DM Type II and Complications

Question 1

T/F: You see a patient 55y.o. with for the first time and no other previous medical records who has a FPG of 235 mg/dL. You can diagnose this patient with Diabetes Type II

Answer 1

False: Must be confirmed on another day by any one of the criteria

Question 2

Diagnostic criteria for DM type II

Answer 2

• Random glucose >200mg/dL
• Fasting serum glucose > 126mg/dL
• Serum glucose level >200 mg/dL obtained 2 hours after a 75-g glucose challenge (should be obtained after 72 hours of eating 300 g of carbohydrate per day)

Question 3

Tests NOT used in initial diagnosis of DM II

Answer 3

Insulin levels, C-peptide levels, screening for autoantibodies

Question 4

Prediabetes criteria and what does this mean

Answer 4

Fasting serum glucose of 100-125 mg/dL- Indicates increased risk of progressing to diabetes, may be associated with onset of insulin resistance, commonly a part of Metabolic syndrome

Question 5

Metabolic syndrome criteria

Answer 5

Insulin resistance
Hypertension
Dyslipidemia (Trigs >150 or HDL-C<40)
Abdominal obesity

Question 6

Fasting glucose levels that indicate significant beta cell failure

Answer 6

200 mg/dL

Question 7

In treatment of DM II you should always start with what?

Answer 7

Therapeutic Lifestyle Modification

Question 8

Patients with FPG < 250 mg/dL should be treated how

Answer 8

• Medical nutritional therapy, exercise program. If not controlled in 3 months, move to next step

Question 9

Patients with FLG > 250 but <400 mg/dL who do not have signs of dehydration, acidosis or marked ketosis

Answer 9

In addition to medical nutritional therapy, begin monotherapy with an oral antidiabetic agent (metformin)

Question 10

T/F: Patients with marked elevated FPG and ketonuria or ketonemia or symptomatic patients may require require insulin therapy initially to overcome glucose toxicity?

Answer 10

True

Question 11

What is considered best first line agent for DM II?

Answer 11

Metformin

Question 12

Do not use or use metformin cautiously in what patients?

Answer 12

Do not use in Pts prone to lactic acidosis, if serum creatine is elevated, use cautiously in renal and hepatic disease

Question 13

If blood glucose is severely elevated, you should use what therapy

Answer 13

Sulfonylureas (Glyburide, Glipizide)- May be 1st choice in lean persons who have more pancreatic dysfunction than insulin resistance

Question 14

a-glucosidase inhibitors are most effective in persons with

Answer 14

Mild fasting hyperglycemia, predominantly postprandial hyperglycemia

Question 15

An agent used in adjunct to oral agents (Metformin and/or sulfonylureas) that is given as SQ injection and is an Incretin mimetic

Answer 15

Exenatide/ Liraglutide

Question 16

Shin spots are:

Answer 16

Pigmented atrophic macular areas on the skin over the tibia frequently seen in diabetic patients

Question 17

Necrobiosis Lipoidica is:

Answer 17

Cutaneous sign associated with DM, an irregular erythematous patch, occurs anywhere on the legs, 2-10cm

Question 18

Inability to perceive monofilament indicates

Answer 18

Advanced neuropathy

Question 19

Medical management of Diabetic neuropathy

Answer 19

• Specific: Duloxetine (Cymbalta)

- Gabapentin, Amitriptyline, other neurostabilizers (Carbamazepine), Analgesics (NSAID, Acetaminophen)

Question 20

Onset of nonproliferative retinopathy is indicated by:

Answer 20

Microaneurysms (early findings). Proliferative retinopathy with neovascularization/hemorrhages

Question 21

Diabetic patients with BP over what needs medication

Answer 21

135/85- ADA recommends lowering BP to 130/80 mmHg or less

Question 22

Diabetics with LDL greater than what need lipid lowering therapy

Answer 22

130 mg/dL- Target LDL is 100, maybe even as low as 70

Question 23

Emergency complications of DM (3)

Answer 23

1) Diabetic ketoacidosis
2) Nonkinetic hyperosmolality syndrome
3) Hypoglycemia (insulin reaction)