Diabetes Canada

Question 1

When to screen for diabetes in people without additional risk factors

Answer 1

40 years and older

every 3 years

Question 2

5 Diabetes risk factors

Answer 2

Family history/1st degree relative w/ type two diabetes
High risk population/non-white/low SES
Hx of gestational diabetes/ prediabetes
CVS risk factors
Presence of end organ damage

Question 3

In people with diabetes risk factors, when do you screen?

Answer 3

screen Q6 to 12 months

Question 4

FPG <5.6 mmol/L

HgA1C = 5.5%

Answer 4

Normal result

Question 5

FPG 6.1-6.9 mmol/L

HgA1C 6.0-6.4%

Answer 5

Impaired fasting glucose

Pre diabetes

Question 6

FPG 7.0 mmol/L

HgA1C = 6.5

Answer 6

Diabetes

Question 7

List the ABCDES3 of diabetes management

Answer 7

A1C target
BP control
Cholesterol
Drugs to protect heart
Exercise
Screening
Smoking cessation
Self management

Question 8

What is the most ideal hgb A1C target in the general population

Answer 8

= 6.5

Question 9

What is the general blood pressure target and diabetes management

Answer 9

<130/80

Question 10

What is the general cholesterol target in Dbts mgmt?

Answer 10

LDL<2.0 or >50% reduction

Question 11

In functionally dependent adult what is the A1c target

Answer 11

7.1-8.0%

Question 12

In the frail elderly/with dementia what is the A1c target

Answer 12

7.1-8.5%

Question 13

Blood sugars within what time frame account for 50% of hgb A1c

Answer 13

Last 30 days

Question 14

Iron deficiency anaemia can do what to HgA1C readings?

Answer 14

Falsely elevate

Question 15

What are the general preprandial and postprandial blood sugar targets

Answer 15

Pre- 4-7

Post- 5-10

If not at target, may reduce post to 5-8

Question 16

If HgbA1C is <1.5% above target- next step?

Answer 16

Discuss lifestyle Adjustments and reassess at 3 months

If still note at target- start/ increase metformin

Question 17

If HgbA1C >/= 1.5% above target- next step?

Answer 17

Start metformin + other antihyperglycemic agent

Question 18

If patients present and are symptomatic of hypo or hyper glycaemia upon initial evaluation, what are the steps taken

Answer 18

Insulin +/- metformin

Question 19

What class of antihyperglycemic agent medication show cardio protective benefit

Answer 19

SGLT2 - Empagliflozin, ConAgliflozin

GLP1- liraglutide, semaglutide

Question 20

What is the typical starting dose of basal insulin and up titration

Answer 20

10 units

Increase 1 unit / day

Question 21

When patients are not meeting HgbA1C Targets, the goal is to correct within——-

Answer 21

3-6M

Question 22

What to medication’s are indicated with an eGFR of 15

Answer 22

Linagliptin

Liraglutide

Question 23

When/ in whom is Statin therapy started (5 crit)

Answer 23

Clinical CVD
>/= to 40 years
Microvascular complications
DM >15yrs and >30yrs old
Indicated as per dyslipidaemia guideline

Question 24

When initiating ACE/ARB- what does follow up look like?

Answer 24

Check Cr and K at baseline and 1-2 weeks after starting.

Assess hyperkalemia and stop if Cr increases 30%

Question 25

What diabetics are started on ACE/ARBs

Answer 25

Clinical CVD Age >/= 55y with additional risk factor or end organ damage (albuminuria, retinopathy, LVH) Or macrovascular complication

Question 26

Is starting ACE/ARB therapy in diabetics dependent on BP?

Answer 26

No!

Question 27

ASA Is indicated in what form of prevention in diabetes

Answer 27

Secondary

Question 28

Physical activity recommendations and diabetes

Answer 28

150 min of moderate to vigerous exercise / week | Resistance training 2x/ week

Question 29

Recommended diets in diabetes

Answer 29

Vegan/ vegetarian Medeteranean DASH Portfolio

Question 30

People with type two diabetes are screened for retinopathy at diagnoses and——-

Answer 30

If negative every 1-2 years

Question 31

In people with type 1 diabetes when to screen for retinopathy?

Answer 31

5 years after diagnosis if older than 15years If negative- anual screening

Question 32

When are diabetics evaluated for chronic kidney disease

Answer 32

Urine ACR done at diagnosis and anually

Question 33

How is chronic kidney disease diagnosed and diabetics?

Answer 33

Urine ACR > 2.0 ng/ mmol or eGFR < 60ml/min Require 2/3 results over 3 months

Question 34

How often are patients screened for neuropathy

Answer 34

Annually | via 10 g monofilament test

Question 35

ECGs are done and baseline and repeated at 3-5 year intervals in who?

Answer 35

``` >40 yrs OR— Dbts >15 yrs and >30y/o End organ damage > 1 CVD risk factors = smoking/ HTN/ Fam hx/ CKD/ Obesity/ Erectyle Dysf/ heart dx ```

Question 36

Teachings pts about driving-

Answer 36

Dont drive with BG <4.0mmol/L | Wait 40 mins after treating and until BG atleast 5.0mmol/L

Question 37

Medications included in SADMANS

Answer 37

``` Sulfonyureas/ secreragogues ACE-inhib Diuretics Metformin ARBs NSAIDS SGLT2 inhib ```