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LMCC Part II > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what are the 5 Rs to consider when organizing diabetes care in the office or clinic

A 
recognize
register
resource
relay
recall
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2
Q

what three tests can be used for diabetes screening and diagnosis

A
  1. HbA1c
  2. fasting plasma glucose
  3. 2 hour plasma glucose
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3
Q

how do you determine a patients glycemic targets

A

patients age

duration of diabetes

risk of hypoglycemia

CV disease presence

life expectancy

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4
Q

how often should you do blood work for diabetes follow up

A

every 3 months HbA1c

can do every 6 months if targets consistently met and treatment and lifestyle are stable

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5
Q

what causes type 1 diabetes

A

beta celld estruction

leading to total insulin deficiency

susceptible to ketoacidosis

either autoimmune or unknown etiology

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6
Q

what is latent autoimmune diabetes

A

a slow progressive form of autoimmune diabetes that shares clinical characteristics of T2DM

it is a form of T1DM

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7
Q

what causes T2DM

A

combination of insulin resistance and inadequate insulin secretory response

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8
Q

risk factors for T2DM

A

age over 40

first degree relative with T2DM

member of high risk population i.e aboriginal, hispanic, south asian, asian, african descent

history of prediabetes

history of gestational diabetes

presence of vascular risk factors

presence of associated diseases

use of medications associated with diabetes

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9
Q

what vascular risk factors increase risk of T2DM

A

obesity

DLD

HTN

abdo obesity

vascular disease

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10
Q

what other diseases are associated with T2DM

A

PCOS

acanthosis nigricans

HIV

psychiatric disorders

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11
Q

what medications are associated with diabetes

A

atypical antipsychotics

highly active ART

glucocorticoids

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12
Q

can T1DM be prevented

A

no

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13
Q

can T2DM be prevented

A

yes–onset and course can be ameliorated using lifestyle modification and pharmacologic intervention

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14
Q

would you consider pharmacologic treatment even in patients without diabetes but with impaired glucose tolerance

A

yes–can consider metformin or acarbose

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15
Q

screening guidelines for T2DM

A

q3 years at age 40 and above or those at high risk

screen more frequently in people with additional risk factors for DM

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16
Q

what is a screening tool you can use for DM

A

the CANRISK questionnaire

Canadian Diabetes Risk Assessment Questionnaire

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17
Q

what criteria can be used to diagnose DM

A

fasting plasma glucose of 7 or higher

HbA1c of 6.5% or higher

2 hour plasma glucose of 11.1 or higher after a 75g oral glucose tolerance test

a random plasma glucose of 11.1 or higher in a patient with the classic symptoms of hyperglycemia

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18
Q

what are the classic symptoms of hyperglycemia

A

polyuria
polydipsia
unexplained weight loss

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19
Q

in a patient with no symptoms of diabetes/hyperglycemia, what do you do if one screening lab test returns in diabetes range?

A

a repeat, confirmatory test (preferably the same test) must be done another day (in a timely fashion) –if the results of the two different tests are both above diagnostic cutoff, dx is confirmed

*a repeat test is not required if they have symptoms

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20
Q

if you suspect T1DM, should you delay treatment while waiting for the confirmatory test

A

no

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21
Q

what does the following “R” suggest in the 5Rs of diabetes management:
recognize

A

consider diabetes risk factors for all patients and screen appropriately

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22
Q

what does the following “R” suggest in the 5Rs of diabetes management:
register

A

develop a list of patients with diabetes to facilitate recall ad track changes in practice management

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23
Q

what does the following “R” suggest in the 5Rs of diabetes management:
resource

A

support self management through the use of interprofessional teams including a PCP, DM care educator, nurses, dietician, pharmacist and specialist

consider referral to Diabetes education clinic

24
Q

in which patients might a team specialized in diabetes be warranted?

A

patients with T1DM at diagnosis and at least annually

women with diabetes who require pregestational assessment and counselling

women with diabetes in pregancy

individuals with complex T2DM or who are not reaching target

25
what does the following "R" suggest in the 5Rs of diabetes management: relay
facilitate information sharing between patient with diabetes and the diabetes care team
26
what does the following "R" suggest in the 5Rs of diabetes management: recall
develop a system to remind patients of timely review and assessment
27
what is the focus of glycemic goals
achieving target A1c levels and minimizing symptomatic hyper- and hypoglycemia
28
what is the A1c target for most patients with diabetes
6.5-7%
29
in which patients might you consider an A1c target at or below 6.5%
in some patients with T2DM to further lower risk of nephropathy and retinopathy must be balanced with the risk of hypoglycemia
30
in which patients might you consider an A1c target of 7.1-8.5%?
limited life expectancy high functional dependency extensive CAD at high risk of ischemic events multiple co morbidities hx of recurrent severe hypoglycemia hypoglycemia unawareness longstanding DM for whom it is difficult to achieve A1c 7 or below despite effective doses of multiple antihyperglycemic agents including insulin
31
risk factors for hypoglycemia
prior episode of severe hypoglycemia long term diabetes current A1c below 6 autonomic neuropathy hypoglycemia unawareness current treatment with insulin elderly
32
what practical/reporting consideration is there in patients with diabetes/at high risk for hypoglycemia
a driver with a medical condition, like DM, that has the potential to affect their fitness to drive may be required to have a drivers medical exam report completed by their GP
33
how do you reduce the risk of hypoglycemia
increase frequency of blood glucose checks--including episodic assessment during sleeping hours make glycemic targets less stringent consider multiple insulin injections
34
in patients with T2DM and only using oral antihyperglycemics, how often should they check their blood glucose
1-2 times per week usually
35
how much should people exercise
at least 150 minutes per week of aerobic exercise and two sessions per week of resistance training
36
what insulin regimen should be suggested for people with T1DM
multiple (3-4) daily insulin injections or the use of continuous subcutaneous insulin infusion (insulin pump) should be considered as part of an intensive diabetes management program
37
should you use a CV risk assessment calculator in people with T1DM
no
38
how do you assess CV risk in the DM population
a CV risk assessment tool medical history physical exam full fasting lipid profile
39
how do you approach CV risk protection
lifestyle management glycemic control BP control pharmacological interventions
40
what is a mnemonic to help remember vascular protection strategies
ABCDEs A1c and optimal glycemic control Blood pressure Cholesterol Drugs for vascular protection Exercise/eating Smoking cessation
41
what drug might you consider for vascular protection in people with DM
ACEi consider this in any patient 55 or older, or with evidence of organ damage, even in absence of hypertension in patients with DM and HTN, consider ACEi or ARB
42
is the routine use of ASA in primary CV disease protection recommended
no--not even in people without DM but especially in people with DM, the risk of bleeding is higher
43
what is the first line strategy for vascular protection from a lipid lowering standpoint
first line is lifestyle second line is statins --use in people with clinical macrovascular disease, 40 or older, younger than 40 but with DM for more than 15 years, microvascular complications or other circumstances that warrant therapy
44
should you use statins to treat to a specific lipid target?
no, not according to the BC guidelines, though the CCA and CDA recommend treating high risk and intermediate risk patients to a specific LDL-C target of 2.0 or less
45
how often should DM patients get dilated retinal pupil exam
at diagnosis then every 1-2 years or as indicated | for T1DM, first follow up exam is 5 years after dx then every 1-2 years
46
how can DM retinopathy change during pregnancy
can worsen--women with DM considering pregnancy or in early pregnancy should be assessed by ophtho
47
what is the best way to prevent diabetic neuropathy
achieve long term glycemic control
48
how do you screen for DM neuropathy
with 10g monofilament or 128 Hz tuning for during foot exam
49
signs of autonomic neuropathy
erectile dysfunction GI disturbance orthostatic hypotension
50
what psychiatric conditions should be screened for in DM
depression anxiety eating disorders
51
how do you manage a patient with DM initially
lifestyle intervention, consider metformin right away (but dont have to) if A1c is less than 8.5, let them try lifestyle alone (or lifestyle with metformin) for 2-3 months if A1c is above 8.5, initiate metformin immediately and consider combination with another antihyperglycemic agent
52
what happens if your patient cant achieve glycemic targets with just lifestyle alone
start (or increase) metformin if still not at target after a trial of metformin or increased dose of metformin, then add an antihyperglycemic agent best suited to the individual based on patient characteristics, risks and benefits, and cost
53
if, after lifestyle changes, metformin, and a second anithyperglycemic agent, your patient is still not achieving glycemic targets, what do you do
``` add another agent from a different class or add/intensify insulin regimen ```
54
in a patient who started with an A1c above 8.5, and started metformin immediately, what do they do if you cant achieve glycemic goals
if still not at target after a trial of metformin or increased dose of metformin, then add an antihyperglycemic agent best suited to the individual based on patient characteristics, risks and benefits, and cost if still not at target, ass another agent from a different class, or add/intensify insulin regimen
55
in which patients should you start insulin
those with symptomatic hyperglycemia with metabolic decompensation (even with lifestyle changes and/or metformin )

LMCC Part II (52 decks)

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