Diabetes

Question 1

Prediabetes A1C

Diagnostic criteria diabetes

Answer 1

5.7-6.4

A1C>6.5
FPG >126
2 hour PG 200 after OGTT
Random PG >200 with hyperglycemic symptoms

Question 2

Recommended A1c for type I pediatric patient

Recommended A1c for pregnant patient

Answer 2

A1C

Question 3

How often to test A1C in peds?

Answer 3

4-6 x a year in young patients

3-4 in older children

Question 4

Screen for autoimmune in type I

Answer 4

celiac, thyroid, b12

Question 5

Hypoglycemic presentation

Answer 5

infant: irritable not eating jittery hypotonic
toddler: poor commnication, tantrums, picky eating

Question 6

Test type II in pediatric when?

Answer 6

BMI >85 + 2 of following:
family history, race, signs insulin resistance (acanthosis, small birth weight, htn lipids), maternal hx
initiate at age 10 and q 3 years

Question 7

Gestational diabetes

increased risk

Answer 7

family hx 
bmi >30 
age>25 
baby>9 lbs 
hx abnormal glucose 
race
maternal weight 9 
glycosuria at first visit 
PCOS 
steroid use 
HTN 
loss of previous baby

Question 8

When to screen for gestational diabetes?

Answer 8

1st visit if any risk factors
at 24-28 weeks
if previous GDM then screen at 6-12 weeks
OGTT

Question 9

Women with hx GDM: how often to screen

Answer 9

q 3 years

Question 10

1 step ogtt

2 step

Answer 10

fasting >92
1 hr> 180
2hr> 153

2 step (do 1 and if >140 go on to 3 hour)
fasting >95
1 hr>155
3 hr >140

Question 11

Finger stick goals for pregnant patients

Answer 11

fasting 2 values in a week then start medication

Question 12

Type II risk factors

Answer 12

> 45 BMI>25 family hx race htn 140/90 HDL 150 PCOS impaired glucose vascular disease

if at risk screen every 3 years

prediabetes- yearly

Question 13

Symptoms hyperglycemia

Answer 13

polyuria polydipsia weight loss

Question 14

Retinopathy
nonproliferative
preproliferative
proliferative

Answer 14

nonproliferative- dot and blot fluid near macula microaneurysms
pre- distended arteries cotton wool spots
proliferative- neovascularization >1/3 optic disc floaters cobwebs

Question 15

Nephropathy

microalbumin

Answer 15

> 30 ACE and ARB

Question 16

Biguanide
action

benefits

SE
cautions

Answer 16

metformin
decrease liver glucose, increased intestinal absorption, increase insulin action

weight loss, decrease ldl increase hdl
SE: GI, metallic, transient diarrhea
caution in renal patients

Question 17

Sulfonylurea
action
se
cautions

Answer 17

glyburide glipizide
stimulate insulin
SE: hypoglycemia
LIVER

Question 18

TZDS
action
se
caution

Answer 18

pio and rosi
increase insulin sensitivity (decrease glucose prod and increase glucose utilization) enhance beta cell function
SE: weight gain (fat and fluid distention)
CV risk BB wwarning Actos increase risk of MI

Question 19

GLP1
action
se
caution

Answer 19

Byetta Bydureon Victoza Tanzeum

noninsulin injectables increase insulin secretion decrease glucagon increase satiety and slow gastric emptying

Question 20

DPP4
action
se
caution

Answer 20

Januvia onglyza trajenta nissina
dipeptydl peptidase enzyme inactiates incretins, help pancreas make more insulin) promote increase levels of insulin
SE: few
LIVER AND KIDNEY

Question 21

SGLT2
action
SE
caution

Answer 21

Invokana farxiga jardiance
increase urinary excretion of glucose
SE: yeast UTI
caution:??

Question 22

Cholesterol goals for diabetic patients

Answer 22

Total 55 women

LDL

Question 23

Hypoglycemia what to give

Answer 23

15 g simple carb
4oz juice 8 oz milk 1 tbsp jelly 2 tbsp raising s 5-6 oz soda 3 glucose tabs
if severe: 25-30 mg + 15-30 complex like cracker or bread