Clinic Modules

Question 1

Biggest 3 factors that will decrease pts blood pressures

Answer 1

1. DASH Diet
   
   • Fresh fruits, veggies, whole grains, low-fat dairy, and low in saturated and total fats
   -Expect -11mmHg chane
2. Aerobic exercise
   
   • 90-150 minutes/week at 65-67% maximal predicted heart rate
     
     • Can expect 5-8mmHg change
3. Sodium restriction
   
   • Optimal intake 1500mg
   • Expect decrease in 5-6 mmHg

Question 2

Indicators for Primary aldosteronism

Answer 2

Resistant HTN

Hypertensive w/ K <3.5

Hypertensive w/ marked diuretic induced hypokalemia (K<3)

Incidental adrenal mass

FH of early onset of HTN

Stroke at age <40

Question 3

Therapy to start if A1c 7.5-8.9

> 9

10

Answer 3

Metformin + first-line agent

…+ 2 first-line agents

Start insulin right away

Question 4

Causes of falsely low A1c

Answer 4

Anemia/blood loss

Blood transfusion

Splenomegaly

Thalassemia

ESRD

Sickle Cell Anemia

Question 5

Conditions that can produce diabetes like states

Answer 5

Chronic pancreatitis

Chronic steroid use

Question 6

Latent Autoimmune Diabetes of Adults

Answer 6

Basically DM I in adults; will see anti-GAD and decreased c-peptide

Question 7

Time to refer DM I pts to ophthalmologist

Answer 7

5 years after diagnosis

Question 8

Diet recommendations EVERY visit for pts

Answer 8

Count carbs (45-65% of calories)

Recommend omega-3 FAs (salmon, almonds) and mediterranean diet

Moderate use of alcohol can decrease risk of DM

-Can also refer to diabetes.org

Question 9

Insulin w/ lowest risk of hypoglycemia

Answer 9

Tresiba

Question 10

What should you start immediately on symptomatic DM patients?

Answer 10

Insulin; symptoms usually correlate to A1c>9

Question 11

Starting insulin dose and method for increasing

Answer 11

Baseline A1c <8% =» .1-.2U/kg

Baseline A1c >8 =».2-.3U/kg

Every 3rd morning, assess average AM FBG

• If 140-180, increase dose by 10%
• If >180, increase dose by 20%
• If BG <70, decrease dose by 10-20%
• If BG <40, decrease dose by 20-40%

Question 12

Starting dose for prandial insulin

Answer 12

Start w/ 5 units of 10% basal dose prior to biggest meal of day

=» Check glucose 2 hrs late (aiming for <180)

Question 13

What to do if using premixed insulin

Answer 13

Give 2/3 basal dose in AM, 1/3 PM

-Increase until AM glucose <130