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PC1-Exam 2 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

When should a postprandial or postmeal blood glucose should be obtained?

A

One to two hours after the start of the meal

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2
Q

How often should buy pressure be measured for patients that have diabetes?

A

Blood pressure should be measured at every routine clinical care visit. Patient found to have an elevated blood pressure greater than or equal to 140/90 should have blood pressure confirmed with multiple readings, including measurements on separate days, today is hypertension.

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3
Q

Automated office blood pressure monitoring has how many MMHg lower than conventional office readings?

A

5 to 10 mmhg lower than conventional office readings on average

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4
Q

Hypertension is defined as what? List blood pressure reference

A

Blood pressure greater than or equal to 140/90

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5
Q

Normal blood pressure and clinic or office meeting at less than 140/90 but has an elevated home blood pressure of greater than or equal to 135/85, the lower home blood pressure threshold is based on outcome studies. What is this?

A

Masked hypertension

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6
Q

An elevator office blood pressure of greater than or equal to 140/90 and a normal untreated home blood pressure less than 135/85. What is this?

A

White coat hypertension

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7
Q

Too small of a blood pressure cuff will give what type of reading?

A

A higher blood pressure reading

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8
Q

Two large of a blood pressure cuff will will cause what?

A

Lower blood pressure value

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9
Q

What is the blood pressure goal for diabetics who have hypertension?

A

Most patients with diabetes and hypertension should be treated to a systolic blood pressure goal of less than 140 and a diastolic blood pressure goal of less than 90.

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10
Q

What is the sodium restriction for patients who have diabetes that are making lifestyle management changes?

A

Restricting sodium intake less than 2300 mg a day

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11
Q

1 kg (2.2 pounds ) lost equals to how many MMHg reduction?

A

1 MMHg 

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12
Q

For diabetic patients that have a blood pressure systolic between 140 and 159 and a diastolic blood pressure of 90-99 should be treated with what medication?

A

An ace inhibitor or an ARB

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13
Q

For patients treated with an ace inhibitor, ARB, or diuretic,
What lab should be monitored?

A

Serum creatinine, estimated glomerular filtration rate, Serum potassium

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14
Q

Patients with urinary albumin excretion greater than or equal to 300 MG/G creatinine should have what medication?

A

An ace inhibitors or ARB be included as part of their blood pressure lowering regimen

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15
Q

 Which two classes of diabetic medications are associated with Lorene systolic and diastolic pressure?

A

Sodium glucose cotransport 2 inhibitors
glucagon like peptide one receptor agonist

are associated with reduction stomach and diastolic blood pressure.

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16
Q

For people with diabetes and untreated blood pressure of less than 140/90, What is the recommendation for treatment?

A

An ARB or an ace inhibitor is not recommended for patients without hypertension to prevent the development of diabetic Kidney disease and is associated with an increase rate of cardiovascular events.

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17
Q

What is the model for diabetes management?

A

The chronic care model.

This model emphasizes person centered team care, integrated long-term treatment approaches to diabetes and comorbidities, and Ongoing collaboration of communication and goal setting between all team members.

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18
Q

What does DSMES stand for? What is it associated with?

A

Diabetes self management education support. Successful diabetes care requires a systematic approach to supporting patient’s behavior change effort including this.

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19
Q

What is the A1c range for a pre-diabetic?

A

5.7 to 6.4%

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20
Q

What is the fasting plasma glucose for a pre-diabetic?

A

100 to 125

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21
Q

What is the two hour post Oral glucose tolerance test glucose range?

A

149 to 199

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22
Q

What is classified as a diabetic in regards to A1c value?

A

An A1c value of 6.5 or greater

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23
Q

What is classified as a diabetic for a fasting plasma glucose?

A

Greater than 126

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24
Q

What is classified as a diabetic for a patient who had done the oral glucose tolerance test?

A

Greater than 200

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25
Q

What is the diabetes classification for a random plasma glucose?

A

Greater than 200

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26
Q

Children with type one diabetes typically present how?

A

Children with type one diabetes typically present with polyuria polydipsia and approximately half present with diabetic ketoacidosis.

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27
Q

If the patient has a test result near the margins of the diagnostic threshold what show the clinician do?

A

The clinician should follow the patient closely and repeat the test in 3 to 6 months.

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28
Q

For patients that are having an oral glucose tolerance test what should they not do? And why?

A

Patients should not partake in Fasting or carbohydrate restriction three days prior to the test should be avoided as I can falsely elevated glucose levels.

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29
Q

Women who are diagnosed with gestational diabetes should get tested for diabetes how often? 

A

Women who are diagnosed with gestational diabetes should have lifelong testing at least every three years.

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30
Q

Patients with prediabetes, impaired glucose tolerance, or impaired fasting glucose should be tested how often?

A

Yearly

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31
Q

For other patients with no risk factors testing should begin at what age?

A

Age 35 

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32
Q

Testing should be considered in adults overweight or obesity which includes a BMI greater than 25 and who have one or more of the following risk factors? List some 

A

First agree relative with diabetes,

high risk race/ethnicity African-American, Latino, Native American, Asian American, Pacific Islander) 

History of CVD
hypertension
Hdl cholesterol less than 35 
Triglyceride level more than 250
Women with polycystic ovarian syndrome
HIV
Physical and activity
Ancanthosis nigiricans
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33
Q

For Asian Americans, What BMI is considered overweight?

A

A BMI of 23 or more

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34
Q

Screening should be considered in youth who are overweight which means greater than what percentile?

A

Greater than 85th percentile for overweight, greater than 95th percentile for obesity

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35
Q

Screen should be considering In youth that are overweight and who have one or more additional risk factors based on the strength of their association with diabetes? List some

A

Maternal history of diabetes or gestational diabetes during child’s gestation.
Family history of type two diabetes in a first or second-degree relative.
Race /ethnicity
Signs of insulin Resistance or conditions associated with insulin resistance such as Ancanthosis nigricans, hypertension, dyslipidemia PCOS, small for gestational age birthweight

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36
Q

What is the diabetes prevention program?

This is for Prevention or delay of type two diabetes

A

It is an intensive lifestyle behavior change program consistent with the DPP to achieve and maintain 7% loss of initial body weight and increase a moderate intensity physical activity to at least 150 minutes a week.

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37
Q

Met Forman therapy for prevention of type two diabetes should be considered adults with pre-diabetes which qualifies as?

A

Those age 25 to 59 years with a BMI greater than 35,
higher fasting plasma glucose of more than 110,
higher A1c greater than 6.0, and then
women with Prior gestational diabetes

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38
Q

Long-term use of metformin may be associated with what vitamin deficiency??

A

Vitamin B 12 deficiency

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39
Q

Does the FDA have any approved medication for diabetes prevention?

A

There are no agents That have been approved.

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40
Q

What are the four times to evaluate the need for diabetes self management education to promote skills acquisition? 

A

At time of diagnosis,

Annually,

When not meeting treatment targets,

When complicating factors develop (such as medical, physical, psychosocial) 

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41
Q

Children and adolescents with type one or type two diabetes or prediabetes should engage in what?

A

Should engage in 60 minutes a day or more of moderate or vigorous intensity aerobic activity, with figures muscle strengthening and bone strengthening activities at least three days of the week

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42
Q

Are most adults with type one and type two diabetes should engage and what for physical activity?

A

Should engage in 150 minutes or more a moderate to vigorous intensity aerobic activity per week, spread over at least three days a week, with no more than two consecutive days without activity.

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43
Q

Adults what type one and type two diabetes should engage in how many sessions of resistant exercise on nonconsecutive days?

A

2 to 3 sessions a week

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44
Q

Flexibility and balance training are recommended how many times a week for older adults with diabetes? Yoga tai chi may be included based on individual preference.

A

2 to 3 times a week for older adults with diabetes

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45
Q

For patients that have diabetic retinopathy or severe nonproliferative diabetic retinopathy what do they need to be aware of when exercising?

A

Vigorous intensity aerobic or resistance exercise may be contraindicated because of the risk of triggering Vitreous hemorrhage or retinal detachment.

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46
Q

What is A1c goal for nonpregnant adults without significant hypoglycemia?

A

An A1c less than seven

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47
Q

Assessing glycemic status should occur how often in a patient who is mean treatment goals?

A

At least two times a year.

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48
Q

How often should You assess glycemic status if a patient has recently changed therapy or is not meeting glycemic goals?

A

At least quarterly and as needed in patients whose therapy has recently changed and/or who are not meeting glycemic goals 

49
Q

What is the number of days a continuous glucose monitor should be worn?

A

Recommended is 14 days.

50
Q

Level one hypoglycemia is considered in what range?

A

54 to 69

51
Q

Level two hypoglycemia Is considering what range?

A

Less than 54

52
Q

What is the preferred treatment for patients who have a blood glucose lower than 70?

A

Give 15 g of glucose such as a cup of orange juice is the preferred treatment for the conscious individual with a low blood because less than 70. Wait 15 minutes after treatment and recheck blood sugar if continued Hypoglycemia the treatment should be repeated.

53
Q

What should be prescribed for all individuals an increased risk of level two or level three hypoglycemia?

A

Glucagon

54
Q

What are the recommendations for preprandial capillary plasma glucose in nonpregnant adults with diabetes?

A

80-130

55
Q

What are the recommendations for postprandial capillary blood glucose and non-pregnant adults with diabetes?
When should it be taken?

A

Less than 180
Postprandial glucose measurement should be made one or two hours after the beginning of the meal, generally peak levels in patients with diabetes.

56
Q

What is level three hypoglycemia?

A

A severe event characterized by alter mental and physical status requiring assistance for treatment of hypoglycemia.

57
Q

What is the weight loss recommendation for most people with type two diabetes and overweight or obesity?

A

Maintain more than 5% weight loss is recommended

58
Q

What is the recommended calorie deficit for patients that are overweight or obese with or without type two diabetes?

A

500-750 kcal/day energy deficit

59
Q

To maintain weight loss goals, program should Encourage regular physical activity for how many minutes a week?

A

200 to 300 minutes/week

60
Q

When is it reasonable to consider discontinuing weight loss medication and evaluate alternative medication or treatment approaches for weight loss?

A

When early response is insufficient which is typically less than 5% weight loss after three months or if there is significant safety or tolerability issues you should Consider discontinuation

61
Q

What two classes of medications should you really provide education on hypoglycemia?

A

Sulfonylurea  and insulin

62
Q

What do SGL 2 inhibitors end in?

A

“Floz”

63
Q

What are some advantages for SGL 2 inhibitors?

3

A

Weight loss,
Reduces risk of cardiovascular event
Reduces BP

64
Q

What are the disadvantage for SGLT 2 inhibitors?

A

DKA risk, bone fractures, urinary tract infections, increase LDL cholesterol

65
Q

What does GLP-1 receptor agonists end in?

A

“Tide”

66
Q

What are some advantages of GLP – one receptor agonist? (3)

A

Weight loss, reduce cardiac events, No hypoglycemia.

67
Q

What are some disadvantages for the GLP – 1 receptor agonist?

A

G.I. side effects are common, pancreatitis, injection site reactions, expensive, risk for thyroid cancer 

68
Q

What do DPP-4 inhibitors end in?

A

“Liptin.”

69
Q

What are some advantages to DPP-4 inhibitors?

1

A

No changes in weight

70
Q

What are the disadvantages for DP – four inhibitors? (2)

A

Pancreatitis, not fully established. Joint pain

Caution with heart failure

71
Q

What do Theozlidnediones end in?

A

“Zone”

72
Q

What is an advantage of  Theozlidnediones? (2)

A

Improves lipids, decreases risk of MI (pioglitazone )

73
Q

What is the disadvantage of  Theozlidnediones? (3)

A

Not to be given for heart failure. Can cause bladder cancer.

Weight gain

74
Q

What do you sulfonylureas end in?

A

“IDE” 

75
Q

What are the advantages to Sulfonylureas ?

A

Rapid effect

Cheap 

76
Q

What are the disadvantages for  Sulfonylureas?

A

Not for chronic kidney disease And can cause hypoglycemia.weight gain

77
Q

What is MRA medication for hypertension? When should it be used?

A

Mineral corticoid receptor antagonist, it should be use for patients who have resistant hypertension

78
Q

What is the diet for a lipid management?

A

Mediterranean or dash diet

79
Q

In adults not taking statins it is reasonable to obtain a Lipid profile at the time of diagnosis and at initial medically evaluation and how many years after what age or more if frequently indicated?

A

Every five years if you’re under the age of 40 years or more frequently indicated

80
Q

Obtain a lipid profile at initiation of statins or other lipid lowering therapy, how many weeks after initiation or a change in dose should be reassessed by a lipid profile?

A

4-12 weeks

81
Q

What type of Statin should be given to patients with diabetes Aged 40 to 75 years without ASCVD, in addition to lifestyle therapy?

A

Moderate intensity Statin therapy

82
Q

What is the recommendation on Aspirin therapy for patients who are diabetic and have a history of ASCVD?

A

Use Aspirin therapy 75 to 162 mg a day a secondary prevention strategy and those with diabetes and history of ASCVD.

83
Q

For patients with ASCVD and a document aspirin allergy should be given what medication?

A

Clopidogrel 75 mg a day should be used

84
Q

Aspirin therapy may be considered as a primary prevention strategy in those with diabetes who are at increased cardiovascular risk, after a comprehensive discussion with the patient on the benefits versus the comparable increased risk of bleeding.
True or false

A

True

85
Q

What are the preferred 2 medications for patients with or without Metformin based on glycemic needs are appropriate for therapy for individuals with type two diabetes with or at high risk for ASCVD, heart failure and or chronic kidney disease?

A

SGL2 inhibitors and GLP—1 receptors

Evidence a

86
Q

The early introduction of insulin should be considered if there is evidence of ongoing catabolism (weight loss) If symptoms of hyperglycemia are present, or when A1c levels are greater than 10% or blood glucose levels are greater than 300. Is this true and what is the evidence rate?

A

This is true, evidence E

87
Q

For diabetics medication regimen and medication taken behavior should be reevaluated at regular intervals which are what?

A

Should be reevaluated at regular intervals every 3 to 6 months
Evidence E

88
Q

For individuals with type two diabetes who have an established ASCVD or indicators of high CV risk, establish chronic kidney disease, or heart failure, what two medications are recommended as part of the glucose lowering regimen and comprehensive CV risk reduction, independent of A1c and in consideration of patients specific factors?

A

SGL2 inhibitor and or GLP-1 receptor agonist

Evidence A

89
Q

What is ASCVD defined as?

A

It is defined as coronary heart disease, cerebrovascular disease, or peripheral artery disease presumed to be of atherosclerotic origin — is the leading cause of morbidity and mortality for individuals with diabetes

90
Q

Should metformin be continued upon initiation of insulin therapy for ongoing glycemic and metabolic benefits?

A

Yes

91
Q

For a patient with heart failure who has type two diabetes what is the recommended medication?

A

SGL2 inhibitors 

92
Q

Where are the four types of medications that have a no or low inherent risk of hypoglycemia?

A

DPP-4 inhibitors
GLP-1 receptor agonist
SGL2 inhibitors
Thiazolidinediones

93
Q

In patients with diabetes at higher risk especially those with multiple ASCVD risk factors for age 50 to 70 years what type of statin intensity should be given?

A

High intensity statin (Rotuvistatin and Atorvastatin)

94
Q

For patients with diabetes age 40 to 75 without ASCVD, what type of Statin therapy should be used in addition to lifestyle therapy?

A

Moderate-intensity statin therapy 

95
Q

Aspirin therapy 75 to 162 mg a day may be considered as a primary prevention strategy for those with diabetes who are at increased risk for what?

A

Increase cardiovascular risk which means (if they have hypertension, dyslipidemia)

96
Q

How often should urinary albumin and eGFR be assessed in type one diabetes with duration of more than five years and in all patients with type two diabetes regardless of treatment?

A

At least annually. B recommendation

97
Q

Patients who have diabetes in a urinary albumin greater than 300 and/or an eGFR 30-60 , How long should these patients being monitored to go to therapy?

A

At least twice annually to guide therapy

98
Q

In patients with diabetic kidney disease and type two diabetes what medication should be used in patients with an eGFR more than 20 and a urinary albumin more than 300?

A

SGL2 inhibitors

99
Q

What medication is recommended if patients with chronic kidney disease who are increased risk for CV events are unable to take a SGL2 inhibitor?

A

A nonsteroidal MRA Finerenone 

100
Q

Is an ace inhibitor or ARB recommended for the primary prevention of chronic kidney disease in patients with diabetes who have a normal blood pressure, normal creatinine and a normal eGFR?

A

No it is not recommended

101
Q

What is important to know about metformin Contra indication in relation to chronic kidney disease?

A

It is contraindicated in patients with a EGFR less than 30. It should not be initiated for patients with an EGFR less than 45.

102
Q

What medication for diabetes should be given to all patients with stage three chronic kidney disease or higher and type two diabetes regardless of glycemic control as they slow chronic kidney disease progression and reduce heart failure risk independent of glycemic control?

A

SGL2 inhibitors

Empaglifozin, canaglifozin

103
Q

For patients with type two diabetes what is the recommendation for dilated and comprehensive exams?

A

Should have one done by time of diagnosis of diabetes

104
Q

For patients with type two diabetes if there is no evidence of retinopathy after the first dilated eye exam what is the recommendation afterwards, considering glycemia is well controlled?

A

Screen should be every one or two years

105
Q

Is aspirin a contraindication in the presence of retinopathy?

A

No, aspirin does not increase the risk of retinal hemorrhage.

106
Q

When should patients be assessed for diabetic peripheral neuropathy for type one and type two diabetes?

A

For type one diabetes peripheral neuropathy should be assessed five years after the diagnosis.

For type two diabetics it should be at diagnosis and at least annually after.

107
Q

What are the assessments used for polyneuropathy?

A

Assessment of either temperature or pinprick sensation.

Vibration sensation using a 128HZ tuning fork.

All patients should have a 10 G monofilament testing to identify feet at risk for ulceration and amputation

108
Q

What are three medications recommended as a natural pharmacologic treatment for neuropathic pain and diabetes?

A

Pre-Gabalin, duloxetine, or gabapentin

109
Q

Patience with symptoms of claudication or decreased or absent pedal pulses should be referred to what?

A

Should be referred for ankle-brachial-index

110
Q

Screening for early detection mild cognitive impairment or dementia should be performed for adults at what age?

A

For adults 65 years of age or older at the initial visit and annually as appropriate

111
Q

For older adults with type one diabetes, what method of glucose monitoring should be considered to reduce hypoglycemia?

A

Continuous glucose monitoring

112
Q

For children older than 10 years old with type two diabetes classification which 3 classes of drugs can be given to these patients?

A

Insulin, Metformin, and GLP-1receptor agonist

113
Q

For hospitalized patients , When should insulin therapy be initiated for treatment of a persistent hyperglycemia—what does the blood glucose need to be at to start therapy?

A

If blood glucose is greater than 180

114
Q

For hospitalized patients, insulin therapy target glucose range is what?

A

140 to 180 is recommended for the majority of critical ill and non-critical patients.

115
Q

What is defined as hyperglycemia and hospitalized patients?

A

Greater than 140

116
Q

LDL less than what is optimal?

A

Less than 100

For both diabetes and non diabetic patients

117
Q

Goals for hdl in men and women with diabetes

A

Hdl greater than 50

LDL greater than 40

118
Q

What’s is the triglyceride goals for both diabetic and nondiabetic patients ?

A

Less than 150

119
Q

What is the interval for zoster (shingles) vaccine? What age?

A

give at age 50 or older, series of 2 doses

2-6 months apart (minimum is 4 weeks)

PC1-Exam 2 (3 decks)

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