Diabetes Kania Part 1

Question 1

Beta-cell-centric construct: Egregious Elevan

Answer 1

-Beta cells may be destroyed or simply quit working
-Diabetic patients have been shown to have decreased incretin effect, which normally helps stimulate insulin release
-Alpha cells in the pancreas can also dysfunction leading to an increase in glucagon
-Insulin resistance can occur in the tissue (adipose, muscle, and liver); obesity can increase risk
-Changes in levels of hormones that control appetite can lead to overeating and increased blood sugar; some hormone changes can increase insulin resistance
-Different gut bacteria can modify blood glucose levels and may decrease GLP-1 levels
-Autoimmune reaction and increased inflammation can destroy beta cells
-Quick stomach emptying can lead to increased glucose absorption
-Upregulation of SGLT2 can lead to increase glucose reabsorption in the kidney

Question 2

What is normal plasma usually maintained at?

Answer 2

60-140 mg/dL

Question 3

Normal FBG

Answer 3

<100 mg

Question 4

FBG in diabetes

Answer 4

126 or greater

Question 5

Normal 2h OGTT

Answer 5

<140 mg/dL

Question 6

2h OGTT in diabetes

Answer 6

<200 mg

Question 7

Normal A1c

Answer 7

<5.7%

Question 8

Diabetes A1c

Answer 8

6.5% or greater

Question 9

Normal random glucose

Answer 9

<200 mg/dL

Question 10

Random glucose in diabetes patients

Answer 10

200 mg/dL or greater

Question 11

Normal UACR

Answer 11

<20 mg/g

Question 12

Normal eGFR

Answer 12

> 60 mL/min/1.73m2

Question 13

When to check T1DM patients for microalbuminuria

Answer 13

Annually for patients who have had it for 5 years or more

Question 14

When to check T2DM patients for microalbuminuria

Answer 14

As soon as patient is diagnosed then check annually

Question 15

When should microalbuminuria be screened twice annually?

Answer 15

If UACR is greater than 300 mg/g and/or eGFR is less than 60 mL/min/1.73m2 (ACEI or ARB is also strongly recommended)

Question 16

How should you optimize glucose control in a patient with T2DM + kidney disease (UACR > 200mg/g)

Answer 16

Preferably use SGLT2I with evidence of decreased CKD progression if eGFR > 20 mL/min/1.73m2

Question 17

When to test glucose lab values?

Answer 17

Test every 3 years starting at 35 or if obese and/or risk factor

Question 18

When is someone diagnosed with pre-DM?

Answer 18

1 positive result in A1c, FBG, or OGTT

Question 19

When is someone diagnosed with DM?

Answer 19

2 positive results in A1c, FBG, or OGTT

Question 20

When should gestational diabetes be tested?

Answer 20

Every 3 years after diagnosis

Question 21

How to treat pre-DM

Answer 21

Initiate metformin especially in:
-Obesity
-Age <60
-Women with prior GDM

Question 22

Goal LDL for non-ASCVD patients

Answer 22

<70; if patient has UACR 300 or more goal 30% reduction

Question 23

Goal LDL for ASCVD patients

Answer 23

<55; if patient has UACR 300 or more goal 30% reduction

Question 24

Goal UACR

Answer 24

<30 mg/g

Question 25

Goal eGFR

Answer 25

>60

Question 26

eAG equation

Answer 26

28.7 * A1c - 46.7 = eAG

Question 27

How does a 1% change in A1c affect eAG

Answer 27

25-35 mg/dL change in eAG

Question 28

ADA goal for A1c

Answer 28

<7%

Question 29

ADA goal for FBG

Answer 29

80-130 mg/dL

Question 30

ADA goal for random blood glucose

Answer 30

<180 mg/dL

Question 31

ADA goal for BP

Answer 31

-<130/80 T1/T2DM -110-135/85 DM + pregnancy

Question 32

What to use to treat microalbuminuria in diabetic patients

Answer 32

-ACE1 or ARB is strongly recommended for non-pregnant patients with UACR 300 or more or a eGFR less than 60 -Preferably use SGLT2I in T2DM + kidney disease (UACR >200mg/g) if eGFR is greater than 20 -Use GLP1RA if SGLT2I not tolerated or contraindicated

Question 33

Why should ACE and ARB not be used together

Answer 33

Can cause hyperkalemia

Question 34

What to use to treat diabetic neuropathy

Answer 34

Pregabalin, duloxetine, or gabapentin

Question 35

What hypertensive agents should be used in patients with diabetes and atherosclerotic CVD (ASCVD)

Answer 35

-ACEis and ARBs at MAX (esp for patients with UACR > or = 300mg/g)

Question 36

How to treat patients 20-39 YO + No ASCVD

Answer 36

No statin - moderate statin based on risk (monitor annually)

Question 37

How to treat patients 45-75 YO + No ASCVD

Answer 37

Moderate statin (monitor annually)

Question 38

How to treat patients 45-75 YO + 1 or more risk factor

Answer 38

High statin, decrease LDL by 50% or more and target LDL less than 70

Question 39

Possible risk factors of ASCVD

Answer 39

-LDL of 100mg/dL or more -HTN -Smoking -CKD -Albuminuria -Family history of early ASCVD

Question 40

How to treat all ages + ASCVD + DM

Answer 40

-High statin + lifestyle mod -Decrease LDL by 50% or more (goal LDL less than 55) -If LDL still elevated despite the max statin add ezetimibe

Question 41

Examples of high statin

Answer 41

-Atorvastatin 40-80 mg -Rosuvastatin 20-40 mg

Question 42

Examples of moderate statin

Answer 42

-Atorvastatin 10-20 mg -Rosuvastatin 5-10 mg

Question 43

Antiplatelet agents + DM

Answer 43

-Aspirin(75-162 mg/day) as secondary prevention w/ DM + history of cardiovascular -Use clopidogrel (75mg) if allergic to aspirin

Question 44

When can aspirin be used as primary prevention?

Answer 44

-If the patient is over 50 years old -If they have 1 major risk factor -NOT a risk of bleeding