Diabetes: Lecture 5

Question 1

best way to asses Diabetes?

Answer 1

Combo of A1c, BG or Continuous glucose monitoring

Question 2

Using A1c test frequency

Answer 2

every 3 months of not at goal

every 6 months in pt meeting goal

Question 3

Limitation of A1c

Answer 3

does not provide a measure of glycemic variability or hypoglycemia

Question 4

Time in range goal?

Answer 4

> 70%

Question 5

Coefficient of variation Goal?

Answer 5

= 36%

measure of glucose variability ie Roller-coaster

Question 6

Hypoglycemia

Answer 6

Defined as BG < 70

Rapid onset and progression of Symptoms

Question 7

Classification of Hypoglycemia

Answer 7

Lvl 1 = <70 >54
Lvl 2 = < 54
Lvl 3 = altered mental and/or physical status requiring assistance for treatment of hypoglycemia

Question 8

Cause of neurogenic symptoms of Hypoglycemia

Answer 8

Due to activation of autonomic nervous system

Question 9

Cause of neuroglucopenic symptoms of Hypoglycemia

Answer 9

Due to inadequate glucose to the brain

Question 10

How to treat mild to moderate hypoglycemia, pt can swallow.

Answer 10

Use 15 grams of glucose from carbs....
3-5 hard candy
4 oz juice
3-4 glucose tablets
soda

check after 15 min and if still under <70, repeat. Follow up with a snack after

Question 11

How to treat severe hypoglycemia, cant safety swallow or unconscious

Answer 11

GlucaGen = injection
Evoke = injection
Baqsimi = spray nose

Question 12

Diabetic Ketoacidosis defining features

Answer 12

Hyperglycemia
Ketosis
Metabolic acidosis

Question 13

Who gets DKA?

Answer 13

usually Type 1

often how we diagnose

Question 14

DKA presenting features?

Answer 14

Fatigue
Headache
Polyuria
Polydipsia
Weight loss
Nausea

Question 15

Labs of someone with DKA?

Answer 15

Glucose >250
Low serum bicarb <18
Low arterial pH <7.3
Ketonemia and moderate ketonuria

Question 16

DKA complications

Answer 16

Cerebral edema (often kids)
Respiratory distress syndrome
Thromboembolism
Rhabdomyolysis

Question 17

DKA management

Answer 17

Fluid admin
Insulin replacement
Potassium replacement
Do a work-up
Monitor pt
Educate/Follow-up

Question 18

HHS

Answer 18

Hyperosmolar Hyperglycemic state

Often seen in Type 2 Diabetes

don’t see the ketones, but dehydration is more profound

Question 19

HHS defining features?

Answer 19

Hyperglycemia
Hyperosmolality
Dehydration

Question 20

HHS onset?

Answer 20

Days to weeks

Question 21

Labs for HHS

Answer 21

Glucose >600

Plasma osmolality >320 mOsm/kg

Question 22

Presenting Symptoms HHS

Answer 22

Polyuria
Polydipsia
*Neurological signs
Dehydration

Question 23

Big differences between DKA and HHS?

Answer 23

Glucose and Ketones (Neg for HHS, Pos for DKA)

Question 24

Macrovascular diseases

Answer 24

Cerebrovascular disease

Coronary Heart Disease

Question 25

Microvascualr diseases

Answer 25

Retinopathy Nephropathy Neuropathy PVD

Question 26

Landmark Trials Diabetes

Answer 26

``` DCCT = Type 1 UKPDS = Type 2 ``` Helped establish glucose control for A1C <7%

Question 27

Take home points of DCCT and UKPDS

Answer 27

Improved glycemic control is associated with decreased rates of microvascular complications no sig correlation between tight glycemic control and reduction of CVD events Long term follow up suggests that there is reduction in CVD events with tighter control

Question 28

Trials to compare effects of intensive vs standard glycemic control on CVD outcomes in high risk patients with Type 2 diabetes?

Answer 28

Accord Advance VADT

Question 29

ACCORD, ADVANCE, VADT

Answer 29

No sig risk reduction in microvascular events with tight glucose control reduction in microvascular complications, but sig increase hypoglycemic events Intensive treatment associated with increase all-cause mortality (ACCORD) Neutral or increased risk of CV events n ACCORD

Question 30

Cardiovascular risk factors w/ Diabetes

Answer 30

``` Dyslipidemia Hypertension Smoking Obesity/overweight CKD Presence of albuminuria ```

Question 31

1st line for Hypertension w/ Diabetes

Answer 31

ACE, ARB, Thiazide, DHP CCB monitor eGFR, Scr and K on ACE/ARB

Question 32

Lipid screening w/ Diabetes

Answer 32

every 5 years <40 not on statin

Question 33

Lipid Treatment w/ Diabetes

Answer 33

Primary prevention: aged 40-75 should be on Moderate statin unless contraindicated, if high risk use high intensity 2ndary prevention: any age, high intensity statin

Question 34

high intensity statins

Answer 34

Atorvastatin 40-80mg | Rosuvastatin 20-40mg

Question 35

When to use Aspirin in patients with DM

Answer 35

2ndary prevention = recommended with h/o ASCVD event controversial in primary prevention, can be considered but have to do pro/con

Question 36

Who would not likely be recommended aspirin

Answer 36

DM pt that's <50 yr old and not for those >70yrs old

Question 37

Screening for Diabetic Kidney Disease

Answer 37

Type 1 = Typically develops after ~10yrs of diabetes, screen after 5 Type 2 = start screening at diagnosis

Question 38

Decreasing eGFR and Increasing Albuminuria causes an......... in risk of Cardiovascular death

Answer 38

Increase

Question 39

Treatment of Diabetic Kidney Disease

Answer 39

ACE or ARB recommended for Hypertension with Albuminuria SGLT2i regardless of glycemic control GLP1-RA (for benefit) *can use NSMineralocrticid RA Finerenone if unable to use SGLT2i*

Question 40

Diabetic Retinopathy prevalence strongly related to.....

Answer 40

duration of diabetes and level of glycemic control

Question 41

Retinopathy screening

Answer 41

Annual eye exam Type 1 - 5 years after diagnosis Type 2 - start at diagnosis

Question 42

Retinopathy treatment

Answer 42

Non to reverse it can try laser or VEGF therapy

Question 43

Diabetic Peripheral Neuropathy

Answer 43

diminished perception of vibration, pain, temp in lower extremities Lea to ulcers and amputations

Question 44

Best way to prevent Diabetic Neuropathy

Answer 44

Glycemic control cant reverse

Question 45

Diabetic Peripheral Neuropathy screening

Answer 45

Type 1 - 5 years after diagnosis | Type 2 - start at diagnosis, annually

Question 46

How to assess Diabetic Peripheral Neuropathy

Answer 46

Pinprick Temp Vibration perception Pressure sensation

Question 47

Diabetic Peripheral Neuropathy treatment

Answer 47

Pregabalin Duloxetine Gabapentin (off-label)