Chapter 35 (4) Flashcards
Type 2 diabetes is a complex disorder involving:
A suboptimal response of insulin-sensitive tissues in the liver
Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type 1 diabetics have:
Autoantibodies to two tyrosine phosphatases
Diagnostic criteria for diabetes include:
Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl
Routine screening of asymptomatic adults for diabetes is appropriate for:
Native Americans, African Americans, and Hispanics
Screening for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter:
Any of the above
Insulin is used to treat both types of diabetes. It acts by:
Increasing peripheral glucose uptake by skeletal muscle and fat
Adam has type 1 diabetes and plays tennis for his university. He exhibits a knowledge deficit about his insulin and his diagnosis. He should be taught that:
He should increase his carbohydrate intake during times of exercise.
Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset
and duration of action?
Glulisine
The drug of choice for type 2 diabetics is metformin. Metformin:
Decreases glycogenolysis by the liver
Before prescribing metformin, the provider should:
Draw a serum creatinine level to assess renal function.
Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to
Step 2 therapy because they:
Have a significant risk for hypoglycemia
Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include:
Low risk for hypoglycemia
Control targets for patients with diabetes include:
Blood pressure less than 130/80 mm Hg
Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes:
Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dl.
Treatment with insulin for type 1 diabetics:
Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight
When the total daily insulin dose is split and given twice daily, which of the following rules may be followed?
Give two-thirds of the total dose in the morning and one-third in the evening.
Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include:
Those with no significant cardiovascular disease
Prevention of conversion from prediabetes to diabetes in young children must take highest priority and should focus on:
Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease
The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are:
Metformin and insulin
Unlike most type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in
older adults is:
Involuntary loss of 10% of body weight in less than 6 months
The drugs recommended for older adults with type 2 diabetes include:
Third-generation sulfonylureas
Ethnic groups differ in their risk for and presentation of diabetes. Hispanics:
Both 1 and 2
Have a high incidence of obesity, elevated triglycerides, and hypertension
Do best with drugs that foster weight loss, such as metformin
The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk
for micro- and macro-vascular complications include:
Glycemic targets between 7% and 7.5%
All diabetic patients with known cardiovascular disease should be treated with:
Angiotensin-converting enzyme inhibitors and aspirin to reduce risk of cardiovascular events
