88
Q

waist circumference cut off point for asians, japanese, south & central americans in women

A

80cm

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89
Q

waist circumference cut off point for europeans, middle-eastern, sub-saharan african, mediterranen in Men

A

94cm

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90
Q

waist circumference cut off point for europeans, middle-eastern, sub-saharan african, mediterranen in women

A

80cm

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91
Q

metabolic syndrome requires at least 3 risk factors for diagnosis

A

yes

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92
Q

elevated TG risk factor is (for metabolic syndrome)

A

at least 1.7

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93
Q

elevated FBG risk factor (for metabolic syndrome) is

A

at least 5.6mmol/L

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94
Q

HDL-C risk factor in women for metabolic syndrome

A

less than 1.3

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95
Q

HDL-C risk factor in men (for metabolic syndrome)

A

less than 1

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96
Q

at risk, but not pre-diabetes is FBG and A1C

A

FBG 5.6-6mmol/L, A1C 5.5 to 5.9%

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97
Q

not at risk is FBG and A1C

A

FBG <5.6mmol and A1c <5.5%

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98
Q

cystic fibrosis is a risk factor for diabetes

A

true

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99
Q

obstructive sleep apnea is a risk factor diabetes

A

true

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100
Q

hyperuricemia/gout is a risk factor for diabetes

A

true

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101
Q

people with pre-diabetes at an increased risk of

A

CVD and developing DM

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102
Q

the CANRISK tool is intended for those ___ age

A

> at least 40 yo

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103
Q

losing 5% body weight can reduce risk of IFG&IGT developing into t2dm by?

A

60%

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104
Q

alternate health eating index can be used to reduce risk of diabetes

A

true

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105
Q

progession of diabetes from preidabetes can be redued by 30% with metformin

A

yes

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106
Q

metformin fro the prevention of diabetes may be more effective in:

A

those with a history of gestational DM, significant obesity (BMI>35), younger individuals (<60yo)

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107
Q

metformin can be used to prevent diabetes in those iwht

A

IGT/impaired glucose tolerance

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108
Q

improved glycemic control reduces risk of

A

CV and microvascular complications

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109
Q

UPKDS looked at those with long-standing or recently diagnosed diabetes?

A

recently diagnoses

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110
Q

trials that looked at intensive glycemic control on long-standing diabetes

A

ADVANCE, ACCORD, VADT

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111
Q

UKPDS and DCCT both showed

A

reduced microvascular complications but also reduced CV long-term in long-term follows

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112
Q

intensive glucose lowering therapy reduces the risk of

A

microvascular complications and composite of major adverse events (MACE) and MI

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113
Q

intensive glucose lowering therapy did not reduce risk of

A

CHF, total mortality, cardiac death, stroke

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114
Q

when a1c is higher, major contribution

A

is fasting glucose

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115
Q

when a1c is 7% or less (lower), major contribution is

A

postprandial glucose

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116
Q

a 2hppg <8mmol/L is about ___ a1c

A

<7%

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117
Q

in type 1 and 2 diabetes, an a1c of less than or equal to 7% can

A

reduce microvascular complications and CV complications (if implemented early enough)

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118
Q

if a1c less than 7% cannot be achieved with ppg 5-10mmol and fasting 4-7mmol, what targets should be implemented?

A

fasting 4-5.5mmol and postprandial 5-8mmol/L

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119
Q

mean blood glucose from days 90 to 120 contribute ___ % of a1c

A

10%

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120
Q

iron deficiency can increase or decrease A1c

A

increase

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121
Q

B12 deficiency can increase or decrease A1c

A

increase

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122
Q

decreased erythropoeisis can icnrease or decrease a1c

A

increase

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123
Q

alcoholism can increase or decrease a1c

A

increase

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124
Q

chronic renal failure can increase or decrease a1c

A

both

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125
Q

splenectomy can increase or decrease a1c

A

increase

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126
Q

increased lifespan of erythrocyte can increase or decrease a1c

A

increase

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127
Q

large doses of ASA can increase or decrease a1c

A

increase

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128
Q

hyperglyceridemia can increase or decrease a1c

A

decrease

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129
Q

chronic liver disease can increase or decrease a1c

A

decrease

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130
Q

use of erythropoetin, b12, iron can increase or decrease a1c

A

decrease

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131
Q

reticulocytosis can increase or decrease a1c

A

decrease

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132
Q

alternate site testing areas

A

palm, thigh, forearm

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133
Q

capillary testing of beta-OHB is preferred over urine testing of ketones because

A

earlier detection of ketosis and resolution

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134
Q

in type diabetes, when should test for ketones?

A

when prepandial BG is a tleast 14mmol/L or when symptoms of DKA are present

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135
Q

flash glucose monitoring may help reduce time spent in hypoglycemia in type 1 diabetes - true or false

A

true

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136
Q

what does moderate to high levels of physical activity reduce in diabetes?

A

morbidity (risk of CVD) and mortality

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137
Q

habitual, prolonged sitting can increase

A

risk of death cardiovascular events

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138
Q

cycling is considered to be aerobic exercise

A

true

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139
Q

walking is considered aerobic exercise

A

true

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140
Q

swimming is considered aerobic exercise

A

true

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141
Q

jogging is considered aerobic exercise

A

true

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142
Q

aerobic exercises uses rhythmic movements of large muscle groups

A

true

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143
Q

fast cycling is moderate or vigorous activity?

A

vigorous

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144
Q

climbing stairs or hill walking is moderate or vigorous activity?

A

vigorous

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145
Q

swimming is moderate or vigorous activity?

A

vigorous

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146
Q

aerobics is moderate or vigorous activity?

A

vigorous

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147
Q

brisk walking is moderate or vigorous?

A

moderate

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148
Q

dancing is moderate or vigorous?

A

moderate

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149
Q

light cycling is moderate or vigorous?

A

moderate

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150
Q

gardening and domestic chores is moderate or vigorous?

A

moderate

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151
Q

interval training can reduce risk of hypoglycemia in type __ diabetes

A

1

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152
Q

interval training can increase cardiorespiratory fitness gains in type __ diabetes

A

2

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153
Q

what are some strategies to reduce hypoglycemia during/after exercise in type 1 diabetes?

A

1) perform resistance exercise before aerobic exercise 2) perform brief maximmal-intensity sprints at start of exercise, periodically during activity and at end of exercise 3) reduce or suspend basal insulin if activity < or equal to 45 minutes 4) reduce total daily basal insulin by 20%.

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154
Q

how much can nutrition therapy reduce A1c?

A

1-2%

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155
Q

unsaturated oil is a preferred dietary fat

A

yes

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156
Q

nuts is a preferred dietary fat

A

yes

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157
Q

what is the recomended dietary intake of CHO?

A

no less than 130mg

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158
Q

total energy from CHO should be?

A

45-60%

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159
Q

total energy coming from protein should be

A

15-20%

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160
Q

total energy comng from fats is

A

20 to 35%

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161
Q

saturated fatty acids from diet should be no more than ___

A

9%

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162
Q

total energy intake from added sugars hould be no more than

A

10%

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163
Q

how much fibre should one consume daily?

A

30 to 50g

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164
Q

viscous soluble dietary fibre can improve __?

A

glycemic control

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165
Q

which diet can reduce cv events/

A

Mediterrance, vegan/vegetarian (reduce MI), DASH, dietary patterns emphasizing fruits+veggies, dietary pulses/legumes, fruits+vegetables, nuts

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166
Q

which can can reduce LDL-C

A

low GI, high fibre diet, vegan/vegetarianm DASH, dietary patterns emphasizing nuts, whole grains, dietary pulses/legumes

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167
Q

what is the max acceptable daily intake of sucralose?

A

8.8mg/kg/day

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168
Q

max of aspartame?

A

40mg/kg/day

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169
Q

max of acesulfame potassium?

A

15mg/kg/day

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170
Q

max of cyclamate?

A

11mg/kg/day

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171
Q

max of erythritol?

A

1000mg/kg/day

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172
Q

duration of insulin degludec is

A

42h

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173
Q

less stringent glycemic targets to help avoid hypoglycemia can be how many months

A

up to 3

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174
Q

if a type 1 diabetes patient is not achieving glycemic control with basal-bolus therapy, what is the next step?

A

use CSII with or without CGM

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175
Q

type1 diabetic on CSII should undergo periodic evaluation of continued CSII therapy

A

true

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176
Q

these agents increase insulin and lower glucagon levels

A

DPP4-inhibitors, GLP1-agonist

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177
Q

before intensifying insulin, if glycemic control is nto yet achieved, what agents can you add? to ensure less weight gain and minimize risk of hypoglycemia

A

DPP4, GLP1-agonist, SGL2 inhibitor

178
Q

what is the A1c lowering effect of metformin?

A

1%

179
Q

a1c lowering effect of DPP4?

A

0.5 to 0.7%

180
Q

a1c loewring of GLP1-agonsit

A

1%

181
Q

a1c lowering effect of SGLt2 inhibitor>

A

0.4 to 0.7%

182
Q

a1c lowering effect of acarbose?

A

0.7 to 0.8%

183
Q

how much weight can be lost with SGL2 i?

A

2 to 3 kg

184
Q

how much weight can be lost with GLP1 agonists?

A

1.6 to 3kg

185
Q

a1c lowering effect ofsulfonylureas/

A

0.7 to 1.3

186
Q

a1c lowering effect of meglinitides

A

0.7 to 1.1

187
Q

a1c lowering effect of TZDs?

A

0.8 to 0.9%

188
Q

a1c lowering effect of orlistat?

A

0.2 to 0.4

189
Q

insulin glargin U-300 vs. 100 reduces risk of overall and nocturnal hypoglycemia

A

true

190
Q

withhold SLG2 prior to major surgery, during acute infections and serious illness to reduce risk of

A

ketoacidosis

191
Q

your eGF should be at least __ to use acarbose

A

30ml/minute

192
Q

your eGF should be at least __ to use metformin

A

30ml/minute

193
Q

your eGF should be at least __ to use glyburide

A

60ml/minute

194
Q

your eGF should be at least __ to use gliclazide, glimepiride,

A

30ml/minute

195
Q

your eGF should be at least __ to use canna, dapa and empa

A

45for cana and empa, 60ml/minute for dapa

196
Q

do not initiate canna or empa if your eGFR is less than

A

60 ml/minute (do not initiate between 45-60ml

197
Q

your eGF should be at least __ to use pioglitazone and rosiglitazone

A

trick question; can use regardless

198
Q

your eGF should be at least __ to use insulin

A

any; caution below 30ml/minute

199
Q

this medication be used even regardless of kidney function

A

dulaglutide (cautionat <15ml), linagliptin, sitagliptin, (adjust dose), alogliptin (adjust dose), pioglitazone, rosiglitasone, repaglinide

200
Q

your eGF should be at least __ to use exenatide and lixi

A

30ml.minute

201
Q

your eGF should be at least __ to use liraglutide

A

15 ml/minute

202
Q

your eGF should be at least __ to use saxagliptin

A

15ml/minute

203
Q

after hypoglycemia is corrected, if the meal is >1h away, what hsould be consumed to prevent hypoglycemia?

A

15g CHO and a protein snack

204
Q

in moderate hypoglycemia, these symptoms are present

A

neuroglyopenic and autonomic

205
Q

in severe hypoglycemia, is what is the typical BG?

A

<2.8mmol

206
Q

tingling is a___ symptom

A

autonomic

207
Q

sweating is a ___ symptom

A

autonomic

208
Q

anxiety is a ___ symptom

A

autonomic

209
Q

headache is a ___ symptom

A

neuroglycopenic

210
Q

low health literacy is a risk factor for hypoglycemia

A

true

211
Q

long duration of insulin is a risk factor hypoglycemia

A

true

212
Q

prior episode of severe hypoglycemia is a risk factor for hypoglycemia

A

true

213
Q

current low a1c is a risk factor for hypoglycemia

A

true

214
Q

autonomic neuropathy is a risk factor for hypoglycemia

A

true

215
Q

chronic kidney disaese is a risk factor for hypoglycemia

A

true

216
Q

15g of sugar is ___ cubes of sugar

A

5

217
Q

15g of sugar is ___ ml of juice

A

150ml

218
Q

islet or pancreas transplantation is a strategy used to redduce severe hypoglycemia and/or to attempt to regain hypoglycemia awareness.

A

true

219
Q

how many of sugar do you need to treat severe hypoglycemia?

A

20g

220
Q

how can you treat an unconscious patient with severe hypoglycemia

A

1) IV 10-25g glucoe (20-50ml d50w) over 3 minutes OR with no IV access 2) 1mg glucagon subcut/IM

221
Q

how do youtreat diabetic ketoacidosis?

A

IV insulin 0.1 units per kg/h

222
Q

do you need bicarbonate therapy for ketoacidosis?

A

only if pH is less than or equal to 7

223
Q

a mildy elevated glucose level completely rules out DKA in pregnancy and SGLT2 inhibitor

A

false

224
Q

what fluid do you need to treat DKA/HHS?

A

0.9% sodium chloride IV at 500ml/h for 4h, 250mg/h for 4h

225
Q

what level beta-hydroxybutyrate warrants further testing of DKA after a capillary BG >14mmol/L?

A

> 1.5mmol/L

226
Q

resolution of ketosis in DKA is done by??

A

normalization of plasma anion gap. once PG concentration falls to 14mmol/L, dextrose should be started to avoid hypoglycemia

227
Q

hyperglycemia is associated with increased in-hospital

A

complications, mortality and longer length of stay

228
Q

for noncritically ill hospitalized patients, preprandial glucose and random glucose target should be

A

5-8mmol/L, <10mmol/L

229
Q

for critically ill in hospital patients, blood glucose shoudl be

A

6-10mmol/L

230
Q

what BG target level is appropriate for diabetes patients undergoing CABG

A

5.5-11.1mmol/L IV, not subcut to prevent infection

231
Q

waht is a healthy BMI?

A

18.5 to 24.9

232
Q

when can bariatric surgery be considered? What BMI level?

A

35.5

233
Q

for those with diabetes and end stage renal disease, which improves long-term outcomes: dialysis or transplant?

A

transplant

234
Q

an examination to assess fitness to drive should be taken every ___ years

A

2

235
Q

peolpe with a history of severe hypoglycemia or hypogylcemia unawareness are required to measure hteir BG every __- hours

A

2, OR wear a continous blood glucose monitor

236
Q

when should a patient on insulin and/or insulin secretagogues be no longer able to drive?

A

after 1 episode of severe hypoglycemia while driving in the last 12 months ;more than 1 episode of severe hypo while awak but not driving in the last 6 months (12 months for commercial drivers)

237
Q

how often should a resting ECG be done>

A

every 3 to 5 years

238
Q

when should an ECGbe done?

A

> 40 years, 1 least 1 CV risk factor, >30 years and duration of diabetes >15, end organ damage, age 40+ planning to take vigorous activity

239
Q

what does ezetimibe do?

A

lowers ldl-c

240
Q

what do fibrates do?

A

lowers TG, variable effect on LDL-C, variable effect on HDL-C

241
Q

what does niacin do?

A

raises HDL-C, lowers TG,, lowers LDL-C, lowers LipA

242
Q

what do PCSK9 inhibitors do?

A

lowers LDL-C, lowers Lpa, modest effect in TG_lowering and HDL-C raising

243
Q

lipid panel should be performed every ___

A

1 to 3 yeras

244
Q

after tx for dyslipidemia is started, how often should lipid panel be checked?

A

every 3 to 6 months

245
Q

in all people with ACS, if no history of diabetes, when would capillary bloog glucose testing be necessary in hospital?

A

if A1C is at least 6.5% and random BG is at least 11.1

246
Q

the presence of heart failure is __ fold higher in diabetes than in non diabetes

A

2-4 fold

247
Q

how does diabetes cause heart failure independent of ischemic hear disease?

A

by diabetic cardiomyopathy that reduces left ventricular ejection fraction

248
Q

individuals with heart failure should receive the same HF therapies regardless of diabetes

A

true

249
Q

beta blockers should still be precribed to HF patients when indicated

A

true

250
Q

if RAAS employed in those with diabetes, HF and egfr <60ml/min, what should starting ACE/ACER dose be?

A

halved

251
Q

chronic kidney disease increases risk of ___

A

cardioascular disease

252
Q

if severe hyperkalemia, RAAS blockade should be

A

held or discontinued

253
Q

if mild to moderate hyperkalemia, what are reasonable steps to take?

A

temporarily hold RAAS or reduce, consider a non potassium sparing diuretic, counsel on low potassium diet

254
Q

stage 2 CKD is ___egfr

A

60 to 89ml/min

255
Q

stage 3a CKD is ___ egfr

A

45 to 59ml/min

256
Q

stage 3b CKD is ___ eGFR

A

30 to 44ml/min

257
Q

stage 4 ckd is ___ eGFR

A

15 to 29

258
Q

stage 5 CKD is

A

<15ml/min

259
Q

in order to diagnose CKD in those with eGFR<60, ACR of at least 2mmol/L must be made __-

A

on at least 2 or 3 samples over a 3 month period

260
Q

which drug can be used in addition to a statin to delay the progression of established retinopathy?

A

fenofibrate

261
Q

what are risk factors for neuropathy?

A

increased BP, BG, TG, BMI, smoking

262
Q

what are the tests used to screen for neuropathy?

A

10g monofilament (used on dorsal of great toe bilaterally) or vibration perception (128hz tuning fork)

263
Q

what is usually affected first in neuropathy?

A

feet & legs, then hands and arms

264
Q

what are symptoms of diabetic neuropathy?

A

affecting the legs and feet - shooting pain, burning, tingling, feeling of being pricked with pins, throbbing and numbness

265
Q

when should neuropathy screening begin for type 1 diabetes?

A

5 years post pubertal

266
Q

which 2 anticonvulsants are not health canada approved for the treatment of neuropathy but are still used off label?

A

gabapentin and valproate

267
Q

which 2 antidepressants are not health canada approved for the treatment of neuropathy but are still used off label?

A

elavil, and venlafaxine

268
Q

assessment of the foot should include

A

neuropathy, structural absnormalities (bone deformities,), skin changes (calluses, infections, ulcers), peripheral arterial disease

269
Q

what is the prevalence of ED men with diabetes?

A

34-45%

270
Q

hypogonadal men with diabetes have a higher risk of cardiovascular mortality than eugonadal men with diabetes

A

true

271
Q

what are symptoms of low testosterone?

A

depressed mood and reduced energy, reduced lean body mass, reduced libido, ED

272
Q

men who do not respond to PDE5I should be screened for

A

hypogonadism with a morning serum testosterone level taken before 7am

273
Q

if a child is suspected with having diabetes, immediate diagnosis should be made to prevent

A

diabetic ketoacidosis

274
Q

what is the concern with pediatric diabetic ketoacidosis

A

cerebral edema (increased risk vs adult diabetic ketoadisos)

275
Q

what is the a1c target in a child with type 1 diabetes

A

7.5 or less

276
Q

what is the fasting target in a child with type 1 diabetes

A

4 to 8 mmol/L

277
Q

what is the 2h postprandial target in a child with type 1 diabetes

A

5-10mmol/l

278
Q

in child with severe/excessive hypoglycemia (type1), what is a more appropriate preprandial target?

A

6-10mmol/L

279
Q

how many carbs do you need to treat a <5yo with mild to moderate hypoglycemia

A

5g

280
Q

how many carbs do you need to treat a 5-10yo with mild to moderate hypoglycemia

A

10g

281
Q

severe hypogylcemia and later cognitive impairment is of more concern in this group of children

A

<6yo

282
Q

treatment of choice for initial therapy in children with type 1 diabetes

A

longacting basal insulin + rapid acting insulin

283
Q

in severe hypoglycemia in a child less than or equal 5yo, how much glucagon should be administered?

A

0.5mg

284
Q

in severe hypoglycemia in a child over 5yo, how much glucagon should be administered?

A

1mg

285
Q

mild or impending hypoglycemia in children can be treated with:

A

gluagon - 10mcg per year, minimum 20, maximum 150 mcg

286
Q

how do you treat severe hypoglycemia in unconscious child in hospital?

A

0.5 to 1mg/kg IV over 1-3 minutes dextrose

287
Q

what is the recommended physical activity for children? type 1, type 2?

A

type 1: at least 3 times per week, at least 60 minutes per week type 2: daily, 60 minutes minimum

288
Q

in children with DKA, the administration of ___ has been associated with cerebral edema

A

sodium bicarbonate, as such, it is typically avoided

289
Q

in children with DKA, insulin infusion is typically not started for

A

at least 1hr after fluid replacement therapy

290
Q

how do you treat cerebral edema in children with DKA>

A

mannitol or hypertonic saline

291
Q

how do you diagnose chronic kidney disease in children and when?

A

at least yr 12yo with diabetes duration >5y; morning ACR (preferred or random), followed by a repeat of morning ACR in 1 month, and if abnormal, then a 24h collection. should be persistent over 6-12 months

292
Q

all children with type1 DM should be screened for HTN ___

A

at least twice annually

293
Q

what is the prevalence of celiac disease in children with type1 diabetes?

A

4-9%

294
Q

type 2 diabetes in childhood is associated with severe and early

A

cardiovascular and microvascular complications

295
Q

screening for type 2 diabetes in children with risk factors should be conducted every __ years

A

2

296
Q

BMI at ___ is a risk factor for diabetes in children

A

at least 95th percentile for age and gender

297
Q

screen for diabetes in children if nonpubertal at 8yo if at least ___ risk factors

A

3

298
Q

screen for diabetes in children if pubertal with at least __ risk factors

A

2

299
Q

what is the physical activity recommendation in all children with type 2?

A

at least 60 minutes daily (moderate to vigorous)

300
Q

how to treat a child with type 2 diabetes , A1c at least 9, with metabolic decompensation?

A

Insulin + metformin (unless acidosis is present)

301
Q

what is the target a1c for most children with type 2?

A

less or equal to 7%

302
Q

what is the a1c target during pregnancy? planning pregnancy?

A

less than or equal to 6.5%, less than or equal to 7% (ideally 6.5)

303
Q

what is first line therapy for gestational diabetes?

A

diet and physical activity; if glycemic target not met, then metformin or insulin

304
Q

in those with high risk of diabetes in pregnancy, how early can screening be started?

A

any stage

305
Q

what is considered abnormal for 50g glucose challenge, 1hr test?

A

normal is <7.8mmol/L; diagnosis of GDM is at least 11.1mol/L, abnormal is 7.8 -11mmol/L

306
Q

after the 50g glucose challenge, if abnormal, do the 75g 2h challenge, what confirms GDM?

A

fasting greater than or equal to 5.3mmol/L, 1h 10.6mmol, 2h 9.0

307
Q

what is the alternate GDM screening protocol?

A

75g challenge, fasting at least 5.1mmol/L, 1h 10mmol/L, 8.5mmol/L

308
Q

after giving birth, when should screening for type 2 diabetes begin? and with what? How often?

A

between 6 weeks and 6 months postpartum. 75g challenge; every 3 years

309
Q

what benefit does breastfeeding (minimum 4 months) by a GDM women confer to child

A

reduced risk of hypoglycemia, obesity, development of diabetes

310
Q

in pregnancy, poorly controlled diabetes increases risk of

A

stillborn, miscarriage, baby born with malformation

311
Q

what is the prevalance of diabetes in pregnancy?

A

3 to 20%

312
Q

all pregnant women without known pre-existing diabetes should be screened for GDM between __

A

24 to 28 weeks of pregnancy

313
Q

at what age is it a risk factor for GDM?

A

35

314
Q

preconception a1c of 7% or less can reduce the risk of

A

spontaenous abortion, stillbirth, congenital anomalies, pre-eclampsia, progression of retinopathy in type 1,

315
Q

when should folic acid supplementation begin and for how long?

A

3 months prior to conception and 12 weeks after delivery

316
Q

what is pre-eclampsia?

A

occurs only in pregnancy; hypertension and albuminuria

317
Q

pregnant women with CKD or albuminuria is at risk of

A

hypertension and pre eclampsia

318
Q

once pregnant, women should be switched to ___ for glycemic control

A

insulin

319
Q

glucose targets in pregnancy are

A

fasting less than 5.3, 1hg pp less than 7.8, 2h pp <6.7mol/L

320
Q

what can reduce the risk of pre-eclampsia in women with pre-existing diabetes?

A

ASA 81mg daily at weeks 12-16

321
Q

what ist he BG target during labour and delviery to reduce risk of hypogylcemia in baby?

A

4to 7 mmol/L

322
Q

why is frequent SMBG necessary in the few days postpartum

A

high risk of hypoglycemia

323
Q

when should screening for postpartum thyroiditis be initiated in type 1 diabetes

A

2-4 months post partum

324
Q

metformin and glyburide can be used during pregnanc

A

true

325
Q

when can glyburide be used in pregnancy?

A

if insulin is declined and metformin not tolerated

326
Q

in women with previous GDM and IGT postpartum, what drug can be used to prevent onset of diabetes?

A

metformin

327
Q

the clock drawing test is used to test what?

A

capacity to inject insulin

328
Q

how many canadians have diabetes?

A

about 10%

329
Q

what reduces glucagon, food intake, blood glucose?

A

GIP and GLP1

330
Q

what does amylin do?

A

complements action of insulin; promotes satiety

331
Q

hormones that increase BG

A

catecholamines, growth hormon, glucagon, glucocorticosteroids

332
Q

what percentage of t2dm is LADA?

A

15-20%%

333
Q

what is the cutoff for elevated TG?

A

1.7

334
Q

gluconeogensis and ketogenesis occur during

A

periods of low BG to produce fuel for the brain

335
Q

energy per gm of carb?

A

4kcal

336
Q

energey per gm of protein?

A

4kcal

337
Q

energy per gm of fat?

A

9kcal

338
Q

energy per gm of alcohol?

A

7kcal

339
Q

energy per gm of sugar alcohol?

A

8kcal

340
Q

how much of fat consumsed is converted into glucose

A

<10%

341
Q

how much of protein is converted into glucose

A

58%

342
Q

how much of carbs is converted into glucose?

A

90to100%

343
Q

simple and complex carbs have __ effect on BG

A

same

344
Q

fructose increases __?

A

uric acid, BG and TG

345
Q

this sweetener should be avoided in pregnancy and pregnancy

A

cyclamate

346
Q

a third or more of fibre should be viscous soluble fibre

A

true

347
Q

insoluble fibres include

A

seeds, wheat bran, whole grains, skins of vegetables and fruits

348
Q

soluble fibres include

A

psyllium, rice, barley, seeds, legumes, potatoes, some fruits, some vegetables

349
Q

which fibre helps with constipation, BG and cholesterol?

A

soluble (insoluble helps with constipation only)

350
Q

low GI is

A

<55

351
Q

moderate GI is

A

56 to 69

352
Q

high GI is

A

70 +

353
Q

sweet potato, yam, legumes is: high low med GI

A

low

354
Q

potato, sweet corn, popcorn is : high low med GI

A

med

355
Q

french fries, pretzels, rice cakes, soda crackers, tropical fruit is high low med GI

A

high

356
Q

barley, pasta/noodles, conerted rice is :high low med GI

A

low

357
Q

brown rice is :high low med GI

A

med

358
Q

short-grain rice is high low med GI

A

high

359
Q

white bread & bagels is:

A

high GI

360
Q

whole wheat and rye bread is :

A

med GI

361
Q

pumpernickel and stone ground whole wheat is

A

low GI

362
Q

bran flakes, corn flakes, rice krispiers is

A

high GI

363
Q

all bran, oat bran is

A

low GI

364
Q

grapenuts, puffed wheat, oatmeal is

A

med GI

365
Q

saturated fats should make up max how much daily energy?

A

9%

366
Q

MUFA should make up max daily energy?

A

20%

367
Q

PUFAs should make up max faily energy?

A

10%

368
Q

these fats raise blood cholesterol levels

A

saturated and trans

369
Q

these fats lower blood cholesterol levels

A

MUFA and PUFA

370
Q

what is 1 standard drink? in beer

A

341ml 5% beer

371
Q

what is 1 standard drink? in alcohol spirits

A

43ml 40% alcohol spirit

372
Q

what is 1 standard drink? g of alcohol

A

10

373
Q

what is 1 standard drink? ml of wine

A

142ml of 12% wine

374
Q

what does alcohol inhibit?

A

gluconeogensis

375
Q

alcohol intake limit for women, men?

A

less than or 2 equal to 2 drinks, max 9 per week. less than or equate to 3 drinks per day, max 14 per week

376
Q

alcohol can ___

A

increase ketones, mask hypoglycemia, inhibit hepatic production of glucose

377
Q

what size cup is 15g worth of legumes (peas, lentils, beans)

A

1 cup

378
Q

what size cup is 15g worth of parsnips, peas, qinter squash,

A

1 cup

379
Q

what size cup is 15g worth of rasberries, blackberries and strawberries?

A

2 cups

380
Q

juice of about 12-15g CHO is ___ ml

A

125ml

381
Q

the following diets decrease a1c and increase HDL-C

A

low GI, dash, mediterraance, veggie/vegan

382
Q

these diets redue BP

A

dash, mediterranean

383
Q

this diet reduces TG

A

mediterrance, atkins

384
Q

what is the ornish diet?

A

very low fat

385
Q

what is the weight watches diet?

A

very low fat

386
Q

what is the zone diet?

A

high protein

387
Q

what is the atkins diet?

A

low carb

388
Q

what is the starting dose of insulin in type 2?

A

0.1 to 0.2 units/kg or 10 units

389
Q

what is the total basal-bolus dose?

A

0.3 to 0.5 untis per kg/d

390
Q

how is insulin distrubted for basal-bolus regimen?

A

40% basal, 20% bolus (35% pre breakfast + dinner, 30% pre lunch)

391
Q

infusion site in CSII needs to be changed every __

A

2 to 3 days

392
Q

how much is basal insulin in CSII

A

50%

393
Q

what are the contraindications to acarbose?

A

severe renal impairment, ulcers, cirrhosis, inflammatory bowel disease,

394
Q

these 2 drugs cannot be used if hx of bladder cancer

A

dapaglifozin, pioglitazone

395
Q

the following can be used in reduced renal dunction

A

repaglinide, linagliptin, dulaglutide, pio, rosiglitazone, insulin, alogliptin, sitagliptin

396
Q

tingling of the lips and and tongue are symptoms of

A

nocturnal hypoglycemia

397
Q

symptoms of nocturnal hypoglycemia

A

headache, difficulty getting up in morning, night sweats, nightmares, tingling of lips and tongue

398
Q

risk factors for hypoglycemia unawarenss

A

smoking, obesity, long standing diabetes, age, history of bouts of hyp,

399
Q

what is the dawn phenomenon?

A

increase in BG in morning due to body’s natural growth hormones in the morning or wearing off of previous day’s insulin

400
Q

a 1% decrease in a1c is about a __ decrease in mmol/l

A

2

401
Q

which is the major ketone body in ketosis?

A

3beta-hydroxybutyrate

402
Q

urine ketone test measures

A

acetoacetate

403
Q

when do you go to emergency?

A

ketones >12h, vomiting >2-4h, BG >16.6mmol/L

404
Q

primary symptom in HHS is

A

dehydration

405
Q

avoidance of hypo or hyperkalemia is important in HHS/DKA

A

hypo

406
Q

these 2 statins are most effective - reduces ldl-C by at least 50%

A

lipitor 40-80, crestor 20-40

407
Q

what is the percentage of people who will develop signs of kidney disease in diabetes?

A

50%

408
Q

___ is the leading cause of CKD in developed countries

A

diabetes

409
Q

___ is the leading cause of kidney failure in canada

A

diabetes

410
Q

risk factors for CKD

A

duration of diabetes, male, HTN, poor BG control, obesity, smoking

411
Q

kidney and __ disease are strongly related

A

heart

412
Q

when to screen for nephropathy int ype 1?

A

diabetes > 5 years (at 12+ yo)

413
Q

causes of transient albuminuria

A

febrile illness, mensutration, UTI, recent major exercise, decompensated HF, acute elevation in BP & BG

414
Q

what percentage of men with diabetes have ED?

A

35to 45%

415
Q

what percentage has bladder dysfunction?

A

37 to 50%

416
Q

after 10 years with diabetes, what percentage develops peripheral neuropathy?

A

40 to 50%

417
Q

what are the risk factors for neuropathy?

A

elevated BG, elevated TG, smoking, BMI, HTN

418
Q

this occurs in almost everyone who has diabetes over 25 years

A

nonproliferative retinoatphy

419
Q

proliferative retinopathy occurs in ___ of diabetes after 15 years

A

1/3

420
Q

risk factors for reitnopathy

A

increased BP, a1c; long duration diabetes, pregnancy (with type 1), proteinuria, low hemoglobin level, dyslipiedmia

421
Q

when to screen for retinopathy in type 1?

A

> 5 years duration in at least 15 yo

422
Q

in men >60 yo with diabetes,___ % has complete ED

A

40%

423
Q

at diagnosis of diabetes, ___ of men have ED

A

1/3

424
Q

at 6 years after diagnosis with diabetes, ___ of men men ED

A

50%

425
Q

ED is associated with CV events and mortality

A

true

426
Q

risk factors for ED

A

increasing age, duration of diabetes, poor BG control, smoking, HTN, dyslipidemia, androgen def, CVD, retinopathy

427
Q

hypogonadism occurs in ___ of men with diabetes

A

30-40%

428
Q

retinopathy is more common in first nations

A

true

429
Q

how often should fatty liver be screened in type 2 DM in kids?

A

yearl

430
Q

how do you diagnose children with type 2?

A

A1c AND random/fasting. if discrepancy, use 75g oral glucose tt

431
Q

list the 5 As of the empowerment model

A

acceptance, affect, autonomy, alliance, active participation

432
Q

what are the stages of change?

A

precontemplation, contemplation, preparation, action, maintenance

433
Q

prepration is when someone is ready to make a change in the next ___ days

A

30

434
Q

contemplation is when the person is thinking about making changes in the next __ months

A

6

435
Q

action is when someone is comitting to a change for ___

A

6 months

436
Q

what are the principles of motivational interviewing?

A

express empathy, roll with resistance, develop discrepancy, resolve ambivalance, support self-effiaccy

437
Q

what is the minimum eGFR for liraglutide?

A

15ml/min

438
Q

what ist he minikmum eGFR for exenatide and lixixenatide?

A

30ml/min

439
Q

what is the minimum egfr for saxagliptin?

A

15ml/min

440
Q

how much weight can you use lose with orlistat?

A

2 to 4kg

441
Q

how much weight can you gain with SU?

A

1.5 to 2.5kg

442
Q

how much weight can yo gainw ith insulin? long acting?

A

4 to 5kg, 0 to 4kg (long acting analogue alone)

CDE (2 decks)

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