DM - Overview

Question 1

4 types of DM

Answer 1

T1
T2
GDM
LADA

Question 2

What is LADA

Answer 2

Latent autoimmune diabetes in adults

Question 3

What is responsible for the high morbidity and mortality from DM

Answer 3

micro and macrovascular complications of DM

Question 4

People with DM are more prone to what 3 things

Answer 4

cancer, dementia, infections

Question 5

Macrovascular complications include:

1

Answer 5

atherosclerosis

Question 6

Microvascular complications include:

7

Answer 6

strokes
cardiac disease
blindness
impotence
renal failure
foot ulcers
limb loss

Question 7

Preventing complications involves control of what two things?

Answer 7

lipids
HTN

Question 8

What immunizations are important for diabetics to get?

3

Answer 8

• Influenza
• Pneumococcal once after 18 and then again after 65
• all other vaccines

Question 9

Why is it important for insulin to be injected into abdominal sc tissue instead of limbs?

Answer 9

vigorous use of limbs can enhance absorption causing hypoglycemia

Question 10

At dx what should diabetics have done for screening for dyslipidemia

Answer 10

lipid panel

dont need FRS because DM is a statin indicated condition

fasting unless known high TG as per CCS guidelines

Question 11

How often shoud lipid panel screening be done in DM patients

Answer 11

3-6 months after treatment initated

Question 12

first line tx for diabetics with dyslipdemia

Answer 12

statin

Question 13

How is peripheral neuropathy screened for in diabetic patients?

Answer 13

monofilament or tuning fork applied to dorsal big toe bilat

Question 14

First line treatment of peripheral neuropathy

2

Answer 14

antidepressants and anticonvulsants

pregablin, amitriptyline, venlafaxine

Question 15

How often should patients with diabetes be screened for peripheral neuropathy

Answer 15

at dx and annually

higher if at high risk

Question 16

What are key elements of foot care education for patients

Answer 16

avoid foot trauma, professionally fitted foot wear
daily foot inspection
moisturizing
nail care- straight across
avoid walking barefoot
dry feel well

Question 17

What 3 things need to be monitored and controlled in diabetic patients to prevent end organ damage

Answer 17

glucose, HTN, dyslipidemia

Question 18

What 4 organs/systems are most at risk for end organ damage in DM

Answer 18

heart, kidneys, eyes, nervous system

Question 19

To prevent end organ damage what is the goal timeframe to initiate preventative and treatment measures

Answer 19

6-12 months

Question 20

What is the first priority for a newly dx’d DM patient if asymptomatic

Answer 20

get BP to 130/80 if elevated

Question 21

What is the most important factor in preventing end organ damage in DM

Answer 21

controlling HTN

Question 22

First line to control HTN in diabetics

2

Answer 22

ACEi or ARBs

Question 23

Add on therapy for DM with HTN

Answer 23

CCB

Question 24

What is a caution with thiazides in DM

Answer 24

can be used but in low doses because can worsen glucose control

Question 25

Why should bblockers not be used in DM with HTN

Answer 25

mask s/s hypoglycemia

Question 26

What type of cardiac event is common in this group?

Answer 26

silent MIs

Question 27

What is sometimes added on to DM care to prevent CV issues

Answer 27

ASA81

people with DM have increased platelet reactivity and aggregation

Question 28

In what level of prevention is ASA acceptable for DM patients

Answer 28

secondary level - prevent CVD events in those with DM and established CVD

not in primary level due to risk vs benefit of bleeding