Lecture 25: DM screening and management 1

Question 1

what is the initial cause of weight loss in T1DM? what about later?

Answer 1

intial - water depletion
later - muscle mass loss

Question 2

why does blurred vision occur in DM

Answer 2

exposure of lenses to hyperosmolar fluids

Question 3

what are the manifestations of peripheral in DM

Answer 3

ED and gastric dysmotility

Question 4

how often should those at risk for DM be screened

Answer 4

if screening is normal thy should be retested every 3 years

Question 5

how does hematocrit affect BG

Answer 5

low hematocrit (<40%) causes INCREASED glucose

high hematocrit (>50%) causes INCREASED glucose

Question 6

how does acetominophen affect BG

Answer 6

decreases it

Question 7

how does Alcohol affect BG reading

Answer 7

decreases it

Question 8

how do elevated uric acid levels affect BG

Answer 8

decreases it

Question 9

how does renal failure affect BG

Answer 9

inceases it

Question 10

how does pheochromocytomas affect BG

Answer 10

increases it

Question 11

how does pancreatitis affect BG

Answer 11

increases it

Question 12

how does hypopituitarism affect BG

Answer 12

decreaes

Question 13

how does liver disease affect BG

Answer 13

deceases it

Question 14

what are the 4 A’s that decrease glucose

Answer 14

acetominophen
alcohol
high uric AAAcid levels
Hct ABOVE 50%

Question 15

what would cause an elevation in “young” RBCs

Answer 15

• shortened erythrocyte survival (hemolytic anemia)
• decreased mean erythrocyte age (recent blood loss)
• IV iron or erythropoietic drugs

Question 16

splenectomy and chronic or recurrent acute stress response causes…

Answer 16

false elevations in HbA1c

Question 17

young RBCs
Sickle cell
abnormally low protein levels
all can cause…

Answer 17

false lows of HbA1c

Question 18

indicated to assess hypoglycemia and/or to assist with dx of DM

Answer 18

OGTT

Question 19

indicated for:
* identifying causes of hypoglycemia
* eval of beta cell function
* eval of insulinomas

Answer 19

C-peptide or C-peptide insulin ratio test

Question 20

C your FATE acronym is used when?

Answer 20

C-peptide is useful with:
Factitious hypoglycemia
Anti-insulin antibodies
T1 v T2 DM dx
Exogenous insulin use

Question 21

renal failure
pancreas transplant
sulfonylureas
all have what effect?

Answer 21

increases C-Peptide levels

Question 22

what would decrease C-peptide levels

Answer 22

destruction of all or part of the pancreas

Question 23

low C-peptide and low insulin is suggestive of

Answer 23

DM

Question 24

high C-peptide and high insulin is suggestive of

Answer 24

sulfonylurea use or CKD

Question 25

insulin autoantibodies are found in 50-70% of what demographic

Answer 25

children with T1DM

Question 26

when might ketosis be seen outside of DM

Answer 26

• altered nutrition (alcoholism/starvation/dieting)
• increased metabolic demands (cold, pregnant, exercise)

Question 27

what medications can interfere with a ketone test

Answer 27

• vit C
• levodopa
• valproic acid
• phenazopyridine

Question 28

when would you consider lowering the target A1c to <6.5%

Answer 28

• short DM duration
• lo.ng life expectancy
• Tx w/metformin or lifestyle only
• no sig CVD/vascular complications

Question 29

when would you consider raising target A1c to <8.0%?

Answer 29

• severe hypoglycemic hx
• severe dz (low life expect, advanced compications, comorbidities)
• long term DM patients

Question 30

what is the exercise recommendation of DM

Answer 30

• at least 150min/week (200-300 preferred) of moderate (50-70-% max HR) aerobic exercise divided over 3+ days
• no more than 2 consecutive days w/o exercise
• resistance training 2+ days/week
• try not to sit for more than 30-90 min at a time

Question 31

what vaccines should DM ptients get

Answer 31

all of them.
* flu for pts 6+ months old
* pneumococcal
* hepatitis B
* covid

Question 32

how do you manage hyperlipidemia in DM

Answer 32

• recommended to recieve yearly lipid profile
• mod to high intensity stain therapy depending on age and risk factors for CVD/atherosclerosis

Question 33

what antiplatelet tx should be given to DM patients who have ASCVD

Answer 33

aspirin 81mg