ENDO- DM2

Question 1

What are the classification of diabetes?

Answer 1

DM1A1B, DM2
3] Secondary diabetes: result of other disorders or treatments.,

4] GDM

Question 2

What are the criteria for diagnosis?

Answer 2

1] Symptoms + >200mg/dl

2] (FPG) >126mg/dl or greater,
No food intake for at least 8hr

3] 2 hr plasma glucose of 200mg/dl during OGTT,
75g anhydrous glucose dissolved in water

4] HbA1c >6.5% as diagnostic tool

Question 3

When is a HgbA1c diagnostic for diabetes

Answer 3

> 6.5%, with symptoms otherwise confirm 2 weeks later

Question 4

What is the requirement before diagnosising diabetes for all tests?

Answer 4

confirmed on subsequent day unless symptoms of hyperglycemia are present.

Question 5

What are Impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) patients at risk for?

Answer 5

can be diagnosed with hyperglycemia insufficient/insuline intensity
] IFG= FPG 100-125mg/dl,
2] IGT= 2 hr plasma glucose of 140-199mg/dl,
3] Pre Diabetes HbA1c between 5.7%-6.4%

Type 2 diabetes and CV
does not necessarily mean one will go on to get diabetes.

Question 6

What is the most common cause of insulin resistance?

Answer 6

Obesity -not all

have adequate beta cell compensation and therefore do not get diabetes,
genetic predisposition to beta cell failure
STRESS

Question 7

Pt ask how did I get Type 2 DM is a progressive disease. Explain

Answer 7

1] Beta cell dysfunction first leads to impaired glucose tolerance, which in some, progresses to Type 2 DM,

2] Beta cell dysfunction starts long before glucose rises and worsens after diabetes develops

Question 8

What are the additional effects of hyperglycemia

Answer 8

addition defects in insulin secretion and
insulin action (glucotoxicity)

Question 9

Do all DM PT have symptoms?

Answer 9

NO
1] Asymptomatic until complications develop- 1/3 undiagnosed

2] MC Polyuria, polyphagia and weight loss occur long after hyperglycemia has been present,

3] Other symptoms include blurred vision, lower extremity paresthesias, yeast infections, balanitis in men.

Question 10

What is the state that its initial presentation of type 2?

Answer 10

Hyperosmolar hyperglycemic State (HHS)

Question 11

What is WHO’s diagnostic criteria for metabolic syndrome?

Answer 11

1] On antihypertensive therapy or BP>140/90,

2] Lipids: P TG >150, HDL 35,

3] BMI: >30 or waist:hip ratio: >.85-0.9,

4] Glucose: IGT or as Type II,

5] Microalbumin

DX
1] Type II DM or IGT + 2 of above,
2] if GT is normal 3 above

Question 12

What is NCEP ATP III criteria/diagnostic for metabolic syndrome?

Answer 12

1] BP>130/85,

2] Lipids: P TG >150, HDL 40,

3] Waist circumference: >40 inches n M, 35 inches in women,

4] Glucose: FBG 110

DX
1} 3 of above criteria

Question 13

What is AACE criteria for metabolic syndrome?

Answer 13

1] HTN

2] Lipids: P TG >150, HDL 35,

3] BMI: >30 or waist:hip ratio: >.85-0.9,

4] Glucose: IGT or as Type II,

5] Insulin resistance, acanthosis nigricans, hyperuricemia, CHD, PCOS,

DX
1] Type II DM or IGT and 2 of above, 2] if GT is normal 3 above

Question 14

What things contribute to insulin resistance?

Answer 14

1] Genetics,
2] Obesity and inactivity,
3] Aging,
4] Medications

Question 15

What disorders can insulin resistance lead to?

Answer 15

1] Type II DM, 2
] Hypertension, 
3] Dyslipidemia, 
4] Atherosclerosis, 
5] PCOS

Question 16

How do you inspire Pt goals Type II management

Answer 16

REDUCE
1] Eliminate sx

2] Microvascular risk- eye and kidney disease) - BP and BG control

3] Macrovascular risk -heart disease and PAD by lipid and BP control, NO smoking, aspirin tx

4] Metabolic risk reduction through control of BG

Question 17

Goal for Self Management Education

Answer 17

Instruct
patients on SMBG,

Diet and lifestyle recommendations.

psychosocial issues incl stress with management

Provide support and answer questions.

Question 18

What are the Lifestyle modifications for Improved Metabolic Control

Answer 18

1] Physical Activity (best insulin sensitizer),
30 minutes and get a residual 4-6 hours of improves insulin sensitivity- Post big meal best

2] Reduce carbohydrate consumption- Avoid whites, sugars, CHO vegetables rather than grains,

3] Encourage above 1st-Wt loss via Restrict CHO

Question 19

What are other recommendations for type II

Answer 19

1] NO smoke,

2] Aspirin Therapy 75-162mg/d w/ increased risk for CVD.,

2] Secondary prevention history of MI, bypass, stroke, TIA, PVD, claudication or angina.

Question 20

What is the goal for A1C?

Answer 20

1] <6.5% for patients W/O COMORBID

2] >6.5% for patients W COMORBID
at low hypoglycemia risk

RX start @ A1C > 7.5%

Question 21

What drugs are recommended for initial monotherapy

Answer 21

1] Metformin,

2] GLP 1 RA- glucagon like
peptide-1 (GLP-1)

3] SGLT-21-Sodium glucose co-transporters 2

4] DPP-4 Inhbitor, dipeptidyl peptidase-4

5] AGI-Alpha-Glucosidase Inhibitors

Question 22

When is step up therapy recommended?

Answer 22

If goal not met in 3 months

Question 23

Describe dual therapy

Answer 23

Met + 1st line monotherapy drug OR Colesevelam, Bromocriptine, AGI

Question 24

Describe triple therapy

Answer 24

Met + (2) 1st line monotherapy drug OR Colesevelam, Bromocriptine, AGI

Question 25

Pt is on dual therapy with A1c 8, FBS <130,

Answer 25

Start Insulin, titrate BUT

***D/C or reducing sulfonyureas

Question 26

What is the initial dosing for insulin in type II management

Answer 26

1] A1C <8% 0.1-0.2 u/kg,

2] A1c 8% 0.2-0.3 u/kg

Question 27

What are the glycemic goals

Answer 27

1] AACE HbA1c goal of <6.5%,

ADA HbA1c goal is <7%,

2] 2 hour post prandial measurement <140mg/dl,

3] BP <130/80

Question 28

What are the KILLERS of DM complications ?

Answer 28

1] Coronary artery disease,
2] Myocardial infarction,
3] Peripheral vascular disease,
4] Cerebral vascular disease

Question 29

What are the management to limit macrovascular complications?

Answer 29

All diabetics should:
keep BP <130/80, 
LDL cholesterol <100, 
HDL >45 men, >55 women, 
TGs, <150, 
quit smoking 
daily aspirin prn

Question 30

Pt c/o tingling in hands and feet. What are these sx? diabetic neuropathy

Answer 30

1] Distal symmetric polyneuropathy (stocking glove distribution),
2] Entrapment neuropathy,
3] Autonomic neuropathy
Foot ulcers- consequence of vascular disease, neuropathy and foot deformities.

Question 31

Pt w/ DM c/o dec libido, what other complications to address? autonomic neuropathy

Answer 31

1] Neurogenic bladder-(flaccid or spastic), overflow incontinence, frequency, urgency, urge incontinence, and retention
2] Sexual dysfunction,
3] Gastroparesis- unable to empty
4] Orthostatic hypotension

Question 32

What is MC of Nephropathy?

Answer 32

Diabetes.

Question 33

What is MC of blindness in the U.S.

Answer 33

DM Retinoathy

Question 34

List the modifiable risk factors for Diabetes management

Answer 34

C:control your glucose, blood pressure and cholesterol, E:early treatment of foot, eye, kidney and heart problems, N:o,
S:smoking,
E:education about diabetes, nutrition and exercise.

Question 35

What are the guidelines for follow up for diabetes

Answer 35

1] NOT at goal-seen Q 3mo with HbA1c at each visit and (metabolic panel and lipid panel if indicated),

2] AT goal-seen Q4-6 mo unless longer duration causes deterioration in control,

3] Regular foot exams- 10g monofilament/yr

4] 24hr urine for microalbumin and creatinine clearance/yr

5] ophthalmologist annually.

6] At each visit glucose monitor- log or meter download.

7] DM2 - monitor 2 hr post meal and occasional fasting

8] MDI or CSII (DM1 pumps) should monitor at least 4 times/d.

Question 36

Describe what additonal therapy other than DM management should be considered

Answer 36

1] ACE I or ARB therapy delay progression of proteinuria. Should be first line for treatment of hypertension and considered without hypertension with proteinuria.

2] Aspirin unless contraindicated

3] Statin therapy if history of MI or LDL >100.

Question 37

When should stepping down be an option

Answer 37

A1c <5.2