DM - Management

Question 1

Therapeutic Lifestyle Change goals

Answer 1

• Weight loss: >7-10%
• Physical Activity: 150 min/week of moderate-intensity exercise (eg, brisk walking)
  + flexibility and strength training
  Diet: Multiple

Question 2

Diet change treatment goals

Answer 2

• Eat regular meals and snacks; avoid fasting to lose weight
• Plant-based diet (↑ fiber, phytochemical/antioxidants & ↓ calories/glycemic index)
• Understand Nutrition Facts Label information
• Incorporate beliefs and culture into discussions
• Use mild cooking techniques, NOT high-heat cooking (>400° F)
• Keep physician-patient discussions informal

Question 3

Diabetic patients making healthful eating changes should Preferentially consume lower-glycemic index foods that are ____

Answer 3

<55 out of 100 for a glycemic index score
multigrain bread, pumpernickel bread, whole oats, legumes, apple, lentils, chickpeas, mango, yams, brown rice

Question 4

Predictors of Poor Glycemic Control

Answer 4

Younger age
Longer diabetes duration
Weight <85th percentile
Not living in a 2-parent household
Type of diabetes care provider
Nonwhite race/ethnicity
Female gender
Lower parental education
Poor early glycemic control

Question 5

Goals of T1D Management

Answer 5

Achieve near-normal BG & A1C
Prevent diabetic ketoacidosis
Prevent severe hypoglycemia
Maximize quality of life
Children: Achieve normal growth and
physical development and psychological maturation

Question 6

A1C goals for T1D in Youth vs. Adults

Answer 6

Youth: <7.5%
Adults: <7.0%

Question 7

When should you check weight for children and adults with T1D

Answer 7

Every 3 months

Question 8

How often for a Retinal examination for children and adults with T1D

Answer 8

Children: Begin 5 years after diagnosis and Every 1-2 years thereafter
Adults: Begin 5 years after diagnosis or
earlier with visual symptoms or if date of T1D onset is unknown, Every 1-2 years thereafter

Question 9

How often should you check A1C for those with T1D

Answer 9

Every 3 months

Question 10

How often should you do a lipid panel for those with T1D?

Answer 10

Children: Annually, once glycemia is stable
Adults: Annually or as needed based on
treatment

Question 11

T/F Blood pressure should be checked at every physical exam for T1D

Answer 11

T

Question 12

Creatinine clearance, eGFR in those with T1D should be checked ______

Answer 12

At diagnosis, then annually

Question 13

ACR (albumin/creatinine ratio) should be checked how often in T1D?

Answer 13

Children: 5 years after diagnosis, then annually
Adults: At diagnosis, then annually

Question 14

Pre-Pregnancy Risk Factors for gestational diabetes

Answer 14

Maternal age >37 yo
Ethnicity
Wt >80 kg or BMI >28 kg/m2
1st degree relative with DM
PCOS
Previous macrosomia/polyhydramnios or previous unexplained stillbirth

Question 15

Maternal Risks with gestational diabetes

Answer 15

↑ urinary tract infections
Pyelonephritis
Asymptomatic bacteriuria
Preeclampsia
Polyhydramnios (10%)

Question 16

Fetal risks with gestational diabetes

Answer 16

Stillbirths
Macrosomia
NO ↑ congenital anomalies: Typically happens later in pregnancy

Question 17

Potential Contraindications to Pregnancy in
Women with Established Diabetes

Answer 17

Ischemic heart disease
Untreated active proliferative retinopathy
Renal insufficiency
Severe gastroenteropathy

Question 18

Things that can help Avoiding Complications in Diabetes with pregnancy

Answer 18

Regular ophthalmologic exams:
* 1st trimester through 1st year postpartum
* Examine active lesions more frequently
Hypertension management
* Systolic BP 110-129 mmHg
Diastolic BP 65-79 mmHg
* Lifestyle changes, behavior therapy, and pregnancysafe medications

Question 19

Recommendations for Glucose Monitoring in
Pregnant Women with Diabetes

Answer 19

• Insulin-requiring pregnant patients should perform SMBG ≥3 times daily
• Weekly A1C during pregnancy

Question 20

Medical Nutrition Therapy During Pregnancy

Answer 20

Healthy low-carbohydrate, high-fiber sources of nutrition
Prefer = fresh vegetables