CDE stuff Flashcards
(442 cards)
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
2
Q
what is high risk of developing diabetes?
A
33% chance of developing diabetes within 10 years
3
Q
what is VERY high risk of developing diabetes?
A
50% chance developing diabetes within 10 years
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
5
Q
how often do you screen for diabetes in someone with the presence of multiple risk factors?
A
every 6 to 12 months
6
Q
what is the blood glucose range for impaired fasting glucose?
A
6.1 to 6.9mmol/L
7
Q
at what blood glucose is fasting blood glucose considered diabetes?
A
7.0mmol/L
8
Q
A1C range for pre-diabetes
A
6.1 to 6.4
9
Q
A1C begins at ___ for diabetes
A
6.5
10
Q
if symptomatic and a1c/fgb/2hPG/random PG) are in glucose range, do you need to repeat confirmatory test?
A
no
11
Q
what microvascular complications do an A1C at 6.5 and below prevent?
A
chronic kidney disease and retinopathy
12
Q
a1c target for functionally dependent?
A
7.1 to 8%
13
Q
a1c target for frail elderly?
A
7.1 to 8.5
14
Q
a1c target for limited life expectancy?
A
7.1 to 8.5
15
Q
a1c target for severe recurrent hypoglycemia and/or hypoglycemia unawarenss
A
7.1 to 8.5
16
Q
what does metabolic decompensation look like?
A
dehydration, HHS, DKA
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
18
Q
first treatment option for a1c> 1.5% above target?
A
physical acitivity, weight management, metformin +/- additional diabetes agent
19
Q
first treatment option for symptomatic hyperglycemia and/or metabolic decompensatoin
A
insulin +/- metfomrin
20
Q
diabetes agent with CV benefit?
A
empaglifozin, cannagliflozin, liraglutide
21
Q
diabetes agent that has this contraindication: medullary thyroid cancer/MEN2
A
glp-1 agonist (liraglutide, exenatide, lixilgutide,
22
Q
which class of medication can cause gallstone disease?
A
glp-1 agonists (liraglutide, exenatide, lixilgutide)
23
Q
which class of medication can cause rare diabetic ketoacidosis (may occur with no hyperglycemia)?
A
sglt2-inhibitors
24
Q
which medication can cause increased risk of fractures and amputations?
A
cannaglifozin
25
which class of medications can cause dose-related changes/increases of LDL-C?
sglt2inhibitors
26
bladder cancer is a contraindication for which drug - empaglifozin, dapa, or canna?
dapa
27
in those with clinical CVD, these 2 drugs can reduce CHF hospitalizations and progression of nephropathy?
empaglifozin and cannagliflozin
28
which drug may worsen heart failure?
saxagliptin (onglyza, komboglyze), TZD
29
which drugs are weight neutral?
acarbose, DPP4-inhibitors
30
TZD risks?
CHF, edema, fractures
31
rare bladder cancer is a risk of which drug?
pioglitazone
32
timeframe for getting to A1c targets?
3-6 months
33
rare joint pain is a side effect of which class of medications?
dpp-4 inhibitors
34
what's included in cardiovascular disease?
cardiac ischemia (silent or overt), cerebrovascular/carotid disease, peripheral arterial disease
35
what is cardiac ischemia?
blocked blood flow to heart muscle
36
what is cerebrovascular disease?
reduced blood flow to the brain; can include stroke
37
what is carotid disease?
reduced blood flow in carotid arteries; 1 supplies blood to brain, the other to face/scalp/neck
38
what is peripheral arterial disease?
reduced blood flow to limbs, head, organs; may cause claudication (leg pain when walking)
39
if someone has CVD, what cardiovascular protection drugs do you need?
Statin + ACEI/R + ASA
40
if CVD, and already on Statin + ACEI/R + ASA but not at glycemic target, what other drug to use? (type 2 diabetes only)
start drug with CV benefit; liraglutide or empaglifozin or cannaglifozin
41
what is microvascular disease?
kidney disease (ACR at least 2), retinopathy, neuropathy
42
What CV protective drugs to start if someone has microvascular disease?
Statin + ACEI/R
43
What CV protective drugs to start if someone has retinopathy?
statin + ACEI/R
44
What CV protective drugs to start if someone has neuropathy?
statin + ACEI/R
45
What CV protective drugs to start if someone has kidney disease?
statin + ACEI/R
46
what risk factors other than microsvascular disease would be an indication to start Statin + ACEI/R (CV protection)
at least 55 yo + CV risk factors
47
when do you start a statin in the absence of CV and microvascular disease?
at least 40yo OR at least 30yo + >15 years duration of DM
48
ACEI/R doses with demonstrated vascular protection
perindopril 8mg daily, telmisartan 80mg daily, ramipril 10mg daily
49
How long can it take for brain function to be fully restored after hypoglycemia?
40 minutes
50
how often to check BG during long drives
before driving, then every 4 hours (unless unaware of hypoglycemia symptoms, then every 2 hours) or real-time continuous glucose monitor
51
BG needs to be at least ____ before driving?
5mmol/L
52
SADMANS stands for
sulfonylureas, ACEI, diuretics (or other direct renin inhibitor- aliskiren), Metformin, ARB, NSAIDs, sglt2-inhibitors
53
A1c target before pregnancy?
7% or less, but strive for 6.5
54
what drugs to stop prior to pregnancy?
non-insulin agents (except glyburide, metformin); ACEI/R unless overt nephropathy, in which case to continue until detection of pregnancy
55
blood pressure medications that can be used in pregnancy?
labetolol and nifedipine XL
56
if planning a pregnancy, what to start?
folic acid 1mg daily 3 months prior, insulin if a1c not at target with metformin/glyburide
57
what are SMART goals?
specific, measureable, achievable, realistic, timely
58
what is the cholesterol target in DM?
<2mmol/L or LDL-C 50% reduction from baseline
59
when to do an ECG?
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
60
when to do a monofilament/vibration screening?
yearly or more if abnormal
61
when to do kidney eGFR , ACR?
yearly or more if abnormal
62
when to screen for retinopathy?
yearly if Type 1 (5 years after diagnosis, at least 15 years old), every1-2 years if type 2 (at diagnosis)
63
what is monogenic diabetes?
rare disorder caused by a genetic defect of beta cell function
64
what is latent autoimmune diabetes in adults (LADA)
apparent type 2 diabetes with immune mediated loss of of pancreatic beta cells
65
Type 1 usually occurs before what age and not usually before which age?
before 25yo but not before 6months
66
monogenic diabetes usually occurs in __?
less than 25 or less than 6 months
67
Baby <6 months has diabetes most likely has which kind?
monogenic/neonatal diabetes
68
monogenic or insulin or non-insulin dependent?
non-insulin dependent
69
what is an autosomal dominant disorder?
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.
70
what is C peptide
byproduct of formation of insulin ; usually absent in type 1, present in type 2 and monogenic diabetes
71
genetic testing is required to confirm which form of diabetes?
monogenic
72
diagnosis of diabetes is FBG ___
at least 7mmol/l
73
diagnosis of diabetes is A1C ___
at least 6.5%
74
diagnosis of diabetes is 2hPG 75g oral glucose tolerance test
at least 11.1mmo/l
75
diagnosis of diabetes is random BG
at least 11.1mmol/L
76
which test (a1c, FBG, 75OGTT) is the best predictor of CVD?
a1c
77
a1c, FBG, 75OGTT are all predictors of microvascular complications
true
78
A1c may be affected by ethnicity and age
true
79
a1c can be used for diagnostic purposes for children and adolescents?
no
80
a1c can be used for diagnostic purposes for screening gestational diabetes?
no
81
a1c can be used for diagnostic purposes for cystic fibrosis?
no
82
a1c can be used for diagnostic purposes for those suspected with type 1?
no
83
autoimmune markers that may be present in type 1 diabetes are :
GAD (anti-glutamic acid decarboxylase) and ICA (anti-islet cell auto-antibodies)
84
impaired glucose tolerance range (2hPG in a 75g OGTT)is
7.8 to 11.0 mmol/L
85
waist circumference cut off point for USA And Canada in Men
102cm
86
waist circumference cut off point for USA And Canada in women
88cm
87
waist circumference cut off point for asians, japanese, south & central americans in Men
90cm
88
waist circumference cut off point for asians, japanese, south & central americans in women
80cm
89
waist circumference cut off point for europeans, middle-eastern, sub-saharan african, mediterranen in Men
94cm
90
waist circumference cut off point for europeans, middle-eastern, sub-saharan african, mediterranen in women
80cm
91
metabolic syndrome requires at least 3 risk factors for diagnosis
yes
92
elevated TG risk factor is (for metabolic syndrome)
at least 1.7
93
elevated FBG risk factor (for metabolic syndrome) is
at least 5.6mmol/L
94
HDL-C risk factor in women for metabolic syndrome
less than 1.3
95
HDL-C risk factor in men (for metabolic syndrome)
less than 1
96
at risk, but not pre-diabetes is FBG and A1C
FBG 5.6-6mmol/L, A1C 5.5 to 5.9%
97
not at risk is FBG and A1C
FBG <5.6mmol and A1c <5.5%
98
cystic fibrosis is a risk factor for diabetes
true
99
obstructive sleep apnea is a risk factor diabetes
true
100
hyperuricemia/gout is a risk factor for diabetes
true
101
people with pre-diabetes at an increased risk of
CVD and developing DM
102
the CANRISK tool is intended for those ___ age
>at least 40 yo
103
losing 5% body weight can reduce risk of IFG&IGT developing into t2dm by?
60%
104
alternate health eating index can be used to reduce risk of diabetes
true
105
progession of diabetes from preidabetes can be redued by 30% with metformin
yes
106
metformin fro the prevention of diabetes may be more effective in:
those with a history of gestational DM, significant obesity (BMI>35), younger individuals (<60yo)
107
metformin can be used to prevent diabetes in those iwht
IGT/impaired glucose tolerance
108
improved glycemic control reduces risk of
CV and microvascular complications
109
UPKDS looked at those with long-standing or recently diagnosed diabetes?
recently diagnoses
110
trials that looked at intensive glycemic control on long-standing diabetes
ADVANCE, ACCORD, VADT
111
UKPDS and DCCT both showed
reduced microvascular complications but also reduced CV long-term in long-term follows
112
intensive glucose lowering therapy reduces the risk of
microvascular complications and composite of major adverse events (MACE) and MI
113
intensive glucose lowering therapy did not reduce risk of
CHF, total mortality, cardiac death, stroke
114
when a1c is higher, major contribution
is fasting glucose
115
when a1c is 7% or less (lower), major contribution is
postprandial glucose
116
a 2hppg <8mmol/L is about ___ a1c
<7%
117
in type 1 and 2 diabetes, an a1c of less than or equal to 7% can
reduce microvascular complications and CV complications (if implemented early enough)
118
if a1c less than 7% cannot be achieved with ppg 5-10mmol and fasting 4-7mmol, what targets should be implemented?
fasting 4-5.5mmol and postprandial 5-8mmol/L
119
mean blood glucose from days 90 to 120 contribute ___ % of a1c
10%
120
iron deficiency can increase or decrease A1c
increase
121
B12 deficiency can increase or decrease A1c
increase
122
decreased erythropoeisis can icnrease or decrease a1c
increase
123
alcoholism can increase or decrease a1c
increase
124
chronic renal failure can increase or decrease a1c
both
125
splenectomy can increase or decrease a1c
increase
126
increased lifespan of erythrocyte can increase or decrease a1c
increase
127
large doses of ASA can increase or decrease a1c
increase
128
hyperglyceridemia can increase or decrease a1c
decrease
129
chronic liver disease can increase or decrease a1c
decrease
130
use of erythropoetin, b12, iron can increase or decrease a1c
decrease
131
reticulocytosis can increase or decrease a1c
decrease
132
alternate site testing areas
palm, thigh, forearm
133
capillary testing of beta-OHB is preferred over urine testing of ketones because
earlier detection of ketosis and resolution
134
in type diabetes, when should test for ketones?
when prepandial BG is a tleast 14mmol/L or when symptoms of DKA are present
135
flash glucose monitoring may help reduce time spent in hypoglycemia in type 1 diabetes - true or false
true
136
what does moderate to high levels of physical activity reduce in diabetes?
morbidity (risk of CVD) and mortality
137
habitual, prolonged sitting can increase
risk of death cardiovascular events
138
cycling is considered to be aerobic exercise
true
139
walking is considered aerobic exercise
true
140
swimming is considered aerobic exercise
true
141
jogging is considered aerobic exercise
true
142
aerobic exercises uses rhythmic movements of large muscle groups
true
143
fast cycling is moderate or vigorous activity?
vigorous
144
climbing stairs or hill walking is moderate or vigorous activity?
vigorous
145
swimming is moderate or vigorous activity?
vigorous
146
aerobics is moderate or vigorous activity?
vigorous
147
brisk walking is moderate or vigorous?
moderate
148
dancing is moderate or vigorous?
moderate
149
light cycling is moderate or vigorous?
moderate
150
gardening and domestic chores is moderate or vigorous?
moderate
151
interval training can reduce risk of hypoglycemia in type __ diabetes
1
152
interval training can increase cardiorespiratory fitness gains in type __ diabetes
2
153
what are some strategies to reduce hypoglycemia during/after exercise in type 1 diabetes?
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%.
154
how much can nutrition therapy reduce A1c?
1-2%
155
unsaturated oil is a preferred dietary fat
yes
156
nuts is a preferred dietary fat
yes
157
what is the recomended dietary intake of CHO?
no less than 130mg
158
total energy from CHO should be?
45-60%
159
total energy coming from protein should be
15-20%
160
total energy comng from fats is
20 to 35%
161
saturated fatty acids from diet should be no more than ___
9%
162
total energy intake from added sugars hould be no more than
10%
163
how much fibre should one consume daily?
30 to 50g
164
viscous soluble dietary fibre can improve __?
glycemic control
165
which diet can reduce cv events/
Mediterrance, vegan/vegetarian (reduce MI), DASH, dietary patterns emphasizing fruits+veggies, dietary pulses/legumes, fruits+vegetables, nuts
166
which can can reduce LDL-C
low GI, high fibre diet, vegan/vegetarianm DASH, dietary patterns emphasizing nuts, whole grains, dietary pulses/legumes
167
what is the max acceptable daily intake of sucralose?
8.8mg/kg/day
168
max of aspartame?
40mg/kg/day
169
max of acesulfame potassium?
15mg/kg/day
170
max of cyclamate?
11mg/kg/day
171
max of erythritol?
1000mg/kg/day
172
duration of insulin degludec is
42h
173
less stringent glycemic targets to help avoid hypoglycemia can be how many months
up to 3
174
if a type 1 diabetes patient is not achieving glycemic control with basal-bolus therapy, what is the next step?
use CSII with or without CGM
175
type1 diabetic on CSII should undergo periodic evaluation of continued CSII therapy
true
176
these agents increase insulin and lower glucagon levels
DPP4-inhibitors, GLP1-agonist
177
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
DPP4, GLP1-agonist, SGL2 inhibitor
178
what is the A1c lowering effect of metformin?
1%
179
a1c lowering effect of DPP4?
0.5 to 0.7%
180
a1c loewring of GLP1-agonsit
1%
181
a1c lowering effect of SGLt2 inhibitor>
0.4 to 0.7%
182
a1c lowering effect of acarbose?
0.7 to 0.8%
183
how much weight can be lost with SGL2 i?
2 to 3 kg
184
how much weight can be lost with GLP1 agonists?
1.6 to 3kg
185
a1c lowering effect ofsulfonylureas/
0.7 to 1.3
186
a1c lowering effect of meglinitides
0.7 to 1.1
187
a1c lowering effect of TZDs?
0.8 to 0.9%
188
a1c lowering effect of orlistat?
0.2 to 0.4
189
insulin glargin U-300 vs. 100 reduces risk of overall and nocturnal hypoglycemia
true
190
withhold SLG2 prior to major surgery, during acute infections and serious illness to reduce risk of
ketoacidosis
191
your eGF should be at least __ to use acarbose
30ml/minute
192
your eGF should be at least __ to use metformin
30ml/minute
193
your eGF should be at least __ to use glyburide
60ml/minute
194
your eGF should be at least __ to use gliclazide, glimepiride,
30ml/minute
195
your eGF should be at least __ to use canna, dapa and empa
45for cana and empa, 60ml/minute for dapa
196
do not initiate canna or empa if your eGFR is less than
60 ml/minute (do not initiate between 45-60ml
197
your eGF should be at least __ to use pioglitazone and rosiglitazone
trick question; can use regardless
198
your eGF should be at least __ to use insulin
any; caution below 30ml/minute
199
this medication be used even regardless of kidney function
dulaglutide (cautionat <15ml), linagliptin, sitagliptin, (adjust dose), alogliptin (adjust dose), pioglitazone, rosiglitasone, repaglinide
200
your eGF should be at least __ to use exenatide and lixi
30ml.minute
201
your eGF should be at least __ to use liraglutide
15 ml/minute
202
your eGF should be at least __ to use saxagliptin
15ml/minute
203
after hypoglycemia is corrected, if the meal is >1h away, what hsould be consumed to prevent hypoglycemia?
15g CHO and a protein snack
204
in moderate hypoglycemia, these symptoms are present
neuroglyopenic and autonomic
205
in severe hypoglycemia, is what is the typical BG?
<2.8mmol
206
tingling is a___ symptom
autonomic
207
sweating is a ___ symptom
autonomic
208
anxiety is a ___ symptom
autonomic
209
headache is a ___ symptom
neuroglycopenic
210
low health literacy is a risk factor for hypoglycemia
true
211
long duration of insulin is a risk factor hypoglycemia
true
212
prior episode of severe hypoglycemia is a risk factor for hypoglycemia
true
213
current low a1c is a risk factor for hypoglycemia
true
214
autonomic neuropathy is a risk factor for hypoglycemia
true
215
chronic kidney disaese is a risk factor for hypoglycemia
true
216
15g of sugar is ___ cubes of sugar
5
217
15g of sugar is ___ ml of juice
150ml
218
islet or pancreas transplantation is a strategy used to redduce severe hypoglycemia and/or to attempt to regain hypoglycemia awareness.
true
219
how many of sugar do you need to treat severe hypoglycemia?
20g
220
how can you treat an unconscious patient with severe hypoglycemia
1) IV 10-25g glucoe (20-50ml d50w) over 3 minutes OR with no IV access 2) 1mg glucagon subcut/IM
221
how do youtreat diabetic ketoacidosis?
IV insulin 0.1 units per kg/h
222
do you need bicarbonate therapy for ketoacidosis?
only if pH is less than or equal to 7
223
a mildy elevated glucose level completely rules out DKA in pregnancy and SGLT2 inhibitor
false
224
what fluid do you need to treat DKA/HHS?
0.9% sodium chloride IV at 500ml/h for 4h, 250mg/h for 4h
225
what level beta-hydroxybutyrate warrants further testing of DKA after a capillary BG >14mmol/L?
>1.5mmol/L
226
resolution of ketosis in DKA is done by??
normalization of plasma anion gap. once PG concentration falls to 14mmol/L, dextrose should be started to avoid hypoglycemia
227
hyperglycemia is associated with increased in-hospital
complications, mortality and longer length of stay
228
for noncritically ill hospitalized patients, preprandial glucose and random glucose target should be
5-8mmol/L, <10mmol/L
229
for critically ill in hospital patients, blood glucose shoudl be
6-10mmol/L
230
what BG target level is appropriate for diabetes patients undergoing CABG
5.5-11.1mmol/L IV, not subcut to prevent infection
231
waht is a healthy BMI?
18.5 to 24.9
232
when can bariatric surgery be considered? What BMI level?
35.5
233
for those with diabetes and end stage renal disease, which improves long-term outcomes: dialysis or transplant?
transplant
234
an examination to assess fitness to drive should be taken every ___ years
2
235
peolpe with a history of severe hypoglycemia or hypogylcemia unawareness are required to measure hteir BG every __- hours
2, OR wear a continous blood glucose monitor
236
when should a patient on insulin and/or insulin secretagogues be no longer able to drive?
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
how often should a resting ECG be done>
every 3 to 5 years
238
when should an ECGbe done?
>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
what does ezetimibe do?
lowers ldl-c
240
what do fibrates do?
lowers TG, variable effect on LDL-C, variable effect on HDL-C
241
what does niacin do?
raises HDL-C, lowers TG,, lowers LDL-C, lowers LipA
242
what do PCSK9 inhibitors do?
lowers LDL-C, lowers Lpa, modest effect in TG_lowering and HDL-C raising
243
lipid panel should be performed every ___
1 to 3 yeras
244
after tx for dyslipidemia is started, how often should lipid panel be checked?
every 3 to 6 months
245
in all people with ACS, if no history of diabetes, when would capillary bloog glucose testing be necessary in hospital?
if A1C is at least 6.5% and random BG is at least 11.1
246
the presence of heart failure is __ fold higher in diabetes than in non diabetes
2-4 fold
247
how does diabetes cause heart failure independent of ischemic hear disease?
by diabetic cardiomyopathy that reduces left ventricular ejection fraction
248
individuals with heart failure should receive the same HF therapies regardless of diabetes
true
249
beta blockers should still be precribed to HF patients when indicated
true
250
if RAAS employed in those with diabetes, HF and egfr <60ml/min, what should starting ACE/ACER dose be?
halved
251
chronic kidney disease increases risk of ___
cardioascular disease
252
if severe hyperkalemia, RAAS blockade should be
held or discontinued
253
if mild to moderate hyperkalemia, what are reasonable steps to take?
temporarily hold RAAS or reduce, consider a non potassium sparing diuretic, counsel on low potassium diet
254
stage 2 CKD is ___egfr
60 to 89ml/min
255
stage 3a CKD is ___ egfr
45 to 59ml/min
256
stage 3b CKD is ___ eGFR
30 to 44ml/min
257
stage 4 ckd is ___ eGFR
15 to 29
258
stage 5 CKD is
<15ml/min
259
in order to diagnose CKD in those with eGFR<60, ACR of at least 2mmol/L must be made __-
on at least 2 or 3 samples over a 3 month period
260
which drug can be used in addition to a statin to delay the progression of established retinopathy?
fenofibrate
261
what are risk factors for neuropathy?
increased BP, BG, TG, BMI, smoking
262
what are the tests used to screen for neuropathy?
10g monofilament (used on dorsal of great toe bilaterally) or vibration perception (128hz tuning fork)
263
what is usually affected first in neuropathy?
feet & legs, then hands and arms
264
what are symptoms of diabetic neuropathy?
affecting the legs and feet - shooting pain, burning, tingling, feeling of being pricked with pins, throbbing and numbness
265
when should neuropathy screening begin for type 1 diabetes?
5 years post pubertal
266
which 2 anticonvulsants are not health canada approved for the treatment of neuropathy but are still used off label?
gabapentin and valproate
267
which 2 antidepressants are not health canada approved for the treatment of neuropathy but are still used off label?
elavil, and venlafaxine
268
assessment of the foot should include
neuropathy, structural absnormalities (bone deformities,), skin changes (calluses, infections, ulcers), peripheral arterial disease
269
what is the prevalence of ED men with diabetes?
34-45%
270
hypogonadal men with diabetes have a higher risk of cardiovascular mortality than eugonadal men with diabetes
true
271
what are symptoms of low testosterone?
depressed mood and reduced energy, reduced lean body mass, reduced libido, ED
272
men who do not respond to PDE5I should be screened for
hypogonadism with a morning serum testosterone level taken before 7am
273
if a child is suspected with having diabetes, immediate diagnosis should be made to prevent
diabetic ketoacidosis
274
what is the concern with pediatric diabetic ketoacidosis
cerebral edema (increased risk vs adult diabetic ketoadisos)
275
what is the a1c target in a child with type 1 diabetes
7.5 or less
276
what is the fasting target in a child with type 1 diabetes
4 to 8 mmol/L
277
what is the 2h postprandial target in a child with type 1 diabetes
5-10mmol/l
278
in child with severe/excessive hypoglycemia (type1), what is a more appropriate preprandial target?
6-10mmol/L
279
how many carbs do you need to treat a <5yo with mild to moderate hypoglycemia
5g
280
how many carbs do you need to treat a 5-10yo with mild to moderate hypoglycemia
10g
281
severe hypogylcemia and later cognitive impairment is of more concern in this group of children
<6yo
282
treatment of choice for initial therapy in children with type 1 diabetes
longacting basal insulin + rapid acting insulin
283
in severe hypoglycemia in a child less than or equal 5yo, how much glucagon should be administered?
0.5mg
284
in severe hypoglycemia in a child over 5yo, how much glucagon should be administered?
1mg
285
mild or impending hypoglycemia in children can be treated with:
gluagon - 10mcg per year, minimum 20, maximum 150 mcg
286
how do you treat severe hypoglycemia in unconscious child in hospital?
0.5 to 1mg/kg IV over 1-3 minutes dextrose
287
what is the recommended physical activity for children? type 1, type 2?
type 1: at least 3 times per week, at least 60 minutes per week type 2: daily, 60 minutes minimum
288
in children with DKA, the administration of ___ has been associated with cerebral edema
sodium bicarbonate, as such, it is typically avoided
289
in children with DKA, insulin infusion is typically not started for
at least 1hr after fluid replacement therapy
290
how do you treat cerebral edema in children with DKA>
mannitol or hypertonic saline
291
how do you diagnose chronic kidney disease in children and when?
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
all children with type1 DM should be screened for HTN ___
at least twice annually
293
what is the prevalence of celiac disease in children with type1 diabetes?
4-9%
294
type 2 diabetes in childhood is associated with severe and early
cardiovascular and microvascular complications
295
screening for type 2 diabetes in children with risk factors should be conducted every __ years
2
296
BMI at ___ is a risk factor for diabetes in children
at least 95th percentile for age and gender
297
screen for diabetes in children if nonpubertal at 8yo if at least ___ risk factors
3
298
screen for diabetes in children if pubertal with at least __ risk factors
2
299
what is the physical activity recommendation in all children with type 2?
at least 60 minutes daily (moderate to vigorous)
300
how to treat a child with type 2 diabetes , A1c at least 9, with metabolic decompensation?
Insulin + metformin (unless acidosis is present)
301
what is the target a1c for most children with type 2?
less or equal to 7%
302
what is the a1c target during pregnancy? planning pregnancy?
less than or equal to 6.5%, less than or equal to 7% (ideally 6.5)
303
what is first line therapy for gestational diabetes?
diet and physical activity; if glycemic target not met, then metformin or insulin
304
in those with high risk of diabetes in pregnancy, how early can screening be started?
any stage
305
what is considered abnormal for 50g glucose challenge, 1hr test?
normal is <7.8mmol/L; diagnosis of GDM is at least 11.1mol/L, abnormal is 7.8 -11mmol/L
306
after the 50g glucose challenge, if abnormal, do the 75g 2h challenge, what confirms GDM?
fasting greater than or equal to 5.3mmol/L, 1h 10.6mmol, 2h 9.0
307
what is the alternate GDM screening protocol?
75g challenge, fasting at least 5.1mmol/L, 1h 10mmol/L, 8.5mmol/L
308
after giving birth, when should screening for type 2 diabetes begin? and with what? How often?
between 6 weeks and 6 months postpartum. 75g challenge; every 3 years
309
what benefit does breastfeeding (minimum 4 months) by a GDM women confer to child
reduced risk of hypoglycemia, obesity, development of diabetes
310
in pregnancy, poorly controlled diabetes increases risk of
stillborn, miscarriage, baby born with malformation
311
what is the prevalance of diabetes in pregnancy?
3 to 20%
312
all pregnant women without known pre-existing diabetes should be screened for GDM between __
24 to 28 weeks of pregnancy
313
at what age is it a risk factor for GDM?
35
314
preconception a1c of 7% or less can reduce the risk of
spontaenous abortion, stillbirth, congenital anomalies, pre-eclampsia, progression of retinopathy in type 1,
315
when should folic acid supplementation begin and for how long?
3 months prior to conception and 12 weeks after delivery
316
what is pre-eclampsia?
occurs only in pregnancy; hypertension and albuminuria
317
pregnant women with CKD or albuminuria is at risk of
hypertension and pre eclampsia
318
once pregnant, women should be switched to ___ for glycemic control
insulin
319
glucose targets in pregnancy are
fasting less than 5.3, 1hg pp less than 7.8, 2h pp <6.7mol/L
320
what can reduce the risk of pre-eclampsia in women with pre-existing diabetes?
ASA 81mg daily at weeks 12-16
321
what ist he BG target during labour and delviery to reduce risk of hypogylcemia in baby?
4to 7 mmol/L
322
why is frequent SMBG necessary in the few days postpartum
high risk of hypoglycemia
323
when should screening for postpartum thyroiditis be initiated in type 1 diabetes
2-4 months post partum
324
metformin and glyburide can be used during pregnanc
true
325
when can glyburide be used in pregnancy?
if insulin is declined and metformin not tolerated
326
in women with previous GDM and IGT postpartum, what drug can be used to prevent onset of diabetes?
metformin
327
the clock drawing test is used to test what?
capacity to inject insulin
328
how many canadians have diabetes?
about 10%
329
what reduces glucagon, food intake, blood glucose?
GIP and GLP1
330
what does amylin do?
complements action of insulin; promotes satiety
331
hormones that increase BG
catecholamines, growth hormon, glucagon, glucocorticosteroids
332
what percentage of t2dm is LADA?
15-20%%
333
what is the cutoff for elevated TG?
1.7
334
gluconeogensis and ketogenesis occur during
periods of low BG to produce fuel for the brain
335
energy per gm of carb?
4kcal
336
energey per gm of protein?
4kcal
337
energy per gm of fat?
9kcal
338
energy per gm of alcohol?
7kcal
339
energy per gm of sugar alcohol?
8kcal
340
how much of fat consumsed is converted into glucose
<10%
341
how much of protein is converted into glucose
58%
342
how much of carbs is converted into glucose?
90to100%
343
simple and complex carbs have __ effect on BG
same
344
fructose increases __?
uric acid, BG and TG
345
this sweetener should be avoided in pregnancy and pregnancy
cyclamate
346
a third or more of fibre should be viscous soluble fibre
true
347
insoluble fibres include
seeds, wheat bran, whole grains, skins of vegetables and fruits
348
soluble fibres include
psyllium, rice, barley, seeds, legumes, potatoes, some fruits, some vegetables
349
which fibre helps with constipation, BG and cholesterol?
soluble (insoluble helps with constipation only)
350
low GI is
<55
351
moderate GI is
56 to 69
352
high GI is
70 +
353
sweet potato, yam, legumes is: high low med GI
low
354
potato, sweet corn, popcorn is : high low med GI
med
355
french fries, pretzels, rice cakes, soda crackers, tropical fruit is high low med GI
high
356
barley, pasta/noodles, conerted rice is :high low med GI
low
357
brown rice is :high low med GI
med
358
short-grain rice is high low med GI
high
359
white bread & bagels is:
high GI
360
whole wheat and rye bread is :
med GI
361
pumpernickel and stone ground whole wheat is
low GI
362
bran flakes, corn flakes, rice krispiers is
high GI
363
all bran, oat bran is
low GI
364
grapenuts, puffed wheat, oatmeal is
med GI
365
saturated fats should make up max how much daily energy?
9%
366
MUFA should make up max daily energy?
20%
367
PUFAs should make up max faily energy?
10%
368
these fats raise blood cholesterol levels
saturated and trans
369
these fats lower blood cholesterol levels
MUFA and PUFA
370
what is 1 standard drink? in beer
341ml 5% beer
371
what is 1 standard drink? in alcohol spirits
43ml 40% alcohol spirit
372
what is 1 standard drink? g of alcohol
10
373
what is 1 standard drink? ml of wine
142ml of 12% wine
374
what does alcohol inhibit?
gluconeogensis
375
alcohol intake limit for women, men?
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
alcohol can ___
increase ketones, mask hypoglycemia, inhibit hepatic production of glucose
377
what size cup is 15g worth of legumes (peas, lentils, beans)
1 cup
378
what size cup is 15g worth of parsnips, peas, qinter squash,
1 cup
379
what size cup is 15g worth of rasberries, blackberries and strawberries?
2 cups
380
juice of about 12-15g CHO is ___ ml
125ml
381
the following diets decrease a1c and increase HDL-C
low GI, dash, mediterraance, veggie/vegan
382
these diets redue BP
dash, mediterranean
383
this diet reduces TG
mediterrance, atkins
384
what is the ornish diet?
very low fat
385
what is the weight watches diet?
very low fat
386
what is the zone diet?
high protein
387
what is the atkins diet?
low carb
388
what is the starting dose of insulin in type 2?
0.1 to 0.2 units/kg or 10 units
389
what is the total basal-bolus dose?
0.3 to 0.5 untis per kg/d
390
how is insulin distrubted for basal-bolus regimen?
40% basal, 20% bolus (35% pre breakfast + dinner, 30% pre lunch)
391
infusion site in CSII needs to be changed every __
2 to 3 days
392
how much is basal insulin in CSII
50%
393
what are the contraindications to acarbose?
severe renal impairment, ulcers, cirrhosis, inflammatory bowel disease,
394
these 2 drugs cannot be used if hx of bladder cancer
dapaglifozin, pioglitazone
395
the following can be used in reduced renal dunction
repaglinide, linagliptin, dulaglutide, pio, rosiglitazone, insulin, alogliptin, sitagliptin
396
tingling of the lips and and tongue are symptoms of
nocturnal hypoglycemia
397
symptoms of nocturnal hypoglycemia
headache, difficulty getting up in morning, night sweats, nightmares, tingling of lips and tongue
398
risk factors for hypoglycemia unawarenss
smoking, obesity, long standing diabetes, age, history of bouts of hyp,
399
what is the dawn phenomenon?
increase in BG in morning due to body's natural growth hormones in the morning or wearing off of previous day's insulin
400
a 1% decrease in a1c is about a __ decrease in mmol/l
2
401
which is the major ketone body in ketosis?
3beta-hydroxybutyrate
402
urine ketone test measures
acetoacetate
403
when do you go to emergency?
ketones >12h, vomiting >2-4h, BG >16.6mmol/L
404
primary symptom in HHS is
dehydration
405
avoidance of hypo or hyperkalemia is important in HHS/DKA
hypo
406
these 2 statins are most effective - reduces ldl-C by at least 50%
lipitor 40-80, crestor 20-40
407
what is the percentage of people who will develop signs of kidney disease in diabetes?
50%
408
___ is the leading cause of CKD in developed countries
diabetes
409
___ is the leading cause of kidney failure in canada
diabetes
410
risk factors for CKD
duration of diabetes, male, HTN, poor BG control, obesity, smoking
411
kidney and __ disease are strongly related
heart
412
when to screen for nephropathy int ype 1?
diabetes > 5 years (at 12+ yo)
413
causes of transient albuminuria
febrile illness, mensutration, UTI, recent major exercise, decompensated HF, acute elevation in BP & BG
414
what percentage of men with diabetes have ED?
35to 45%
415
what percentage has bladder dysfunction?
37 to 50%
416
after 10 years with diabetes, what percentage develops peripheral neuropathy?
40 to 50%
417
what are the risk factors for neuropathy?
elevated BG, elevated TG, smoking, BMI, HTN
418
this occurs in almost everyone who has diabetes over 25 years
nonproliferative retinoatphy
419
proliferative retinopathy occurs in ___ of diabetes after 15 years
1/3
420
risk factors for reitnopathy
increased BP, a1c; long duration diabetes, pregnancy (with type 1), proteinuria, low hemoglobin level, dyslipiedmia
421
when to screen for retinopathy in type 1?
> 5 years duration in at least 15 yo
422
in men >60 yo with diabetes,___ % has complete ED
40%
423
at diagnosis of diabetes, ___ of men have ED
1/3
424
at 6 years after diagnosis with diabetes, ___ of men men ED
50%
425
ED is associated with CV events and mortality
true
426
risk factors for ED
increasing age, duration of diabetes, poor BG control, smoking, HTN, dyslipidemia, androgen def, CVD, retinopathy
427
hypogonadism occurs in ___ of men with diabetes
30-40%
428
retinopathy is more common in first nations
true
429
how often should fatty liver be screened in type 2 DM in kids?
yearl
430
how do you diagnose children with type 2?
A1c AND random/fasting. if discrepancy, use 75g oral glucose tt
431
list the 5 As of the empowerment model
acceptance, affect, autonomy, alliance, active participation
432
what are the stages of change?
precontemplation, contemplation, preparation, action, maintenance
433
prepration is when someone is ready to make a change in the next ___ days
30
434
contemplation is when the person is thinking about making changes in the next __ months
6
435
action is when someone is comitting to a change for ___
6 months
436
what are the principles of motivational interviewing?
express empathy, roll with resistance, develop discrepancy, resolve ambivalance, support self-effiaccy
437
what is the minimum eGFR for liraglutide?
15ml/min
438
what ist he minikmum eGFR for exenatide and lixixenatide?
30ml/min
439
what is the minimum egfr for saxagliptin?
15ml/min
440
how much weight can you use lose with orlistat?
2 to 4kg
441
how much weight can you gain with SU?
1.5 to 2.5kg
442
how much weight can yo gainw ith insulin? long acting?
4 to 5kg, 0 to 4kg (long acting analogue alone)
