Diabetes 1

Question 1

T/F: Hypoglycemia causes damage throughout the body to small vessels (microvascular) and large vessels (macrovascular)

Answer 1

True

Question 2

What are examples of microvascular disease caused by hyperglycemia

Answer 2

Retinopathy, Nephropathy, Neuropathy, Autonomic Neuropathy (ED, gastroparesis, loss of bladder and UTIs)

Question 3

What are examples of microvascular

Answer 3

Atherosclerosis to ASCVD (Coronary Artery Disease, Cerebrovascular Disease, and Peripheral Artery Disease)

Question 4

What is Type 1 diabetes

Answer 4

An autoimmune disease where a patient’s own antibodies attack and destroy beta cells (islet cells) in the pancreas causing no insulin production

Question 5

What happens to the body if there is no insulin

Answer 5

Glucose cannot enter muscle cells, fat is metabolized into ketones and used as an alternative energy source

Question 6

What is a serious complication of uncontrolled diabetes

Answer 6

Diabetic Ketoacidosis (DKA)

Question 7

How is Type 1 diabetes diagnosed in adults

Answer 7

Patients are tested and have LOW OR ABSENT C-PEPTIDE levels (c-peptide is released by the pancrease only when insulin is released)

Question 8

What are the major contributors to Type 2 diabetes

Answer 8

Low level of physical activity, being overweight and obese

Question 9

What happens to the pancreas if the patient has Type 2 diabetes

Answer 9

Pancreas will produce more insulin leading to more INSULIN RESISTANCE, soon the insulin production DECREASES and blood glucose continue to increase

Question 10

What is primary goal for patients with prediabetes

Answer 10

Weight management and regular physical activity

Question 11

What medication was given for someone who has prediabetes, when would it be given

Answer 11

Metformin/ Patients who are younger than 60 years but have an BMI greater than 35 and/or a history of a diabetes diagnosis during pregnancy

Question 12

What is the best test for Gestational Diabetes

Answer 12

Oral Glucose Tolerance Test

Question 13

What are the classic symptoms caused by high blood glucose (HINT: 3P’s

Answer 13

Polydipsia: Excessive Thirst
Polyuria: Excessive Urination
Polyphagia: Excessive hunger or increased appetite

Question 14

How is Diabetes Mellitus diagnosed

Answer 14

An A1C greater than 6.5% or FPG greater than 126 mg/dL or greater than 200 mg/dL after 2-hour PPG: MUST BE CONFIRMED WITH A 2ND TEST

Question 15

T/F: If A1C is not at goal A1C should be monitored every 3 months if not at goal BUT EVERY 12 months if at goal

Answer 15

False: If A1C is not at goal A1C should be monitored EVERY 3 MONTHS if not at goal but EVERY 6 MONTHS if at goal

Question 16

What are the A1C goal, Prepandial goal, and two hour Postprandial goal

Answer 16

A1C: Less than 7 percent
Prepandial: 80-130 mg/dL
2-hour Postprandial: Less than 180 mg/dL

Question 17

T/F: An A1C of 6% is equivalent to an estimated average glucose of 126 mg/dL and each additional 1% increases the eAG by 28 mg/dL

Answer 17

True

Question 18

What is the first line medication for Type 2 diabetes

Answer 18

Metformin

Question 19

When would insulin be given initially for a patient diagnosed for diabetes

Answer 19

A1C greater than 10% or BG is greater than 300 mg/dL

Question 20

If a patient has ASCVD and type 2 diabetes what are the 2nd line medications that are recommended

Answer 20

An SGLT2 inhibitor or GLP-1 agonist

Question 21

If a patient has HF or CKD and type 2 diabetes what are the 2nd line medications

Answer 21

SGLT2 inhibitor

Question 22

If a patient wants to lose weight which diabetes medications should be considered first

Answer 22

SGLT2 inhibitors and GLP-1 agonist

Question 23

T/F: if there is a high risk of hypoglycemia patients can be given SGLT2-inhibitors and GLP-1 agonist

Answer 23

False: If there is a high risk of hypoglycemia use DPP-4 inhibitors, GLP-1 agonist, SGLT2 inhibitors, or TZDs

Question 24

What is the algorithm for adding insulin when necessary

Answer 24

1) Add Basal insulin or bedtime NPH: 10 units a day OR 0.1 to 0.2 units/kg per day
2) Add prandial insulin: 4 units a day or 10% of basal insulin dose
3) Proceed to full basal-bolus regimen

Question 25

How should the basal insulin be adjusted to reach FPG target without hypoglycemia, how should basal insulin be changed if hypoglycemia is present

Answer 25

Increased by 2 units every 3 days// Decrease dose by 10 to 20%

Question 26

How should the prandial insulin be adjusted if A1C is above target

Answer 26

Increase the dose by 1 to 2 units or 10 to 15% twice weekly// Decrease dose by 10 to 20%