DIABETES 1

Question 1

-A 35-year-old man with newly diagnosed T2DM, presenting A1C= 7.9% (0.079 proportion), who has a significant prescription copay, who works rotating shifts and eats irregularly. Priority starting medication?

Answer 1

Metformin 1st, add on
TZD due to cost consideration.
SGLT2- inhibitor, or. DPP-4 inhibitor if needed, but cost an issue

Question 2

testing for DM should be conducted in adults who are overweight BMI greater than or equal to ____ and have additional risk factors?

Answer 2

25

Question 3

True or false?

HTN 140/90 or on tx for htn is a risk factor for DM in the presence of being overweight.

Answer 3

TRue

Question 4

True or false?

HDL cholesterol <35 and/or triglyceride level >250 DM in the presence of being overweight is a risk factor for DM.

Answer 4

True

Question 5

When should DM testing begin for asymptomatic adults?

Answer 5

45 if normal repeat every 3 years unless additional risk factors come up then repeat

Question 6

Fasting plasma glucose that is positive for DX DM?

Answer 6

> /= 126

Question 7

random plasma glucose that is positive Dx for DM?

Answer 7

> /= 200 *** with symptoms the 3 p’s, weight loss, hyperglycemic crisis

Question 8

OGTT 2 hour plasma glucose reading that is + for DM?

Answer 8

> /= 200 after 75g glucose load

Question 9

HgAIC level + for DM

Answer 9

> /= 6.5%

*HGAIC provides a 3 month look back

Question 10

Increased risk is associated with an impaired fasting glucose level of 100-125
True or False?

Answer 10

True

Question 11

-A 56-year-old woman with a 3 year history of T2DM, obesity (BMI= 36 kg/m2), ASCVD, recurrent genital candidiasis and UTI, who desires weight loss.
Priority medication class?

Answer 11

• GLP-1 agonist, enhances weight loss, glycemic control

- Avoid SGLT2-I due to recurrent UTI, genital candidiasis

Question 12

-A 78-year-old man with a 25 year history of T2DM, diabetic neuropathy, gastroparesis, currently using metformin, a SU, and DPP-4 inhibitor, adherent to therapy, an A1C= 9.2% (0.092 proportion) with elevated fasting and post-meal blood sugars. Priority medication(s)?

Answer 12

basal and bolus insulin, using insulin releasers without glycemic control, consider SGLT-2 inhibitor

Avoid D. GLP-1 agonist, due to gastroparesis

Question 13

-An 81-year-old woman with longstanding type 2 DM, with GFR=35 mL/min/1.73 m2, A1C=7.2% (0.072 proportion), current medications include metformin and glipizide, lisinopril, and simvastatin, states, “I can get around in my home with my cane. I am a little less certain on my feet if I do not use the cane.”
Medication(s) to discontinue?

Answer 13

-Discontinue. Metformin due to low GFR and age and SU, due to hypoglycemia risk.
Medication to consider using? -Replace with DPP-4 inhibitor and/ or. SGLT-2 inhibitor due to low hypoglycemia risk.