Diabetes CPG

Question 1

Antibodies noted on Type 1 DM patients

Answer 1

ICA positive

Anti-GAD positive

ICA 512 positive

Question 2

Testing should be considered in all adults of what age?

Answer 2

> /= to 40

Question 3

What is the weigh circumference threshold for testing for DM for males and for females

Answer 3

Females >/= 80 cm
Males >/= 90 cm

Waist to hip ratio

>/= 1 for males
>/= 0.85 for females

Question 4

Disease conditions with strong corelation with DM

Answer 4

PCOS
IGT
IFG
GDM

Question 5

If initial screening for DM is negative repeat screening should be done how often?

Answer 5

Anually

Question 6

FBS criteria for diagnosis of DM

Answer 6

> 7 mmol/L or

>126 mg/dL

Question 7

How long should the patient fast for an FBS?

Answer 7

8-14 hours

Question 8

What is the DM criteria for 75 gram OGTT

Answer 8

> /= 200 mg/dL

Question 9

What is the DM criteria for RBS

Answer 9

> /= 200 mg/dL

Question 10

If Tests are positive but the individual is asymptomatic repeat testing should be done when?

Answer 10

In two weeks time

Question 11

75 gram OGTT is preferred for the following individuals

Answer 11

IFG

Previous CVD/ high risk CVD patient

Metabolic Syndrome

Question 12

Criteria for Pre - Diabetes

Answer 12

1. FBS 5.6 - 6.9

75 gram OGTT = 140- 199

RBS 140 - 199

Question 13

Criteria for Normal blood sugar

Answer 13

FBS <5.6 mmol/L

RBS and 75 gram OGTT <7.7 or 150 mg/dL

Question 14

At what AOG is fetal cell responsive to maternal glucose load?

Answer 14

16th week AOG

Question 15

Routine testing for GDM should be done at what AOG?

Answer 15

24-28 weeks AOG

Question 16

How do you interpret the 75 gram OGTT?

Answer 16

Based on IADPSG
FBS 92
1 hr 180
2 hrs 153

ADA
FBS 95
1 hour 180
2 hours 155
3 hours 140

Question 17

When is a repeat 75 gram OGTT requested for GDM patients?

Answer 17

6-12 weeks post Partum

Question 18

Examples of Microvascular complications of DM?

Answer 18

Retinopathy
Neuropathy
Nephropathy
Autonomic
Sexual dysfunction
Gastroparesis

Question 19

Macrovascular

Answer 19

Stroke
CAD
PVD

Question 20

Cut-off for overweight Asians

Cut off for obese Asians

Answer 20

23 kg/m2

25 kg/m2

Question 21

When is eye exam done for type 2 DM?

Answer 21

Immediately upon diagnosis

Question 22

Required laboratories requested for patients with Dm?

Answer 22

FBS
lipid profile
Hba1c
Liver enzyme

Question 23

Laboratory parameter that is a known predictor of complications?

Answer 23

Hba1c

Question 24

What laboratory parameter is being targeted?

How often do you monitor it?

Answer 24

Hba1c reduction is the aim

Every 3-6 months

Question 25

Target glycemic control for Hba1c?

Answer 25

<7%

Question 26

CBG target pre meals? CBG target post meals?

Answer 26

90-130 mg/dL <180 mg/dL

Question 27

Glycemic control should be achieved within how many months after initiation of therapy?

Answer 27

Within 6 months of Diagnosis/ initiation of therapy

Question 28

BP target for diabetic patients

Answer 28

Generally <140/80 Young, less co morbids <130 mmHg

Question 29

Lipid profile target for diabetic patients?

Answer 29

LDL

Question 30

Statin therapy is initiated regardless of lipid levels for what group of patients?

Answer 30

1. CVD 2. >40 with one or more risk factor for CVD For <40 patients start statin therapy if LDL is >100mg/dL

Question 31

LDL target for patients with overt CVD LDL target for those without overt CVD

Answer 31

Overt CVD <70 or <1.8 mmol/L Without overt CVD <100 or <2.6 mmol/L

Question 32

If max dose of statin is being used and the patient has side effects what percent is the appropriate reduction?

Answer 32

30-40%

Question 33

Aspirin therapy at 75-162 mg/day is used for high risk patients.

Answer 33

Men >50 Women >60 ``` With hypertension Smoking Dyslipdemia Albuminuria Family Hx of CVD ```

Question 34

Weight target for patients with DM

Answer 34

0.5-1 kg/wk or 1-2 lbs/week

Question 35

Macronutrient proportion for DM patients

Answer 35

50-55 % CHO 30% fat 15- 20% protein

Question 36

For DM patients salt intake should be limited at?

Answer 36

< 6 grams/ day

Question 37

Moderate physical activity is how many METs

Answer 37

3-6 METs

Question 38

Moderate intensity is how many percent of max HR?

Answer 38

50-70% Max HR is 220-Age

Question 39

How do you treat a patient with Hba1c < 8 FBS <140 RBS <200

Answer 39

Life style therapy with or without metformin | Recheck after 3 months

Question 40

Drug classification of metformin?

Answer 40

Biguanides Action - decreases hepatic glucose production - increases inuslin sensitivity

Question 41

Thiazolidinediones stimulate what receptor?

Answer 41

PPAR gama receptors E.g. Pioglitazone

Question 42

DPP4 inhibitors MOA and Example

Answer 42

MOA - inhibits DPP4 to increase GLP - 1 GLP-1 increases insulin secretion E.g. gliptins

Question 43

This drug class acts on the distal collecting tubules to prevent glucose reabsorption

Answer 43

SGLT2 inhibitors empaglifuzin

Question 44

Drug class contraindicated for Heart Failure patients

Answer 44

Thiazolidinediones

Question 45

Regular insulin Onset of Action? Peak? Duration? Examples?

Answer 45

Onset of Action? 0.5-1 hr Peak? 2-4 hrs Duration? 6-8 hrs Examples? Humulin R, Actrapid

Question 46

Rapid acting analogues (Lispro, Aspart, Glulisine) Onset of Action? Peak? Duration? Examples?

Answer 46

Onset of Action? 10-15 minutes Peak? 1 hr Duration? 3-4 hrs Examples? Humalog, novorapid, Apidra

Question 47

NPH - intermediate acting inuslin Onset of Action? Peak? Duration? Examples?

Answer 47

Onset of Action? 1-3 hrs Peak? 6-8 hrs Duration? 12-16 hrs Examples? Humulin N, Insulitard

Question 48

Glargine, Detrimir Onset of Action? Peak? Duration? Examples?

Answer 48

Onset of Action? 1-2 hrs Peak? Flat no peak Duration? 24 hours - glargine 16-24 hours detrimir Examples? Lantus, levemir