Lecture 15A Diabetes in older adults

Question 1

The leading reason that the number and percentage of Americans diagnosed with diabetes has increased is _

Answer 1

Obesity.

Question 2

Diabetes diagnosis rates by race/ethnicity

Answer 2

1. American Indians/Alaskan Natives - 15.9%
2. Non-Hispanic blacks - 13.2%
3. Hispanics - 12.8%
4. Asian Americans - 9.0%
5. Non-Hispanic whites - 7.6%

Question 3

According to the Framingham data, _ of those over 65 have diabetes mellitus or impaired fasting glucose.

Answer 3

40%.

Question 4

Type 2 diabetes is especially prevalent among ethnic minorities due to increased _ within some ethnic groups.

Answer 4

Insulin resistance.

Question 5

A diagnosis of type 2 diabetes may be made when laboratory results reveal _

Answer 5

1. A fasting blood glucose of 126 mg/dL or higher.

2. An HbA1c of 6.5% or higher.

Question 6

The American Diabetes Association (ADA) standards of care include _

Answer 6

1. Annually: Dilated eye exam, monofilament foot exam, and immunizations.
2. Recommended: Aspirin use, smoking cessation, and diabetes education.

Question 7

The ADA target for HbA1c is _

Answer 7

7.0% or lower.

Question 8

The ADA target for blood pressure is _

Answer 8

140/90.

Question 9

The ADA targets for lipid levels are _

Answer 9

1. LDL (“bad cholesterol”) below 100 mg/dL.
2. HDL (“good cholesterol”) above 50 mg/dL.
3. Triglycerides below 150 mg/dL.

Question 10

The ADA target for GFR is _

Answer 10

60 mL/min.

Question 11

A patient’s HbA1c level provides an indication of average blood glucose over the previous _

Answer 11

2-3 months.

Question 12

A patient with an HbA1c below 7.0% has been maintaining a mean plasma glucose level of approximately _

Answer 12

150-160 mg/dL.

Question 13

Since looser glycemic targets may be employed when dealing with older adults, most clinicians consider an HbA1c of _ to be acceptable for this age group.

Answer 13

7.5-8%

Question 14

Advancing age enhances the risk of severe or even fatal hypoglycemia due to impaired _

Answer 14

Counter-regulatory hormones (e.g., glucagon).

Question 15

Risk factors for hypoglycemia

Answer 15

1. Older age.
2. Renal insufficiency.
3. Long-acting oral agents (e.g., sulfonylureas).
4. Poor nutrition.
5. Alcohol use.
6. Congestive heart failure (CHF).
7. Post-hospitalization or frequent hospital admissions.
8. Polypharmacy.

Question 16

Treatment of hypoglycemia (BG less than 70 mg/dL) in the inpatient setting

Answer 16

1. Begin with 4-6 oz. of fruit juice (no added sugar), delivering a total of 15 g of glucose.
2. Recheck the patient’s BG after 15 minutes, and give another 15 g of glucose if the patient’s BG remains low.
3. The patient should eat a meal within the next hour after a hypoglycemic episode.
4. If a patient has a BG level of 40-50 mg/dL or lower, they should receive glucagon rather than an oral sugar (this will not be enough).

Question 17

Most older patients with diabetes will die of _

Answer 17

Cardiovascular disease (CVD).

Question 18

Severe hyperglycemia in older people is likely to be _, due to dehydration.

Answer 18

Hyperosmolar hyperglycemic state (HHS) (not DKA).

Question 19

Signs and symptoms of hyperglycemia

Answer 19

1. Dehydration.
2. Visual disturbances.
3. Confusion.
4. Urinary incontinence.
5. Increased risk for falls.

Question 20

Intake of _ should not be limited in older adults with poor appetites.

Answer 20

Carbohydrates.

Question 21

“Carb consistent” diet

Answer 21

The proper name for a “diabetic” diet, in which the person has 45 grams of carbohydrates at each meal, and no snacks in between meals.

Question 22

For people with underlying _, treatment for this condition is the #1 way to prevent/treat diabetes.

Answer 22

Depression.

Question 23

Metformin (Glucophage)

Answer 23

1. A biguanide that keeps the liver from releasing too much glucose.
2. Major side effect is GI discomfort - take with food because the patient will have nausea/vomiting/diarrhea if they take it on an empty stomach.
3. A safe drug for most patients because it does not cause hypoglycemia.

Question 24

Sulfonylureas (Amaryl, Glucotrol) stimulate the pancreas to secrete more insulin, but they are not good for older adults because _

Answer 24

They potentiate hypoglycemia.

Question 25

_ are similar to sulfonylureas, but are better for older adults because they carry a lower risk of hypoglycemia.

Answer 25

Meglitinides (Prandin, Starlix).

Question 26

The best class of medications for diabetic kidney disease is _

Answer 26

DPP-IV inhibitors (Januvia, Onglyza, Tradjenta).

Question 27

Early insulin therapy consists of continuing all oral medications and adding a once-daily basal insulin such as _

Answer 27

Levemir or Lantus.

Question 28

NPH is a(n) _ acting insulin.

Answer 28

Intermediate.

Question 29

Lispro and aspart are _ acting insulins.

Answer 29

Rapid.

Question 30

Regular insulin is considered _ acting.

Answer 30

Short.

Question 31

Detemir and glargine are _ acting insulins.

Answer 31

Long.

Question 32

Insulin pens can be stored at room temperature for _ to _ days.

Answer 32

14 to 28 days.

Question 33

Basal insulin

Answer 33

1. The “background” insulin required to maintain target glucose values when a person is not eating.
2. Examples: Levemir, Lantus, NPH.

Question 34

Bolus insulin

Answer 34

1. Mealtime or prandial insulin that is given “on demand” for meal coverage and to correct high blood sugar.
2. Examples: Apidra, Novolog, Humalog, regular.