Diabetes

Question 1

diabetes

Answer 1

one of the most challenging health problems facing the world
5th leading cause of death
complications = heart attacks, stroke, kidney failure, amputations and blindness

Question 2

how many people expected to be diagnosed by 2025?

Answer 2

380 million

Question 3

diabetes in canada

Answer 3

2.4 million living with it
570,000 living with undiagnosed type 2
6 million at high risk

Question 4

groups at high risk

Answer 4

aboriginal 
asian 
south east asian 
latin american 
african 
boomers

Question 5

economic impact

Answer 5

16. 9 billion by 2020 in canada

1. 3 trillion in the usa as of 2015

Question 6

direct acute care costs

Answer 6

canada = 15.36 billion as of 2012

2 in 10 hospital admissions for diabetes-related complications

Question 7

types of diabetes

Answer 7

type 1 = autoimmune process
type 2 = insulin resistance
gestational = glucose intolerance with pregnancy
other types

Question 8

type 1

Answer 8

“mistaken identity”
beta-cells mistakenly recognized as being foreign and are attacked by t-cells
autoimmune destruction of the beta cells
genetically determined
susceptibility factors increase risk

Question 9

type 2

Answer 9

liver = over production of glucose 
gut = dysfunctional gut hormones 
pancreas = beta cell dysfunction 
cells = insulin resistance

Question 10

screening for diabetes

Answer 10

type 1 = not really developed or recommended

type 2 = fasting plasma glucose

Question 11

reasons to be screened

Answer 11

first-degree relative with type 2 diabetes 
member of high risk population 
presence of complications associated with diabetes 
vascular disease
history of gestational diabetes 
history of delivery of a macrosomic infant 
hypertension
dyslipidemia
overweight
abdominal obesity 
polycystic ovary syndrome 
schizophrenia

Question 12

prevention of diabetes

Answer 12

type 1 = none
type 2 = intensive and structured lifestyle modification that results in loss of approximately 5% of initial body weight reduces risk, pharmacologic therapy

Question 13

diabetes care depends on

Answer 13

daily commitment of the person with diabetes to self manage

support of an integrated diabetes healthcare team

Question 14

diabetes healthcare team

Answer 14

should be multi and interdisciplinary

should establish and sustain a communication network among the health and community systems

Question 15

ABCDES3 of diabetes care

Answer 15

A = A1C - optimal glycemic control 
B = optimal blood pressure 
C = cholesterol reduction
D = drugs to protect heart
E = exercise/ healthy eating 
S = screening for complications 
S = smoking cessation 
S = self-management, stress and other barriers

Question 16

self management education

Answer 16

incorporates knowledge and skills development
cognitive-behavioural interventions
should be implemented for all individuals with diabetes
must be individualized

Question 17

self management education is individualized according to

Answer 17

individuals type of diabetes 
current state of metabolic stability 
treatment recommendations 
readiness for change 
learning style 
ability 
resources 
motivation

Question 18

what is fundamental to the management of diabetes

Answer 18

optimal glycemic control

Question 19

monitoring glycemic control

Answer 19

should be measured every 3 months when glycemic targets are not being met and when diabetes therapy is being adjusted

Question 20

physical activity and diabetes

Answer 20

moderate to high levels of physical activity and cardiorespiratory fitness are associated with reductions in morbidity and mortality with diabetes

Question 21

people with diabetes should be assessed for what before beginning a program of physical activity more vigorous than walking

Answer 21

conditions that might be contraindications to certain types of exercise, predispose to injury or be associated with increased likelihood of cardiovascular disease

Question 22

nutrition therapy

Answer 22

can reduce glycated hemoglobin by 1.0 to 2.0% and when used with other components of diabetes care can further improve clinical and metabolic outcomes
consistency in carbohydrate intake and spacing and regularity in meals may help control blood glucose and weight
replacing high-glycemic index carbohydrates with low ones affects glycemic control

Question 23

insulin therapy in type 1 diabetes

Answer 23

insulin regimens should be tailored to individuals treatment goals, lifestyle, diet, age, general health, motivation, hypoglycemia awareness and ability for self management

Question 24

all individuals with type 1 diabetes should be counselled about

Answer 24

the risk, prevention, and treatment of insulin-induced hypoglycemia

Question 25

pharmacologic management of type 2 diabetes

Answer 25

should be initiated if glycemic targets are not reached within 2 to 3 months of lifestyle management
should be made to attain target A1C within 6 to 12 months
should be initiated with lifestyle management

Question 26

what would save the system 2.03 billion dollars

Answer 26

if canadians with diabetes loss 5% of their body weight

Question 27

how many people with type 2 diabetes are overweight

Answer 27

80 to 90%

Question 28

psychological aspects of diabetes

Answer 28

individuals and their families should be screened for symptoms of psychological distress
preventative interventions like participative decision making, feedback and support should be incorporated into all primary care and self management education interventions to enhance adaptation to diabetes and reduce stress

Question 29

what vaccine is recommended to people with diabetes

Answer 29

pneumococcal