Diabetes and CKD

Question 1

What is insulin resistance syndrome?

Answer 1

*Glucose intolerance (impaired fasting glucose or impaired GTT)
*Abnormal uric acid metabolism
*Dyslipidemia
*Hemodynamic changes (incl. renal Na retention and incr. BP)
*Prothrombotic factors
*Markers of inflammation (elevated CRP and WBC)
*Endothelial dysfunction
Degree contributes significantly toward enhanced protein catabolism

Question 2

What are the AADE7 self-care behaviors?

Answer 2

Healthy coping
Healthy eating
Being active
Taking medication
Monitoring
Reducing risk
Problem-solving

Question 3

What may be included in gastrointestinal autonomic neuropathy (GAN)?

Answer 3

Gastroparesis (50% prevalence)–influenced by BG levels
GERD (30% prevalence)
Diabetic diarrhea (20% prevalence)
Fecal incontinence
Constipation
Gallbladder disease (cholecystitis or biliary obstruction)

Question 4

What are glycemic control goals with DKD?

Answer 4

*Avoid hypoglycemia and symptomatic hyperglycemia in older adults
*HbA1c < 8% for older adults with CKD stage 3 or worse, avoid reliance on HbA1c

Question 5

What are the fasting plasma glucose goals for DKD?

Answer 5

CKD1-5: 80-130 mg/dL
HD: <140 mg/dL
PD: <160 mg/dL

Question 6

What are the 2-hour post prandial glucose goals for DKD?

Answer 6

CKD1-5: 150-180 mg/dL
HD/PD: < 200 mg/dL

Question 7

What are the recommendations to minimize CVD risk in CKD?

Answer 7

Limit fat to 25-35% kcal and focus on limiting sat. fat
Potential beneficial effects of omega-9 (olive oil) and omega-3 (fish oil) fatty acids
Limit cholesterol to 200-300 mg/day
Focus on overall healthy eating pattern