DM background

Question 1

Type 1 DM

Answer 1

deficiency of insulin secretion as result to destruction of pancreatic B-cells (autoimmune or virus–> rubella, coxsakievirus B, cytomealvirus, adenovirus, mumps)

Question 2

Type 2 DM

Answer 2

insulin resistance in muscles and adipose tissue
decline in pancreatic insulin secretion
unrestricted hepatic glucose production

over 90% of all DM cases

Question 3

S&S of Hyperglycemia

Answer 3

polyuria, polydypsia, polyphagia (loosing weight)

Question 4

Type 2 DM risk factors

Answer 4

overweight
sedentary lifestyle

fam hx
cardiovascular dz
previously had an impaired glucose tolerance or impaired fasting glucose
HTN

Question 5

DM screening

Answer 5

BMI greater than 25 Kg/M

if test is negative, test again in 3 yrs

Question 6

A1C

Answer 6

hemoglobin carries glucose in blood, testing A1C can give you an idea how much glucose the hemoglobin has been picking up in the past 3 months (3 mo=life of RBC)

Question 7

Normal A1C

Answer 7

less than 5.7%

Question 8

Pre-Diabetic AIC

Answer 8

between 5.7-6.4%

Question 9

A1C thats diabetic

Answer 9

greater than 6.5%

Question 10

Normal fasting plasma glucose

Answer 10

less than 100mg/dL

Question 11

Pre-Diabetic Fasting plasma glucose

Answer 11

100-125mg/dL

Question 12

Diabetic Fasting plasma glucose

Answer 12

over 126

Question 13

Oral glucose tolerance test–> 2 hrs post

Answer 13

used to Dx gestational diabetes

Question 14

Normal 2 hrs post oral glucose tolerance test

Answer 14

less than 140mg/dL

Question 15

Pre-Diabetes 2 hrs post oral glucose tolerance test

Answer 15

140-199 mg/dL

Question 16

Diabetes 2 hrs post oral glucose tolerance test

Answer 16

over 200 mg/dL

Question 17

Tx goals in Dm

Answer 17

keep A1C below 7%
keep fasting under 100 mg/dL
keep before meal blood glucose level between 7–130mg/dL (which lets you know how well the previous meal was covered)

Question 18

Tx of Pre-Diabetes

Answer 18

metformin can be used esp if they have a BMI of greater than 35kg/m2, and are under 60

Question 19

Macrovascular Complications of DM

Answer 19

coronary artery dz
HTN
dyslipidemia

Question 20

Microvascular Complications of DM

Answer 20

retinopathy
neuropathy
nephropathy

Question 21

Management of complications of CAD w/DM

Answer 21

men over 50, women over 60 with DM and atleast 1 other risk factor (fam hx of CVD, HTN , Smoking, dyslipedemia, albumenemia)

given 81mg ASA

Question 22

Management of HTN with Dm

Answer 22

goal 140/80

use ACE-I or ARB (angiotinsen II receptor blocker) (these are first line tx because they protect kidney)

Question 23

Management of Dyslipidemia with Dm

Answer 23

Goal: LDL under 100

Tx with statin (esp with Hx of MI)

Question 24

management of retinopathy with DM

Answer 24

manage HTN and glucose

Question 25

Management of Neuropathy in DM

Answer 25

manage HTN and glucose

Question 26

Tx of Peripheral neuropathy with DM

Answer 26

gabapentin (2400-3600mg daily dose) divided

TCA’s

Question 27

TX of Autonomic retinopathy

Answer 27

PDE-5 inhibitor (erectile dysfunction)
reglan erythromycin (gastropyresis)
stool softeners)

Question 28

Non-Pharm therapy in management of DM

Answer 28

Exercise–> 30 mins/day

Diet–>avoid high fat foods, carbs, and sugar
increase fober

15g of carbs=1 serving
can usually have 2 servings at breakfast

Question 29

Complications of gestational DM

Answer 29

macrosomia (baby over 9 lbs)
neonatal metabolic problems–> mothers sugar was always high, so new borns sugar will drop right away when born
HTN and preeclampsia

Question 30

When to test for gestational DM

Answer 30

24-28 weeks if no known DM (using OGTT)

Question 31

Tx options for gestational DM

Answer 31

Diest and exercise 1st

Sulfonylureas (glipizide and glyburide) 9aka insulin)