diabetes

Question 1

what common maladies does diabetes cause?

Answer 1

leading cause of renal failure, non traumatic limb amputation, blindness among adults. major cause of heart attack and stroke. nerve damage, periodontal disease and depression

Question 2

prediabetic screening results

Answer 2

fasting glucose: 100-125, A1c: 5.4-6.4. 2hr plasma glucose: 140-199

Question 3

testing for diabetes in asymp. patients

Answer 3

test of BMI> 25, if asian then greater than 23, they have one additional risk factor begin testing at 45. if normal then repeat in 3 year intervals. treat CVD risk factors

Question 4

additional risk factors

Answer 4

physical inactivity, first degree relative with diabetes, high-risk race or ethnicity (blacks, latinos, native americans, asians), women who have delivered a baby greater than 9lbs or with gestational diabetes. hypertension/hyperlipidemia, PCOS, A1c in the pre diabetic range, history of CVD.

Question 5

when to test children for type II

Answer 5

if they are overweight and have 2 additional risk factors.

Question 6

type I screening?

Answer 6

first test for pancreatic autoimmunity (GAD65, Ia-2, ZnT8, insulin autoantibody

Question 7

when to test for GDM?

Answer 7

if risk factors, test at the first visit. screen at 24-28 weeks in women not known to have. test 6-12 weeks postpartum for persistent DM.

Question 8

recommendations for the treatment of diabetes in younger no history of CVD

Answer 8

agressive glycemic treatment.

Question 9

treatment for older adults or with longer history of DM or CVD

Answer 9

gentle with higher A1c goals

Question 10

what other things are necessary to prescribe to patients

Answer 10

smoking cessation, weight management, exercise

Question 11

treatment of type I

Answer 11

most patients should be on MDI 3-4 injections daily or continuous infusion. they need to be educated on how much postprandial insulin they will need based on the carbohydrate.

Question 12

what to look for on follow-up for diabetes

Answer 12

diet, exercise, presence of microvascular and macrovascular complications. evaluate dentition, depression, pain, cognition and behavioral change.

Question 13

physical exam on followup

Answer 13

height, weight, BMI, BP, thyroid, skin, heart, chest, abdomen, feet, dilated eye exams every 1-2 years.

Question 14

labs for follow up

Answer 14

A1c 2-4 a year. annual fasting lipid panel, annual renal assessment, liver function, TSH and coeliac panel with T1D

Question 15

major complication of DM

Answer 15

CVD, sensory, ulcers, neuropahty, retinopathy, renal disease, sexual dysfunction, atherosclerosis, bacterial and fungal infections, autonomic neuropathy,

Question 16

screening for renal disease in DM

Answer 16

look for urine albumin annually and at all type II patients at diagnosis. they need an ACEi or ARB.

Question 17

stages of kidney disease

Answer 17

1. ) kidney damage with normal or increased GFR, >90
2. ) kidney damage with mildly decreased GFR, 60-89
3. ) moderately decreased GFR (30-59).
4. ) severely decreased GFR (15-29)
5. ) kidney failure <15 or dialysis

Question 18

management of CKD

Answer 18

yearly measures of Cr and albumin as well as potassium for all patients. If GFR (45-60) referral, consider dose adjustment, monitor GFR every 6months. monitor electrolytes, bicarb, hemoglobin, calcium, assure that VITD sufficient bone density. lower GFR gets more strict time line. and if lower than 30 then refer to a nephrologist.

Question 19

retinopathy screening

Answer 19

type 1 within 5 years they need to see a ophtho. typeII need immediately after diagnosis. if no signs, then every two years. if present than every year.

Question 20

common presentations of DR

Answer 20

microaneurysms, neovascularization, macular edema (from fluid leaking micro aneurysms), vitreous hemorrhage (from the neovas),