Diabetes

Question 1

what mechanism of GLP-1 makes them especially beneficial for pts with LADA?

Answer 1

GLP-1 decreases apoptosis of beta-cells

Question 2

what can cause a falsely positive high A1C? (1+3)

Answer 2

Anything that slows down the body’s ability to break down RBCs including:
1. Anemias (untreated Fe, vitamin B12, folate)
2. Kidney disease
3. Hypertriglyceridemia

Question 3

what can cause a falsely positive low A1C? (1+3)

Answer 3

Anything that speeds up the breakdown of RBCS:
1. anemia being treated with supplementation
2. Blood donation
3. Pregnancy
4. Hemolysis (autoimmune etiology and meds (ribvarin, interferon alpha, etc))
5. Erythropoietin treatment
6. Dialysis

Question 4

goal for preprandial capillary plasma glucose

Answer 4

80-130mg/dL

Question 5

goal for peak postprandial capillary plasma glucose level?

Answer 5

less than 180

Question 6

what SGLT-2 inhibitor had an association of increased risk of bone fractures?

Answer 6

canagliflozin

Question 7

what puts a patient at increased risk of volume depletion/hypotension on SGLT-2 inhibitors?

Answer 7

concomitant use with diuretics

Question 8

Facts about steel tip infusion sets

Answer 8

-have to change every two days
-anchor point
-no cannula fill

Question 9

What is the steel tip infusion set for tandem

Answer 9

Trusteel

Question 10

What is the steel tip infusion set for Medtronic

Answer 10

Sure-T

Question 11

What is the steel tip infusion set for beta bionics (islet)

Answer 11

Contact detach

Question 12

How much insulin does and ilet pump hold

Answer 12

180 U

Question 13

Where are carbs in burrito?

Answer 13

Wrap, beans, cheese, rice

Question 14

How much insulin does and ilet pump hold

Question 15

How much insulin does an minimed 780?

Answer 15

300 u

Question 16

How much insulin does and t slim pump hold

Answer 16

300u

Question 17

How much insulin does t mobi hold?

Answer 17

200 units

Question 18

How much insulin does Omnipod 5 hold?

Answer 18

200 u

Question 19

How is omnipod controlled?

Answer 19

controlled by a standalone controller or compatible phone app

Question 20

How is tandem mobi controlled?

Answer 20

Primarily controlled by compatible phone app

Question 21

How are tubed pumps controlled?

Answer 21

Can be controlled on the device itself

Question 22

what about SGLT-2 inhibitors lead to prolonged ketosis?

Answer 22

SGLT-2 inhibitors promote ketosis and increase glucagon production leading to prolonged ketosis

Question 23

What is the most common etiology of erectile dysfunction in patients with diabetes?

Answer 23

Vascular is more common than neuropathy

Question 24

Erectile dysfunction in patients with diabetes can be suggestive of what other condition?

Answer 24

coronary arterial disease

Question 25

what is the study which demonstrates the benefit of Actos in patients who have had strokes?

Answer 25

The IRIS study

Question 26

What test should you consider doing if pt has T2DM and has low weight or low LDL?

Answer 26

If patient has low weight or low LDL then get lipoprotein A level as if it is high then you would have to do PCSK9 inhibitor

Question 27

How does Actos affect HDL?

Answer 27

It shifts immature HDL to mature HDL

Question 28

what is normal levels of HDL for females?

Answer 28

50-70/80

Question 29

what is normal levels of HDL for males?

Answer 29

40-70/80

Question 30

What are the three medications which have been proven in studies to prevent strokes?

Answer 30

Actos, Trulicity, and Ozempic (SGLT-2 inhibitors have been shown to decrease Major Adverse Cardiac Events (MACE) but not Strokes specifically)

Question 31

Is Glucerna or Ensure better for patients with DM?

Answer 31

Glucerna (less carbs)

Question 32

How does diuretics affect kidney function?

Answer 32

Can decrease/worsen GFR thus consider decreasing diuretics in pts with CKD 3a-3b (i.e. can do M/W/F instead of daily)

Question 33

Is urine albumin/cr ratio or urine microalbumin/cr ratio more specific to kidney function?

Answer 33

urine albumin/cr ratio is more specific and preferred test

Question 34

Pioglitazone is contraindicated in what type of heart failure?

Answer 34

class III (pts who have related symptoms even when doing activities where they shouldn't; doesn't take a lot of pts to get symptoms)

Question 35

what is the goal for average glucose levels on CGM?

Answer 35

<150 average glucose

Question 36

How much before a procedure should you reduce a Tresiba dose and by how much?

Answer 36

reduce 2 days before a procedure due to the long duration of action of Tresiba; how much to reduce depends on many factors by 50-70% is a good start

Question 37

when to hold MFM before/after surgery?

Answer 37

Hold MFM 48 hours before and 48 hours after surgery

Question 38

Too much of what IV fluid can lead to non-anion gap acidosis?

Answer 38

Too much NS can lead to high chloride levels leading to non-anion gap acidosis

Question 39

What two sulfonylureas can block ischemic excitation thus may increase risk off CV disease?

Answer 39

Glyburide and Glipizide (not glimepiride)

Question 40

How does melatonin affect BG values?

Answer 40

melatonin is produced by pineal gland and releases based on night/day not sleep/wake cycle; melatonin increases insulin resistance thus pts who work night-shift (eating overnight) can have worse BG values.

Question 41

what is the therapeutic dose of Trulicity, Ozempic, and Mounjaro?

Answer 41

Trulicity=0.75mg q weekly; Mounjaro 2.5mg q weekly; Ozempic 0.5mg q weekly

Question 42

what is the target for %CV on CGM report?

Answer 42

less than 30%

Question 43

what is considered a low carb diet?

Answer 43

<30grams of carbs per day

Question 44

what are things that point towards MODY?

Answer 44

-young age of onset (<350 -run in parental family -non-obest -negative islet cell antibody -sustained c-peptide