Diabetes

Question 1

When to test for DM:

Answer 1

1- overweight w\Comorbidities
2- Pre-diabetes every year
3- GD every 3 years
4- Age >45 years

Question 2

What are the risk factors associated with obesity, that fits the criteria for testing for DM?

Answer 2

1- first degree w\DM
2- CVD 
3- high-risk ethnicity 
4- physical inactivity 
5- HDL<35 and\or TG>250 
6- HTN 
7- PCOS 
8- indicators of insulin resistance (Acanthosis)

Question 3

Criteria for Pre-diabetes include:

Answer 3

• FBG: 100-125
• OGTT: 140-199
• A1c: 5.7-6.4

Question 4

Criteria DM diagnosis

Answer 4

• FBG: >126 alone
• RBG: >200 +symptoms
• OGTT: >200
• Hg1c: >6.5

Question 5

Sx of hyperglycemia - Sx of hypoglycemia:

Answer 5

1- hyper: polyurea, polydypsia, polyphagia

2- Hypo: Hunger, sweating, palpitation, headache, dizziness

Question 6

• How to screen for nephropathy in DM?
• When to start treating it?
• how to treat it?

Answer 6

• Creatine-albumin ratio (Microalbuminurea)
• 30 or above
• ACE or ARBs

Question 7

When to screen for complications of DM1-DM2?

Answer 7

DM1: yearly
DM2: after 5 years then yearly

Question 8

MOA of SGLT:

Answer 8

Reduce the reabsorption of glucose in the Proximal convoluted tubules and increase glucose in urine

Question 9

What are some recommendations you would provide your patient with if they’re taking SGLT?

Answer 9

• Drink water + Good hygiene to avoid UTI

- take in the morning to avoid night urination.

Question 10

Although GLP1 are insulin secretors, why don’t they cause hypoglycemia?

Answer 10

Because they’re carbohydrate dependent (insulin only increasing in response to carb eating)

Question 11

What is recommended values for pre-prandial and post-parandial glucose level?

Answer 11

• Pre: 80-130

- Post: <180

Question 12

Differentiate between somogyi and dawn phenomenon:

Answer 12

• Somogyi: Low glucose at 3AM > reduce glargine to decrease insulin
• Dawn: high glucose at 3AM > increase glargine to increase insulin

Question 13

What are the factors that reduce Hb1c?

Answer 13

1- pregnancy
2- hemolytic anemia
3- blood loss.

Question 14

What are the factors that increase Hb1c?

Answer 14

1- lead poisoining- uremia
2- alcohol - opiates - asprin 
3- IDA
4- post-splenectomy
5- hyperbillirubinemia - hypertrigylcridmia

Question 15

Gestational diabetes is only in:

Answer 15

2-3 trimester

Question 16

Name drug-induced diabetes

Answer 16

Corticosteroid - statin

Question 17

Asian american are screened at BMI of

Answer 17

23

Question 18

Which group of patients coming for screening of DM i don’t need to confirm ?

Answer 18

• If he’s symptomatic + RBG>200

- if i do simultaneously two tests together

Question 19

Which test will you repeat when you’re screening for DM and one of them is normal, the other is abnormal?

Answer 19

I repeat the abnonral

Question 20

How to screen for nephorpathy in DM?

Answer 20

By microalbumin

Question 21

What is the action of sulfonylurea?

Answer 21

1- increase insulin secretion > Hypoglycemia

2- Insulin is anabolic > weight gain.

Question 22

What is the site action of incretin GLP (liraglutide - succidena)

Answer 22

• brain reduce apetite
• stomach slowing emptying
• pancreas increase insulin secretion in response to carbs

Question 23

more stringent vs stringent?

• short Life expectancy
• living far away
• long-standing

Answer 23

Less stringent

Question 24

Discrepancy between hg1c and the blood sugar raise the question of

Answer 24

There’s an underlying problem that is changing the Hg1c like IDA *increase)

Question 25

When to start patient with DM on dual therapy?

Answer 25

1.5-2% more than target hb1c - failed monotherapy

Question 26

When to start patient on insulin therapy?

Answer 26

- >10% - severe symptoms - BG>300 - failed dual - failed GLP1

Question 27

If you see the following key words in test in patient with diabetes, your treatment should always be: (CKD - ASCVD - HF)

Answer 27

It should be: Metformin + SGLT2\GLP1

Question 28

How to follow up patient with monotherapy?

Answer 28

After 3 months if controlled after 3-6

Question 29

Patient with diabetes who wants to lose weight, what medications will you give them?

Answer 29

- SGLT2 | - GLP1

Question 30

Patient who has heart failure, what medication should i avoid?

Answer 30

TZD which is also cheap

Question 31

What oral medications for diabetes are known to cause GI upset?

Answer 31

Alpha glucosdiase and metformin

Question 32

Side effects of DPP4 medicaitons include:

Answer 32

Headache and pancreatitis

Question 33

Which medications need not to be adjusted for renal impairment?

Answer 33

Linagliptin

Question 34

SGLT can cause:

Answer 34

UTI

Question 35

Should be avoided medullary thyroid?

Answer 35

GLP1

Question 36

When to half the metformin or stop it in DM?

Answer 36

Half: at GFR of 45 Stop: at GFR of < 30

Question 37

when to start GLP1 over insulin?

Answer 37

In most patients

Question 38

when to start insulin over GLP1?

Answer 38

- Catabolism symptoms like weight loss - A1c>11% - DM1 suspected - inaffective

Question 39

how to start basal insulin?

Answer 39

Dose of 10-20% of body weight and increase every 3 days with 2 units until target

Question 40

What would you do if after the initiation of basal insulin, the patient develops hypoglycemia?

Answer 40

Reduce 10-20%

Question 41

In patients with 1 injectable, we have to do two tests (FBG and Hb1c), why both?

Answer 41

To determine if patinet need the prandial dosage

Question 42

In general after initiation of therapy we always follow up patients after 3 months with:

Answer 42

Hb1c