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CDCES Exam > Level 1 - Getting to the Nitty Gritty (Class 1) > Flashcards

Level 1 - Getting to the Nitty Gritty (Class 1) Flashcards

DiabetesEd

1
Q

How many Americans will have diabetes by 2025?

A

35%

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2
Q

How many adults in the US have diabetes?

A

37 million (11.3%)

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3
Q

How many adults in the US have prediabetes?

A

96 million (38%)

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4
Q

List some impacts on diabetes mgmt. In other words, what do we need to ask patients, in order to get to know them better?

A

-Living situation
-Childhood trauma
-Adequacy of medical mgmt
-Cost-related barriers to meds
-Duration of diabetes
-Other health problems
-Social factors
-Access to care

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5
Q

DEFINITION

Social Determinants of Health (SDOH)

A

the economic, environmental, political, and social conditions in which people live

Those who have adverse SDOH are more likely to have chronic conditions and shorter lifespans

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6
Q

List some examples of positive SDOH.

A
  1. Access to grocery stores
  2. Parks
  3. Feel safe
  4. Low stress levels
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7
Q

What is often out of direct control of the individual and potentially represents a lifelong risk; contributing to health care and psychosocial outcomes and must be addressed to improve all health outcomes?

A

SDOH

We need to tailor treatment for social context

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8
Q

What ethic group has the highest incidence of diabetes?

A
  1. American Indians & Alaska Natives (14.5%)
  2. Non-Hispanic Blacks (12.1%)
  3. People of Hispanic origins (11.8%)
  4. Non-Hispanic Asians (9.5%)
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9
Q

DEFINITION

Population Health

A

health outcomes of a group of individuals, including the distribution of health outcomes within the group.

We want to look at people of a community and other communities to see who has better or worse outcomes, and why?

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10
Q

How do we measure ‘population health’ outcomes?

A
  1. Mortality, morbidity, health, and functional status
  2. Disease burden (incidence, prevalence)
  3. Behavioral and metabolic/clinic factors (exercise, diet, A1c, etc.)
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11
Q

DEFINITION

Integrated person-centered care

A

-considers co-morbidities and prognoses

-is respectful and responsible to individual preferences, needs, and values;

-and ensures that that individual’s values guide all clinical decisions = COLLABORATIVE APPROACH **

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12
Q

According to the recently published ADA in the 2022 Economic Costs of Diabetes in the US, which of the following statements is most accurate?

A. 25% of health care dollars are spent on caring for people with diabetes
B. Although diabetes prevalence remains stable, the direct medical costs attributed to diabetes increased by 7% between 2017 and 2022.
C. The cost burden of diabetes is disproportionately borne by vulnerable and underserved communities.
D. After adjusting for inflation, the total cost of insulin and other diabetes medications increased by 26% from 2017 to 2022.
E. All of the above

A

E. All of the above

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13
Q

What was the cost of diabetes in 2022?

A

$413 billion, including $307 billion in direct health care costs and $106 billion in reduced productivity (people who cannot make it to work, on short- or long-term disability due to diabetes related complications)

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14
Q

(TRUE or FALSE)

People living with diabetes also face financial hardship, which is correlated with higher A1c, diabetes distress, and depressive symptoms.

A

TRUE

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15
Q

(TRUE or FALSE)

Person centered care ensures that the person’s values guide all clinical decisions.

A

TRUE

We want to leverage their knowledge of self; empower and support as the provider

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16
Q

List the 7 self-care behaviors of the foundations of care - well being.

A
  1. Problem solving
  2. Reducing risks
  3. Monitoring
  4. Taking medications
  5. Healthy eating
  6. Healthy coping
  7. Being active
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17
Q

What are the biggest barriers to diabetes self-care?

A

Blame and shame

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18
Q

(TRUE or FALSE)

PWD have lesser function of their GLUT-4 transporter.

A

TRUE

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19
Q

What percent of beta cells for PWD is functioning?

A

About 20%

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20
Q

What do alpha cells release?

A

Glucagon is released when we are fasted; tells the liver to release glycogen

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21
Q

What are the two physiological problems in diabetes?

A
  1. Beta cells do not make sufficient insulin
  2. Alpha cells are hyperactive

Result = higher blood glucose

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22
Q

In the fasting state, hyperglycemia is directly related to:

A. Increased hepatic glucose production
B. Defective insulin stimulation of target tissue glucose disposal
C. Decreased adipocyte lipolysis
D. Loss of pancreatic alpha-cell function

A

A. Increased hepatic glucose production

Liver is having a PARTY and the body does not make enough insulin to keep the BG on target.

Treatment options:
-Increase exercise
-Metformin
-Basal insulin

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23
Q

How are these hormones effect on glucose?

Glucagon
Stress hormones
Epinephrine
Insulin
Amylin
Gut hormones - incretins (GLP-1 & GIP)

A

Glucagon ^ (stress hormone; INCREASES)
Stress hormones ^ (stress; INCREASES)
Epinephrine ^ (stress; INCREASES)
Insulin (pancreas) DECREASES
Amylin (pancreas) DECREASES
Gut hormones - incretins (GLP-1 & GIP) (released by the L cells of the intestinal mucosa, beta cell has receptors) DECREASES*

*help the pancreas release insulin with food and decreases appetite

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24
Q

List the signs of diabetes.

A

-Polyuria
-Polydipsia
-Polyphasia
-Weight loss
-Fatigue
-Skin and other infections
-Blurry vision

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25
Q

What is polyuria?

A

Increase in urine output

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26
Q

What is polydipsia?

A

Excessive thirst

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27
Q

What is polyphasia?

A

Excessive hunger

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28
Q

(TRUE or FALSE)

Prediabetes is associated with heightened CVD risk; therefore, screening for and treatment of modifiable risk factors for CVD are recommended.

A

TRUE

Prediabetes is an indication of inflammation and increases the risk for CAD and stroke.

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29
Q

Prediabetes is best defined as a glucose of:

A. FBG of 100-125 mg/dL
B. Any BG above 99 mg/dL
C. FBG 126-200 mg/dL
D. FBG of 140 mg/dL or higher

A

A.

In prediabetes the pancreas is not able to do its job efficiently

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30
Q

**List the HEALTHY levels for:

FBG
Random BG
A1c

A

FBG: <100

Random BG: <140

A1c: <5.7%

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31
Q

**List the PREDIABETIC ranges for:

FBG
Random BG
A1c

A

FBG: 100 - 125 mg/dL

Random BG: 140 - 199 mg/dL

A1c: 5.7% - 6.4%

*50% working pancreas

32
Q

**List the DIABETIC ranges for:

FBG
Random BG
A1c

A

FBG: > 126 mg/dL

Random BG: 200 mg/dL or higher

A1c: 6.5% or higher

*20% working pancreas

33
Q

What is glucose toxicity defined as?

A

BGs in the 200 to 300s mg/dL

34
Q

(TRUE or FALSE)

If the lab value is close, we will confirm with the same test on a different day to validate.

A

TRUE

We do not need to validate a BG of 400 mg/dL and symptoms

35
Q

Diabetes is defined as a confirmed random glucose of:

A. 126-199 mg/dL
B. 200 mg/dL or greater
C. 140-199 mg/dL
D. 140 mg/dL or greater

A

B

36
Q

(TRUE or FALSE)

The A1c test is a weighted mean.

A

TRUE

Meaning that 50% of the value is from the preceding month and the other 50% from the prior 2 months

37
Q

A 1% increase in A1c translates to how much of an increase in BG?

A

Each 1% = ~ 29 mg/dL

38
Q

Each percentage of A1c = how many mg/dL of blood glucose?

A. 33 mg/dL
B. 27 mg/dL
C. 17 mg/dL
D. 29 mg/dL

A

D

39
Q

What is the normal range for pH?

A

7.35 to 7.45

A low pH indicates the body is using fat for fuel

40
Q

What is T1DM?

A

-Autoimmune pancreatic beta cell destruction

-Most commonly expressed at age 10 to 14

-Insulin sensitive (require 0.5 to 1.0 units/kg/day)

-Expression is due to a combination of genes and environment

41
Q

List the signs for T1DM.

A

-Sudden onset of nighttime bedwetting
-Weight loss
-Thirst
-Hunger

42
Q

What percent of people are diagnosed with T1DM with acute DKA?

A

40 to 60%

43
Q

What are the signs of acute DKA?

A

-Fruity breath
-Hypothermic
-Poor skin turgor
-“Out of it”
-Positives ketones (blood or urine)
-Acidosis

44
Q

List the most discriminative features of T1DM.

A

-Younger than 35 years at diagnosis

-Lower BMI (< 25)

-Unintentional weight loss

-Ketoacidosis (look at beta-hydroxybutyrate, or urine dipstick)

-Glucose at 360 mg/dL or higher

45
Q

How do we know if someone has type 1 or type 2?

A

T1DM - have positive antibodies

46
Q

What is GAD?

A

Glutamic acid decarboxylase (primary antibody to check for in T1DM)

47
Q

What is IA2?

A

Islet antigen 2

another antibody to test for in T1DM

48
Q

What is ZnT8?

A

Zinc transporter 8

another antibody to test for in T1DM

49
Q

What is C-Peptide?

A

It is checking how much endogenous insulin a person makes, but this does not tell us if there is an autoimmune attack happening.

50
Q

(TRUE or FALSE)

If possible, patients should have all 3 antibody tests done when assessing for T1DM?

A

TRUE

CAD
IA2
ZnT8

51
Q

Define stage 1 of T1DM progression.

A

There is autoimmunity, but there BGs don’t reflect pancreatic dysfunction

Presymptomatic

52
Q

Define stage 2 of T1DM progression.

A

Autoimmunity + Dysglycemia, in the prediabetic range

53
Q

Define stage 3 of T1DM progression.

A

Autoimmunity + Overt hyperglycemia, in the diabetic range

54
Q

What is Teplizumab (Tzield)?

A

Humanized CD3 Monoclonal Antibody, that delays the onset of Stage 3 T1DM by 2 years

The mechanism of action delays the deactivation of pancreatic beta cells

It leads to an increase in the proportion of regularly T cells and of exhausted CD8+ T cells in peripheral blood

It does suppress the immune system

55
Q

Summarize T1DM.

A

-Immune mediated pancreatic destruction
-Need insulin replacement therapy (start with basal first)
-Often first present in DKA
-At risk for other autoimmune diseases (Celiac disease; thyroid)
-Evaluate coping strategies

56
Q

(TRUE or FALSE)

Insulin resistance is the seed that causes diabetes to be expressed.

A

TRUE, but

+ environmental factors
+ poor lifestyle habits
+ genetics

57
Q

What factors are associated with insulin resistance?

A
  1. Visceral adiposity
  2. Sedentary lifestyle
  3. Genetics
  4. GDM
  5. PCOS
  6. Acanthosis Nigricans
  7. OSA
  8. Cancer
  9. Steatosis
58
Q

What is Acanthosis Nigricans?

A

It signals high insulin levels in the bloodstream

It appears as patches of darkened skin over parts of the body that bend or rub against each other (neck, underarm, waist, groin, knuckles, elbows, toes)

There is no cure, lesions regress with treatment of IR

59
Q

At what age does screening for prediabetes and T2DM start?

A

Start screening all people at age 35.

If negative, re-screen every 3 years

If prediabetes, check annually

60
Q

(TRUE or FALSE)

It is appropriate to screen for prediabetes or T2DM at ANY AGE if their BMI >25 (Asians BMI > 23) plus 1 or more, additional risk factors.

What are the risk factors? (7)

A

TRUE

RISK FACTORS:
1. First-degree relative with diabetes
2. Member of a high-risk ethnic population
3. Habitual physical inactivity
4. Prediabetes
5. Hx of heart disease
6. Taking high risk meds: Antiretrovirals (for HIV), 2nd generation antipsychotics or steroids
7. History of pancreatitis

61
Q

What are second-generation antipsychotic medications?

A

Olanazpine, haloperidol, clozapine, quetiapine, and risperidone (MORE metabolic effects)

Aripiprazole and ziprasidone (fewer metabolic effects)

These can increase risk for hyperglycemia and associated weight gain

62
Q

If someone is started on a second-generation antipsychotic medication, when should they been screened for hyperglycemia?

A

Baseline

Re-screen at 12-16 weeks after medication initiation

Then, screen annually

63
Q

Who is at risk for T2DM?

A
  1. HTN (>130/80)
  2. HDL < 35 or TG > 250
  3. Hx of GDM
  4. PCOS
  5. Other conditions associated with IR (High BMI, acanthosis nigricans)
64
Q

Frequent skin and yeast infections in people with diabetes are:

A. A sign of poor hygiene
B. Due to poor diet
C. A sign of ongoing hyperglycemia
D. A result of high sugar intake

A

C

Elevated BGs decrease the ability of the WBCs to fight off infection and sugar feeds the bacteria and yeast

65
Q

What is the ‘Ominous Octet?’

A

8 issues in T2DM:

  1. Decreased satiation neurotransmission
  2. Decreased amylin
  3. Increased renal glucose reabsorption
  4. Decreased gut hormones (about 50% less)
  5. Increased lipolysis
  6. Decreased glucose uptake by the muscles
  7. Increase glucose production by the liver
  8. Increased glucagon secretion
66
Q

What other conditions is diabetes associated with?

A
  1. Liver steatosis
  2. OSA
  3. Increased risk of cancers (pancreas, liver, breast, endometrium, colon, bladder)
  4. Alzheimer’s and dementia
67
Q

Define empowerment.

A

Helping people discover and develop their inherent capacity to be responsible for their own lives and gain mastery over their diabetes.

68
Q

What are other causes of hyperglycemia?

A
  1. Meds (steroids, anti-retroviral, antipsychotic)
  2. Agent Orange
  3. TF & TPN
  4. Transplant meds
  5. Cystic Fibrosis
  6. Pancreatitis
69
Q

Which of the following is true about GDM?

A. GDM can be identified in the first trimester.
B. Children of women with GDM are at greater risk of type 1.
C. The rates of GDM are decreasing
D. People can decrease their risks of getting GDM.

A

D.

70
Q

How common is GDM?

A

~7% of all pregnancies

Prevalence has been increasing

71
Q

Within 5 years, what is the chance of developing diabetes in the next 5 years?

A

There is a 50% chance.

72
Q

When are pregnant women screened for GDM?

A

At the first prenatal visit, before 15 weeks, screen for undiagnosed T2DM using standard risk factors.

If positive = “Diabetes in Pregnancy”

If normal, check for GDM at 24-28 weeks with OGTT

73
Q

What is the screening protocol postpartum?

A

Screen at 4-12 weeks postpartum with 75 gram OGTT

Repeat at 3 year intervals or using signs of diabetes

74
Q

How can women decrease their risk of progressing to diabetes postpartum?

A
  1. Encourage breastfeeding (decreases risk by 50%)
  2. Encourage weight control
  3. Encourage exercise
  4. Connect them with PCP
  5. Check lipid profile and BP
  6. Preconception counseling
75
Q
A

CDCES Exam (8 decks)

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