Exam 3 - Diabetes Part 4 Special Populations Kania

Question 1

pregnant pts should get a dilated eye exam before pregnancy or in _____ semester

a. first
b. second
c. third

Answer 1

a. first

Question 2

maternal pts should monitor for retinopathy every _____ and _____ _____ postpartum

Answer 2

trimester; one year

Question 3

treatment for pre-eclampsia risk

Answer 3

aspirin 81-150 mg/day starting at 12-16 weeks, if no CIs

Question 4

pre-conception goal A1C is < ___?

Answer 4

6.5%

Question 5

glycemic targets in pregnancy

FBS: ___-___ mg/dL
1-hr postprandial: ___-___ mg/dL
2-hr postprandial: ___-___ mg/dL
A1C < ___ ideally; < ___ if necessary to prevent hypoglycemia

Answer 5

70-95
110-140
100-120
6%
7%

Question 6

during pregnancy, by ___ weeks insulin resistance inc and total daily insulin dose inc ~ ___% per week through week ___

Answer 6

16
5
36

Question 7

A1C target for elective surgery is < ___

Answer 7

8%

Question 8

target BG of ___-___ mg/dL during perioperative period, within ___ hours of surgery

Answer 8

100-180
4

Question 9

reduce basal insulin the evening before surgery by ~ how many percent?

a. 50%
b. 25%
c. 15%
d. 10%

Answer 9

b. 25%

Question 10

when should metformin be held around surgery time?

Answer 10

day of surgery

Question 11

when should SGLT2Is be held around surgery time?

Answer 11

3-4 days

(4 for ertugliflozin i.e. Steglatro)

Question 12

when should we hold other oral glucose-lowering meds (not SGLT2Is) before surgery?

Answer 12

morning of surgery

Question 13

how much NPH can we give on the morning of surgery?

Answer 13

half NPH dose

Question 14

how much long-acting insulin or pump-basal insulin should we give the morning of surgery? (range)

Answer 14

75-80%

Question 15

short-acting glucocorticoids (prednisone) reach peak plasma levels in how many hours? (range)

Answer 15

4-6 hours

Question 16

morning dose of prednisone = __________ during day but by nighttime levels are nearly back to baseline

Answer 16

hyperglycemia

Question 17

adjustments needed for hospitalized pts on glucocorticoids and insulin (2 of them)

Answer 17

-adjust prandial insulin or add AM NPH dose (since NPH peaks 6 hours later)
-long-acting glucocorticoids (dexamethasone) may mean long-acting insulin may need adjustment

Question 18

insulin requirement levels off in _____ trimester with placental aging

Answer 18

third

Question 19

treatment in pts with type 1 diabetes pre-pregnancy: inc risk of __________ during first trimester

Answer 19

hypoglycemia

Question 20

pregnancy is a __________ state, increasing risk of DKA

Answer 20

ketogenic

(prescribe ketone strips to type 1 pts with diabetes pre-pregnancy)

Question 21

true or false: DKA can increase stillbirths

Answer 21

true

Question 22

why are risk of comorbidities more common for type 2 diabetes pts?

Answer 22

more type 2 pts are overweight, which can lead to more comorbidites

Question 23

for type 2 diabetes pts, pregnancy loss in more common in which trimester?

Answer 23

third

(loss is more common in first trimester for type 1)

Question 24

for type 2 diabetes, the recommended weight gain during pregnancy for overweight women is ___-___ lbs and for obese women is ___-___ lbs

Answer 24

15-25
10-20

Question 26

starting insulin dose for gestational diabetes (range)

Answer 26

0.7-1.0 units/kg/day (divide between basal-bolus insulins)

Question 27

for gestational diabetes, if a patient is taking metformin for PCOS, when it should be discontinued?

Answer 27

by end of 1st trimester

Question 28

drug class to avoid in gestational diabetes

Answer 28

sulfonylureas (due to macrosomia and birth injury can occur)

Question 29

pts with gestational diabetes and prediabetes, lifestyle changes and __________ dec progression to diabetes by 35-40% over 10 years

Answer 29

metformin

Question 30

gestational diabetes post-partum: check OGTT ___-___ weeks postpartum

Answer 30

4-12 (check for diabetes then every 1-3 years)

Question 31

youths with T2DM have _____ rapid decline in beta-cell function a. less b. more

Answer 31

b. more

Question 32

target A1C goal for pediatric population with type 1 or type 2 diabetes

Answer 32

< 7%

Question 33

T1DM in pediatric populations: what is the treatment?

Answer 33

insulin

Question 34

in pediatric pts with T2DM, if their A1C < 8.5%, what is the initial treatment?

Answer 34

metformin (based on renal function)

Question 35

in pediatric pts with T2DM, what is initial treatment if A1C is greater than or equal to 8.5%, BS greater than or equal to 250 mg/dL without acidosis who are symptomatic?

Answer 35

basal insulin + metformin

Question 36

two treatment options for pediatric T2DM pts not at goal on metformin and insulin

Answer 36

-liraglutide -exenatide

Question 37

treatment for pediatric T2DM pts not at goal on metformin, a GLP-1RA, and basal insulin

Answer 37

begin bolus insulin or change to insulin pump therapy

Question 38

treatment for pediatric T2DM pts that present with ketoacidosis

Answer 38

subQ or IV insulin (can add metformin after they get through DKA episode)

Question 39

diabetes in hospitalized pts: initiate insulin for glucose > or equal to ___ mg/dL, then target ___-___ mg/dL

Answer 39

180 140-180

Question 40

diabetes in hospitalized pts: can target glucose > ___ mg/dL in terminally ill pts

Answer 40

250

Question 41

for hospitalized pts, how often should you monitor BS if: pt is eating? pt is not eating? pt is on IV insulin?

Answer 41

eating: check pre-prandial readings not eating: check every 4-6 hours on IV insulin: every 20 minutes to 2 hours

Question 42

treatment for diabetes in hospitalized pts

Answer 42

basal insulin or basal-bolus insulin for noncritically ill pts along with use of correction factor/insulin sensitivity factor