Diabetes Flashcards
What racial groups is not at highest incidence for DM2?
a) African americans
b)native americans
c) Asians
d) Caucasians
Answer: d) caucasians
At risk groups are African Americans, Native americans, Latinos, Asians
Which is not a microvascular concern with diabetes type 2?
a) retinopathy
b) nephropathy
c) neuropathy
d) periperial arterial disease
Answer: d) PAD
PAD is a macrovascular concern of DM
Metformin is considered a weight ______ drug.
Neutral (awaiting discussion board response to this)
Which is not a side effect of metformin?
a) Hyperkalemia
b) B12 deficiency
c) GI (nausea, vomiting)
d) lactic acidosis
Answer: a) hyperkalemia
Which is not a MOA for metformin?
a) increases insulin sensitivity
b) decreases gluconeogenesis
c) increases insulin receptors on muscle cells
d) increase insulin release in pancreas
Answer: d) increase insulin release in pancreas
A drug which DOES includes the sulfonylureas
What is a key educational point about sulfonylureas?
a) avoid if GFR<30
b) avoid alcohol while using
c) monitor K+ while using
d) educate patient that yeast infections are common
Answer: b) avoid alcohol while using
Sulfonylureas can cause a disulfuram-like reaction and alcohol potentiates the hypoglycemic effect of the drug.
Note: DO not breastfeed while on these meds either!
Sulfonylureas are considered weight _______.
Positive
What is the MOA for sulfonylureas?
a) reduce glucose production by liver
b) mimic incretin
c) increase insulin receptors on muscle cells
d) increase insulin production in pancreas
Answer: d) increase insulin release in pancreas
What is a side effect of sulfonylurea?
a) hypoglycemia
b) B12 deficiency
c) GI distress
d) fluid retention
Answer: a) hypoglycemia
What medication should be avoided while patients take sulfonylureas (choose all that apply)?
a) antibiotics
b) other anti-diabetic medications
c) beta blockers
d) insulin
Answer: c&d
Beta blockers should be avoided as they can mask hypoglycemia
Insulin with sulfonylureas can cause HYPOGLYCEMIA
TZD (glitazones) are considered weight _______.
Positive
What patient should not take TZD?
a) pregnant patient
b) history of MI
c) one taking another oral anti-diabetic med
d) history of bladder cancer
Answer: d) history of bladder cancer
TZD (glitazones) have been linked to bladder cancer.
What is NOT a side effect of TZD?
a) hypoglycemia
b) fluid retention
c) hyperkalemia
d) bone fractures
Answer: c) hyperkalemia
Fluid retention is linked to TZD and can cause heart failure.
Bone fractures have been seen in WOMEN using the drug long term.
What is the MOA of TZD?
a) increase insulin release in pancreas
b) decrease kidney reuptake of glucose
c) increase insulin receptors on muscle cells
d) increase insulin sensitivity
Answer: d) increase insulin sensitivity
DPP-4 meds have the MOA of?
a) mimic incretin hormones
b) reduce glucose production in liver
c) increase insulin receptors on muscle cells
Answer: a) mimic incretin hormones
By miminicing incretin these meds increase insulin release.
What is the name of a DPP-4 (generic) drug?
“Gliptin”
Sitagliptin & Saxagliptin
DPP-4 drugs are weight _________.
Neutral
What is NOT a side effect of DPP-4 medications?
a) URI
b) Stevens Johnson
c) UTI
d) Pancreatitis
Answer: ALL are possible side effects of DPP-4 meds (“gliptins”)
SGLT-2 drugs are weight ______.
Weight negative
These drugs are the “flozins”
Which is NOT a side effect of SGLT-2 drugs?
a) hypokalemia
b) UTI
c) yeast infections
d) hypotension
Answer: a) hypokalemia
HYPERkalemia is seen with SGLT-2 drugs (flozins)
What patient should not use SGLT-2 drugs?
a) pregnant patient
b) history of MI
c) history of bladder cancer
d)GFR <30
Answer: d) GFR<30
CKD is a contraindication because these drugs require a functional renal tubular area to work.
What is the MOA of SGLT-2 drugs?
a) increase insulin release in pancreas
b) decrease kidney reuptake of glucose
c) reduce glucose production in liver
Answer: b) decrease kidney reuptake of glucose in the proximal tubule
True or false, metformin, SGLT-2, GLP-1 medications can be used as monotherapy?
True
True or false, a patient has a random blood glucose of 200+ and symptoms. This is considered diagnostic for diabetes?
True. The key here is the fact that symptoms are ALSO present with that blood sugar.
How often should women with GDM be tested for diabetes after their pregnancy?
a) never
b) Q6months
c) annually
d) Q3 years
Answer: d) Q3 years for LIFE
True or false, alcohol raises glucose due to the carbohydrates found in it?
False. Alcohol LOWERS glucose.
An A1C of 5.9-6.1 is considered ______ risk?
Medium
An A1C of 6.2-6.49 is considered ____ risk?
High
Should consider metformin & possibly gastric bypass
What BMI would be appropriate to initiate metformin at?
a) 30
b) 35
c)38
d) 40
Answer: b) 35
Note: 30 is considered obese
Metabolic syndrome is due to insulin resistance. What is NOT a diagnostic criteria for metabolic syndrome?
a) waist circumference (35+ female/40+ male)
b) LDL 190+
c) BP 130/85+
d) HDL (<40 men/<50 women)
Answer: b) LDL 190+
LDL is not one of the 5 factors for metabolic syndrome.
The criteria are waist circum, fasting sugar 100+, BP, triglyceride 150+, & HDL
True or false, abdominal obesity causes issues with insulin resistance?
True.
True or false, metabolic syndrome increases CVD risk by 80%.
True.
Which is not true about the role HTN plays with insulin resistance?
a) HTN causes insulin to increase
b) Insulin increase caused by HTN will cause vessel walls to thicken
c) HTN has a minimal role with insulin resistance
Answer: c) HTN has a minimal role with insulin resistance
What is the relationship between triglycerides and glucose?
a) direct
b) inverse
c) no correlation
Answer: a) direct
High glucose=higher trigs
Lower glucose=lower trigs
To check for albumin in the urine secondary to insulin resistance, what test would we use?
a) urine dipstick
b) UA
c) microalbumin stick
Answer: c) microalbumin stick (spot albumin/Cr ratio)
Note: 30+ is abnormal
What cardiac medication should be avoided for those with glucose issues (DM2)?
a) ACE-I
b) ARB
c) b-blockers
d) CCB
Answer: c) beta-blockers
They decrease glucose uptake
ACE-I/ARB are renal protective and do not worsen insulin resistance
A patient presents with rapid onset symptoms, weight loss, and urine ketones. What is the likely diagnosis?
a) DM 1
b) DM 2
c) metabolic syndrome
Answer: a) DM 1
A patient presents with gradual onset symptoms, weight gain, no urine ketones. What is the likely diagnosis?
a) DM 1
b) DM 2
c) metabolic syndrome
Answer: b) DM 2
True or false, 90-95% of patients with diabetes have type 1?
False. 90-95% of diabetic patients have type 2 (insulin resistant)
Describe the most common pathophysiology for diabetes type 2:
a) abnormal beta cell function
b) deficient muscle uptake of glucose
c) insulin resistance & abnormal beta cell fx
d) increased glucose secretion from liver
Answer: c) insulin resistance and abnormal beta cell function [combo]
The other choices reflect the patho of DM2 but are not the most common presentation.
True or false, even in prediabetes and early diagnosed diabetes type 2, pancreatic beta cells will decrease in number (quantity).
True. Damage is already occurring to beta cells even if the patient is not diagnosed or is newly diagnosed.
What is the AACE goal for A1C?
a) 5.5-6.5
b) <6.5
c) 6.5-8.0
d) <7.0
b) Less than 6.5 if possible without negative effects
c) 6.5-8.0 for those at risk (risk of hypoglycemia or limited life expectancy)
What is the AACE goal for A1C for a patient with limited life expectancy?
6.5-8.0
According to AACE, fasting sugar should be less than _____ and post-prandial sugar should be less than ______.
fasting <110; post-prandial <140
What stage of CKD should you refer patients to nephrology at?
Stage 4 (or sooner)
How frequent should diabetics have their eyes checked for retinopathy?
a) Q6 months
b) annually
c) annually, then every 3 years if no clinical change
d) every 5 years
Answer: b) annually
True or false, as A1C increases, microvascular damage increases.
True.
What percentage of diabetic patients have staged CKD?
a) 20%
b) 30%
c) 40%
d) 50%
Answer: c) 40%
List the stages of CKD by their GFR:
Stage 1: GFR 90+ (normal)
2: GFR 60-90 (mild)
3: 30-59 (moderate)
4: 15-29 (severe)
5: <15 (end stage/dialysis)
How often should a neuro exam be completed for a diabetic patient?
a) every 6 months
b) annually
c) every 3 years
Answer: b) anually
True or false, a foot exam should be conducted at every diabetic patient visit?
True
What is not a component of the diabetic foot examination for neuro?
a) sensation
b) vibration
c) touch (cold/warm)
d) ankle reflexes
e) dorsal petal pulses
Answer: e) DPP
DPP would be valuable in assessing circulatory but is not a key component for neuro on the foot exam.
True or false, neuropathy can be reversed with medication such as gabapentin?
False. Diabetic neuropathy cannot be reversed. It should be prevented as much as possible with tight blood sugar control.
What is not a MACROvascular complication of dm?
a) coronary artery disease
b) cerebrovascular disease
c) retinopathy
d) peripheral arterial disease
Answer: c) retinopathy
Retinopathy is a microvascular complication of DM
The ADA guidelines for fasting blood sugar is:
70-130
The AACE guidelines for fasting blood sugar is:
<110
The ADA guidelines for 2 hour post meal sugar is:
<180
The AACE guidelines for 2 hour post meal sugar is:
<140
The ADA guidelines for A1C (without established ASCVD):
<7
The AACE guidelines for A1C:
<6.5
What medication is FDA approved to decrease risk of CV mortality in diabetic patients?
a) glimepiride
b) Jardiance (empagliflozin)
c) Invokana (canagliflozin)
d) GLP-1 agonist (Exantide)
b) Jardiance (Empagliflozin)
A diabetic patient <40 with no risk factors should or should not be placed on a statin?
NO statin
A diabetic patient <40 with ASCVD risk factors should or should not be placed on a statin?
Should-moderate/high intensity
Note: a patient <40 with ASCVD should be on a high intensity statin
Should a diabetic patient aged 40-75 be placed on a statin if they have no risk factors.
Yes. They should be on a moderate statin.
Note: if they have ASCVD risk factors or established ASCVD they should be on a high intensity statin
Rule of thumb: age group 40-75 should be on a high statin (unless no risk factors then a moderate)
Should a diabetic patient aged 75+ be on a statin?
Yes, moderate intensity.
Rule of thumb for this age group is a moderate statin.
Diabetic patients with CKD should have monitoring of GFR how frequently?
a) every visit
b) every 3 months
c) every 6 months
d) annually
Answer: c) every 6 months
Note: more frequent if more severe CKD. Also annual creatinine.
What patient should be considered for aspirin?
a) diabetic 1 or 2 with a risk of 7.5%+
b) diabetic 1 or 2 with a risk of 10%+
c) diabetic 1 or 2 aged 50+
b) Patient with ASCVD risk factor 10%+
Type 2 diabetic patients should have an eye exam (dilated) done:
a) at time of diagnosis
b) 5 years after diagnosis
Answer: a) at time of diagnosis
They then need to be evaluated annually
What is the child/adolescent A1C goal?
a) <6.5
b) <7.0
c) <7.5
Answer: c) <7.5%
What type 2 patient would need self monitoring blood glucose (SMBG)? Choose the best fit even if more than one option is correct.
a) a patient on two oral meds
b) a patient on basal insulin
c) a patient on sulfonylurea
d) a patient on 3 oral meds
Answer: b) patient on basal insulin
The patient on a sulfonylurea is at risk for hypoglycemia due to the nature of the drug, but the highest priority is the patient on basal insulin.
True or false with working with basal insulin, fix the fast first then work on postprandial.
True.
Fix the fasting blood glucose first and then assess/adjust the meds for postprandial.
A patient is taking three oral diabetic medications and you decide to add basal insulin. What PO med should you reduce?
a) Metformin
b) Glipizide
c) TZD
d) DPP 4 inhibitor
Answer:
b) glipizide (sufonylurea)
What oral diabetic medication is most likely to cause hypoglycemia?
sulfonylureas
Which disorder seen in uncontrolled diabetes with increased glucose?
Pancreatitis
Hypothyroidism
Gall stones
High triglycerides
Answer: high triglycerides
When should a patient inject insulin (Humalog) relative to meal time?
a) During meal
b) one hour before eating
c) 15 min before
d) 30 min before
Answer: c) 15 min before
Which patient could you diagnose with diabetes (choose all that apply):
a) Random glucose of 230 with fatigue and blurred vision
b) Metabolic syndrome for 6 months
c) A1C of 7.8
d) Fasting blood sugar of 125
Answer: a) random glucose of 230 w/ fatigue and blurred vision and c) A1C of 7.8
The patient has symptoms and a blood sugar of 200+
A1C 6.5+ is diagnostic for diabetes
Fasting glucose of 126+ is diagnostic
The most important pathology that is characteristic and differentiates type 2 diabetes from
type 1 diabetes?
a. insulin resistance
b. no internal insulin
The most important pathology that is characteristic and differentiates type 2 diabetes from
type 1 diabetes?
a. insulin resistance (d/t a progressive loss of insulin secretion - Type 2)
b. no internal insulin (beta cell destruction leads to absolute insulin deficiency in Type 1)
Weight loss diabetic drugs include all of the following EXCEPT:
a) GLP-1
b) SGLT-2 Inhibitors
c) Pramlintide
d) sulfonylureas
Answer: d) sulfonylureas
If a patient cannot afford Lantus, what would an acceptable alternative be?
a. bed time
b. regular insulin
c. basal insulin NPH
d meal time insulin
Answer: c) basal insulin NPH
What is the 15-15 rule for hypoglycemia?
Glucose below 70, treat with 15 grams of carbohydrates. Wait 15 minutes, recheck sugar. Repeat as indicated by blood sugar.
When is glucagon indicated?
a) glucose <70
b) glucose <60 in DM1
c) glucose <50 in DM2
d) glucose <40
Answer: d) glucose <40
Life threatening. More common with DM1. Administer glucagon intranasally or subQ injection.
What is the smallest needle length to be used for insulin?
a) 2 mm
b) 3 mm
c) 4 mm
d) 5 mm
Answer: c) 4 mm
What is an appropriate weight based dosage for basal insulin?
a) 0.1 unit/kg
b) 0.2 unit/kg
c) 0.3 unit/kg
d) 0.4 unit/kg
Answer: b) 0.2 unit/kg
True or false, GLP-1 agonists are oral medications.
False. They are injectibles and include medications like exantide.
What criteria is diagnostic for diabetes?
a)
b)
c)
d)
What type of insulin has no peak?
long-acting (Lantus & Levemir)
What medication can cause DKA?
a)sulfonylureas
b)GLP-1
c)SGLT-2
d) TZD
Answer: c) SGLT-2
What signs & symptoms might a patient have with DKA?
a) unconscious, low blood glucose, serum ketones
b) nausea, vomiting, abdominal pain, serum ketones, normal/slightly elevated blood glucose
c) extremely high blood glucose, fever, fruity breath
b) nausea, vomiting, abdominal pain, serum ketones, normal/slightly elevated blood glucose
What are symptoms of hypoglycemia to teach your patient?
a)dry skin, no hunger, vomiting, tremor
b) blood sugar <100, numb fingers, hunger, nausea
c)blood sugar <70, diaphoresis, shakiness, nausea, dizziness
c)blood sugar <70, diaphoresis, shakiness, nausea, dizziness
Patient instructions for taking metformin:
a) take with increased proteins to start
b) take on an empty stomach
c) take with largest meal when starting therapy
Answer: c) take with your largest meal when starting therapy
What is the peak action time of NPH insulin?
a)4-14 hours
b)24 hours
c) 1-2 hours
a)4-14 hours
If FBG is normal and A1C is elevated, how do you explain this to the patient?
a)FBG and A1C are in a negative relationship (inverse)
b) post prandial glucose excursions elevate PP levels and A1C but not always FBG
c) It takes years for the FBG to elevate
b) post prandial glucose excursions elevate PP levels and A1C but not always FBG
Compare effectiveness of NPH insulin to basal insulin:
a)research shows that NPH works as well as basal insulin to affect A1C
b) basal insulin is always more effective than NPH
a)research shows that NPH works as well as basal insulin to affect A1C
A patient enters treatment as a new patient with you and their A1C is <7.5. What is an appropriate treatment approach?
a) metformin
b) basal insulin
c) dual therapy
Answer: a) metformin
Note: other options are appropriate too for monotherapy
A patient enters treatment as a new patient with you and their A1C is 7.5+. What is an appropriate treatment approach?
a) metformin
b) basal insulin
c) dual therapy
Answer: c) dual therapy
A patient enters treatment as a new patient with you and their A1C is 9.0+ with symptoms. What is an appropriate treatment approach?
a) metformin
b) basal insulin
c) dual therapy
Answer: b)basal insulin
Also consider other agents (the insulin can break the elevated glucose cycle)
A patient enters treatment as a new patient with you and their A1C is 9.0+ without symptoms. What is an appropriate treatment approach?
a) metformin
b) basal insulin
c) dual therapy
c) dual therapy
Triple therapy is also appropriate
Which medication(s) give a moderate reduction in post-prandial glucose?
a) metformin
b) DPP-4
c) Sulfonylurea
d) SGLT-2
Answer: b&c
DPP-4 and sulfonylureas give a moderate reduction in PP glucose. The other choices are only mild.
What medications DOES not cause a moderate reduction in fasting glucose?
a) metformin
b) GLP-1
c) SGLT-2
d) TZD
Answer: b) GLP-1
What patient should not be prescribed a GLP-1 agonist (choose all that apply)?
a) GFR 45
b) history of bladder cancer
c) an alcoholic patient
d) history of thyroid cancer
e) history of pancreatitis
Answer: d&e
GLP-1 agonists are linked to thyroid cancer, pancreatitis, and renal failure
What medication is not available as a generic?
a) metformin
b) Sulfonylureas
c) TZD
d) DPP-4
Answer: d) DPP-4
Which of the following does not lower A1C by 1-2 points?
a) metformin
b) DPP-4
c) GLP-1
d) SGLT-2
e) SUs
f) insulin
b) DPP-4
What is the onset, peak, and duration for rapid acting insulin?
Rapid insulin (humalog)
onset: 10-15 min
peak: ~2 hours
duration: ~3 hours
What is the onset, peak, and duration for short acting insulin?
Short acting (regular)
onset: 30-60 min
peak: 4 hours
duration: 5-8 hours
True or false, insulin can cause weight gain.
True.
