Exam 2 - Diabetes Kania

Question 1

normal UACR (urinary albumin-to-creatinine ratio)

Answer 1

< 30 mg/g

Question 2

normal eGFR

Answer 2

> 60 mL/min/1.73m2

Question 3

most common ocular complication of diabetes

Answer 3

retinopathy

Question 4

for T1DM, have an initial eye exam

a. at time of diabetes diagnosis
b. within 5 years after onset of diabetes

Answer 4

b. within 5 years after onset of diabetes

Question 5

for T2DM, have an initial eye exam

a. at time of diabetes diagnosis
b. within 5 years after onset of diabetes

Answer 5

a. at time of diabetes diagnosis

Question 6

treatment for ocular complications

Answer 6

-photocoagulation therapy or anti-vascular endothelial growth factor, ranibizumab

Question 7

what is a diabetes monofilament test?

Answer 7

test done on the feet to check for nerve damage (peripheral neuropathy)

Question 8

what 3 drugs are recommended as initial therapy for peripheral neuropathy?

Answer 8

pregabalin
duloxetine
gabapentin

(others: TCAs such as amitriptyline, venlafaxine, carbamazepine, tramadol, capsaicin and tapentadol as last resort) .

Question 9

what is postural hypotension?

Answer 9

sudden drop in BP and dizziness when you change positions (ex. going from lying down to standing)

Question 10

leading cause of morbidity and mortality in type 2 diabetes pts

Answer 10

atherosclerotic cardiovascular disease (ASCVD)

Question 11

ADA BP goal for:

T2DM or T1DM?
DM + pregnancy?

Answer 11

< 130/80 T2DM or T1DM
110-135/85 DM + pregnancy

Question 12

ACC BP goal for pts with diabetes

Answer 12

< 130/80

(< 140 SBP acceptable for elderly due to fall risk)

Question 13

ACEIs or ARBs are preferred antihypertensive agents for diabetes management. Use at max tolerated doses, especially for pts with UACR > or equal to _____

Answer 13

300 mg/g

Question 14

why can’t we use ACEIs or ARBs in combo?

Answer 14

due to risk of hyperkalemia, syncope, and renal dysfunction

Question 15

CVD risk factors include LDL > or = to _____, HTN, smoking, CKD, albuminuria, and family history of early ASCVD

a. 50 mg/dL
b. 75 mg/dL
c. 100 mg/dL
d. 150 mg/dL

Answer 15

c. 100 mg/dL

Question 16

DM + ASCVD in all ages = _____ _____ statin therapy + _____

Answer 16

high intensity; LSM

Question 17

for pts with DM + ASCVD, target lower LDL by > or = ___% and goal LDL < ___

Answer 17

50%; 55

Question 18

when can we add ezetimibe or a PCSK9 inhibitor for pts with DM + ASCVD?

Answer 18

if LDL elevated despite max tolerated statin dose (goal LDL < 55)

Question 19

ACC/AHA recommendations for DM pts 40-75 yo: primary prevention

Answer 19

moderate-high intensity statin depending upon risk factors

Question 20

ACC/AHA recommendations for DM pts 40-75 yo: for secondary prevention, what strength statin would we use, and what is goal LDL level?

Answer 20

high intensity statin and goal LDL < 70

Question 21

high intensity statin doses (2 of them)

Answer 21

atorvastatin 40-80 mg/day OR rosuvastatin 20-40 mg/day

Question 22

leading cause of non-traumatic amputations

Answer 22

diabetes

Question 23

use of antiplatelet agents in pts with diabetes:
-use aspirin (75-162 mg) as _____ prevention in those with diabetes and a history of CVD.
-for pts with CVD and aspirin allergy, use _____

Answer 23

secondary; clopidogrel (75 mg/day)

Question 24

which pts can we use aspirin (75-162 mg) for primary prevention in pts with diabetes?

Answer 24

men or women 50 or older with one major risk factor who are not at an increased risk of bleeding

Question 25

true or false: we can use aspirin for primary prevention for those at low CVD risk

Answer 25

false

Question 26

ADA fasting BG target range

Answer 26

80-130 mg/dL

Question 27

AACE fasting BG target

Answer 27

< 110 mg/dL

Question 28

ADA random or postprandial BG target

Answer 28

< 180 mg/dL

Question 29

AACE random or postprandial BG target

Answer 29

< 140 mg/dL

Question 30

when to do SMBG for intensive insulin regimens? (3 of them)

Answer 30

prior to meals and at bedtime; prior to snacks or activity; suspicion of hypoglycemia and after treatment

Question 31

when to do SMBG for pts on basal insulin + non-insulin medications?

Answer 31

once daily (fasting blood glucose)

Question 32

when to do SMBG for non-insulin regimens?

Answer 32

as needed

Question 33

what is the goal for most pts for each of these CGM values? TAR > 250 mg/dL TAR > 180 mg/dL TIR (time in range) 70-180 mg/dL TBR < 70 mg/dL TBR < 54 mg/dL

Answer 33

< 5% < 20% > 70% < 4% < 1%

Question 34

ADA target for A1C

Answer 34

< 7% (< 6% in certain pts and pregnant women)

Question 35

AACE target for A1C

Answer 35

< or = to 6.5%

Question 36

according to the UK prospective diabetes study (UKPDS), every 1% drop in A1C leads to a ___% reduction in risk of CVD events

Answer 36

18%

Question 37

according to the VA diabetes trials (VADT), severe __________ is associated with increased _____ mortality

Answer 37

hypoglycemia; CVD

Question 38

a 1% change in A1C can represent a ___-___ mg/dL change in mean blood glucose

Answer 38

25-35

Question 39

formula for relationship between A1C and estimated avg glucose (eAG)

Answer 39

28.7 * A1C - 46.7 = eAG

Question 40

advantages of A1C (2 of them)

Answer 40

-can be measured without fasting -levels not subject to acute changes in insulin dosing, exercise, or diet

Question 41

disadvantages of A1C (3 of them)

Answer 41

-does not replace SMBG or CGM -it is an avg of all #s the past 3 months -conditions that affect red blood cell turnover may impact results

Question 42

when to measure A1C: how many times per year if meeting treatment goals?

Answer 42

twice

Question 43

when to measure A1C: how many times per year if therapy has changed or not meeting treatment goals?

Answer 43

4 times (quarterly)

Question 44

if A1C is very high, which should we fix first? a. FBG b. post-prandial BG

Answer 44

a. FBG

Question 45

if A1C is low, which should we fix first? a. FBG b. post-prandial BG

Answer 45

b. post-prandial BG

Question 46

long-term hyperglycemia leads to _____ damage

Answer 46

organ

Question 47

organ involvement in glucose homeostasis: glucose uptake by the brain is insulin a. dependent b. independent

Answer 47

b. independent

Question 48

organ involvement in glucose homeostasis: glucose uptake by muscle and fat is insulin a. dependent b. independent

Answer 48

a. dependent

Question 49

alpha cells of the pancreas produce _____ to oppose the action of insulin and stimulate the liver to make more glucose

Answer 49

glucagon

Question 50

glucagon causes increase in __________ and __________, and inhibition of _____ release

Answer 50

glycogenolysis; gluconeogenesis; insulin

Question 51

the egregious eleven

Answer 51

1. beta cells destroyed/stop working 2. dec incretin effect 3. alpha cell defect (inc in glucagon) 4. insulin resistance in adipose tissue 5. insulin resistance in muscle 6. insulin resistance in liver 7. brain -> change in appetite hormones 8. gut microbiome -> dec GLP-1 secretion 9. immune system -> autoimmune rxn and inc inflammation can destroy beta cells 10. quick stomach emptying -> inc glucose absorption 11. kidney -> upreg of SGLT2 can lead to inc glucose reabsorption through kidney

Question 52

normal plasma glucose is usually maintained at what range? a. 100-200 mg/dL b. 60-120 mg/dL c. 60-140 mg/dL d. 100-125 mg/dL

Answer 52

c. 60-140 mg/dL

Question 53

min concentration range of glucose needed for CNS to function

Answer 53

40-60 mg/dL

Question 54

resorptive capacity of the kidneys

Answer 54

~180 mg/dL (above this point = osmotic diuresis)

Question 55

muscle and fat use glucose as an energy source, but without glucose, AAs and FA will be used for fuel and an increase in _____ will occur

Answer 55

ketones

Question 56

what is happening during ketoacidosis?

Answer 56

body starts making ketones to use for fuel since it cannot access enough glucose

Question 57

drugs that increase hepatic glucose output (3 of them)

Answer 57

-glucocorticoids -sympathomimetics -niacin

Question 58

how do sympathomimetics lead to increased glucose?

Answer 58

inc in growth hormone, epinephrine and cortisol leads to increased glucose

Question 59

drugs that decrease insulin secretion (4 of them)

Answer 59

-phenytoin -beta blockers -calcium channel blockers -immunosuppresants (ex. cyclosporine, sirolimus, tacrolimus, etc)

Question 60

drugs that inc insulin resistance (3 of them)

Answer 60

-thiazide diuretics -glucocorticoids and oral contraceptives -antipsychotics

Question 61

which drug is toxic to beta cells?

Answer 61

pentamidine (prevents insulin secretion)

Question 62

drugs that stimulate appetite examples (3 of them)

Answer 62

-phenothiazines -marijuana -androgens

Question 63

protease inhibitors to treat HIV can cause drug-induced diabetes. What is their MOA?

Answer 63

mechanism unclear

Question 64

endocrine-related disorders that can contribute to diabetes (3 of them)

Answer 64

-Cushing's syndrome -hyperthyroidism -acromegaly (pts have inc GH, cortisol, glucagon, and epi, which leads to inc glucose)

Question 65

how can pancreatitis, trauma/pancreatectomy, and cystic fibrosis contribute to diabetes?

Answer 65

beta cells are damaged and cannot release insulin

Question 66

infections that can contribute to diabetes (2 of them)

Answer 66

CMV, rubella (viruses destroy beta cells, leading to dec insulin production/release)

Question 67

genetic syndromes that can contribute to diabetes (4 of them)

Answer 67

-Down's syndrome -Turner's syndrome -Huntington's chorea -porphyria (can have insulin deficiency or absence of beta cells)

Question 68

normal fasting blood glucose < ___ mg/dL

Answer 68

100

Question 69

normal 2-hour OGTT < ___ mg/dL a. 200 b. 160 c. 140 d. 100

Answer 69

c. 140

Question 70

pre-symptomatic type 1 diabetes screening (5 things)

Answer 70

1. autoantibodies to insulin 2. glutamic acid decarboxylase (GAD) 3. tyrosine phosphatase islet antigen 2 (IA-2 and IA-2B) 4. zinc transporter 8 5. presence of 2 autoantibodies has been linked to future development of type 1 diabetes

Question 71

ADA criteria for screening in asymptomatic, undiagnosed pts: test all adult individuals beginning at age ___, regardless of weight

Answer 71

35

Question 72

ADA screening in asymptomatic, undiagnosed pts: women diagnosed with gestational diabetes should have lifelong testing at least every ___ years

Answer 72

3

Question 73

pts at an increased risk of diabetes will have an A1C in what range?

Answer 73

5.7-6.4

Question 74

impaired glucose tolerance (IGT) will have a 2-hour OGTT in what range?

Answer 74

140-199 mg/dL

Question 75

what is the range for impaired fasting glucose (IFG)?

Answer 75

100-125 mg/dL

Question 76

4 M's of diabetes therapy

Answer 76

meals, movement, medications, monitoring

Question 77

medical nutrition therapy: how many calories per day? (range)

Answer 77

500-750 calories/day

Question 78

medical nutrition therapy: how many carbs should women and men have per meal?

Answer 78

women - 45 gm/meal men - 60 gm/meal

Question 79

medical nutrition therapy: what % of total calories should be saturated fat?

Answer 79

< 7%

Question 80

medical nutrition therapy: < ___ mg cholesterol/day or < ___ mg/day if already has high cholesterol

Answer 80

300; 200

Question 81

medical nutrition therapy: how many grams of fiber per day?

Answer 81

20-35 grams (helps prevent constipation and dec colon cancer risk)

Question 82

for prevention and treatment of complications, how often should you seek dental care?

Answer 82

every 6 months

Question 83

for diabetic kidney disease, we should have annual screening for __________

Answer 83

microalbuminuria (also follow SCr/BUN)

Question 84

CV risk factor prevention: control _____ and _____ _____; quit _____

Answer 84

lipids; blood pressure; smoking