Exam 2 Lecture 4

Question 1

What is the major cause of death in T-1 DM pateints

Answer 1

Diabetic kidney disease (nephropathy)

Question 2

What are the 3 microvascular complications in diabetics

Answer 2

Diabetic kidney disease
Eye disease
neuropathy
(also urinary retention, diziness, erectile dysfunction)

Question 3

Symptoms for diabetic kidney disease

Answer 3

Persistent proteinuria, decreased GFR, Increased BP

Question 3

How to screen for diabetic kidney disease

Answer 3

screen for microalbuminuria
(-UACR and eGFR)
check annually for T1 DM pts

Question 4

goal UACR

Answer 4

less than 30

Question 5

When to screen twice for nephropathy in diabetes pts

Answer 5

UACR>300
eGFR<60

Question 6

What drugs do we use when UACR and eGFR levels are bad

Answer 6

ACE-I and ARB (when UACR>300 or eGFR<60)

Question 7

other than ACE-I and ARB, how do we reduce proteinuria

Answer 7

Optimize blood sugar
reduce Blood pressure

Question 8

What are drugs other than ACE-I and ARBs that help with proteinuria

Answer 8

SGLT-2 inhibitors and GLP-1

Question 9

why does high BP affect proteinuria

Answer 9

Increased BP squeezes the small arteries going to kidney which lower perfusion, causing damage

Question 10

do not dx ACE-I or ARB for less than _______ increase in Scr

Answer 10

30%

Question 11

protein intake should be limited to______ in nephropathy pts

Answer 11

0.8 g/kg/day

Question 12

What is the most common ocular disorder in diabetes pts

Answer 12

Retinopathy
(others include blurred vision, cataracts, glaucoma)H

Question 13

How to slow down eye disease in DM pts

Answer 13

Blood sugar and BP under control
lipid management

Question 14

What are the different types of neuropathies in DM pts

Answer 14

Peripheral neuropathy
Gastrointestinal neuropathy

Question 15

Drugs to treat peripheral neuropathy

Answer 15

Pregabalin, duloxetine, gabapentin

Question 16

What are sx of gastrointestinal neuropathies

Answer 16

Gastroparesis- slow down of gastric process
diarrhea, constipation

Question 17

What is ASCVD?

Answer 17

atherosclerotic cardiovascular disease (ASCVD)

Question 18

Leading cause of death i n T2 diabetes

Answer 18

ASCVD

Question 19

What disease states comprise ASCVD

Answer 19

coronary heart disease, cerebrovascular disease, peripheral arterial disease

Question 20

T/F HF hospitalizations triple in diabetics

Answer 20

False, doubles

Question 21

What drugs to use in pts with ASCVD and/or HF

Answer 21

SGLT-2 inhibitors
GLP-1

Question 22

Name some SGLT-2 inhibitors

Answer 22

Empagliflozin, canagliflozin, dapagliflozin

Question 23

Name some GLP-1 RAs

Answer 23

Liraglutide, semaglutide, dulaglutide

Question 24

What are CV risk factors

Answer 24

Obesity, HTN, HLD, smoking and CKD

Question 25

What does metabolic syndrome comprise of

Answer 25

obesity, HTN, HLD

Question 26

BP goal for T1 and 2 DM pts

Answer 26

less than 130/80 (110-135/85 for pregnant women) <140 acceptable for elderly

Question 27

treatment option for HTN in T2 DM

Answer 27

ACE-1 or ARBs

Question 28

Can we combine ACE-1s and ARBs? why or why not?

Answer 28

Never used in combination due to risk of hyperkalemia.

Question 29

What does for ACE-I and ARBs

Answer 29

Max tolerated dose (use other drugs in conjunction if it is not enough)

Question 30

What other drugs can be used in conjunction with ACE-Is and ARBs

Answer 30

HCTZ, amlodipine, spironolactone

Question 31

primary vs secondary prevention

Answer 31

Primary- have not had an event yet secondary- they have had a cardiovascular event before

Question 32

primary prevention in 20-39 year olds

Answer 32

Do not give them a statin unless that have risk factors (LDL>100, HTN, smoker, CKD)

Question 33

primary prevention in 40-75 year olds

Answer 33

use moderate intensity statins. If they have atleast one risk factor (LDL>100, HTN, smoker or CKD)

Question 34

Target LDL for primary prevention

Answer 34

Less than 70 (target-reduce LDL by 50%)

Question 35

secondary prevention strategies

Answer 35

High intensity statin + LSM

Question 36

What is the goal LDL in secindary orevention

Answer 36

<55, target- reduce by 50%

Question 37

What do we do if LDL is still high after using high intensity statins

Answer 37

Add ezetimebe or PC5K9 inhibitors

Question 38

Name high intensity statins and doses

Answer 38

Atorvastatin (40-80) Rosuvastatin (20-40)

Question 39

Name moderate intensity statins

Answer 39

Atorvastatin (10-20) Rosuvastatin (5-10) Simvastatin (20-40)

Question 40

Can diabetes affect teeth?

Answer 40

Yes, called periodontal disease

Question 41

What is an antiplatelet agent

Answer 41

Aspirin

Question 42

Use of aspirin

Answer 42

Can be used in primary and secondary prevention in diabetes and CVD pts

Question 43

What to use if aspirin allergy

Answer 43

clopidogrel

Question 44

can we use clopidogrel and aspirin together?

Answer 44

Yes, for upto a year

Question 45

When to consider aspirin for primary prevention

Answer 45

>50 yo patient with major risk factors (CHF, ASCVD, HTN, HLD, smoking or CKD)

Question 46

When can we never use aspirin

Answer 46

Do not use if at risk of bleeding. So do not use aspirin for low CVD pts

Question 47

bedtime glucose goal

Answer 47

90-150

Question 48

When to check blood glucose when taking intensive insulin

Answer 48

prior to meals and at bedtime before snacks/activity suspicion of hypoglycemia

Question 49

When to check BG when taking basal insulin

Answer 49

once daily

Question 49

Goals for glucose monitoring for CGM

Answer 49

(continuous glucose monitoring) TIR (time in range)- >70% TBR (below)- <5% TAR (above) <25% time active>70%

Question 50

glucose monitoring goals for high risk hypoglycemic pts CGM

Answer 50

TIR>50% TAR>49% TBR<1%

Question 51

normal A1c

Answer 51

4-6%

Question 52

diabetic A1c target

Answer 52

7%

Question 53

What does A1c reflect

Answer 53

avg blood glucose over 8-12 weeks

Question 54

For every 1% reduction in A1c,

Answer 54

18% reduction in CVD risk

Question 55

consider aggressive therapy for high A1c in

Answer 55

newly diagnosed patients with no history of hypoglycemia

Question 56

Advantages of A1C

Answer 56

can be measured without fasting (not subject to acute changes)

Question 57

Disadvantages of A1c

Answer 57

Does not replace SMBG or CGM conditions that affect the blood cell turnover impacts A1c

Question 58

IF A1c is high, which one do we fix first?

Answer 58

fasting blood glucose

Question 59

If A1C is <7.3 what do we fix

Answer 59

Post prandial (post meal) glucose