Part B DM Insulin (Lecture 3)

Question 1

At 1st prenatal visit what should you do?

Answer 1

Test blood sugar to rule out any undiagnosed DM

Question 2

At 24-28 weeks of gestation what should you do?

Answer 2

Test blood sugar in pregnant women with no history of DM

Question 3

4-12 weeks post partum, what should you do?

Answer 3

Test blood sugar for persistent DM using 75g OGTT criteria

Question 4

How often should women with a H/O GDM be screened?

Answer 4

Every 3 years

Question 5

What are the two strategies for GDM Diagnosis?

Answer 5

• One step: 75 g OGTT
• Two step: 50 g (non fasting) screen filled by a 100-g OGTT for those with a positive screen

Question 6

When should a One step strategy be performed?

Answer 6

In the morning after a overnight fast (8 hr minimum)

At 24-48 weeks in women NOT previously diagnosed with DM

Question 7

One step abnormal fasting value?

Answer 7

≥ 92 mg/dL

Question 8

For 2 step: 1st step non fasted 50 g after an hour a blood glucose of ____ is considered normal

Answer 8

<130

Question 9

For 2 step: 1st step non fasted 50 g after an hour a blood glucose of ____ is considered abnormal

Answer 9

≥ 130 mg/ dL

Question 10

What must be done if blood glucose level is ≥ 130 after 1 hour after 1st step

Answer 10

Must be followed with a fasted 100-g, 3 hr, OGTT

Question 11

How many abnormal values makes a GDM diagnosis using the 2nd step?

Answer 11

2 abnormal values makes a diagnosis

Question 12

2nd step fasting abnormal value

Answer 12

≥95 mg/dL

Question 13

2nd step 1-hour abnormal value

Answer 13

≥180 mg/dL

Question 14

2nd step two-hour abnormal value

Answer 14

≥155 mg/dL

Question 15

2nd step three hour abnormal value

Answer 15

≥ 140

Question 16

One step abnormal one hour value?

Answer 16

≥ 180

Question 17

One step abnormal Two hour value?

Answer 17

≥ 153

Question 18

Fasting glucose goal for GDM

Answer 18

<95

Question 19

One hour post prandial goal for GDM

Answer 19

<140

Question 20

2 hour postprandial goal for GDM

Answer 20

<120

Question 21

A1C goal in pregnancy

Answer 21

<6% (may be relaxed to <7% if necessary to prevent hypoglycemia)

Question 22

True or False: “lifestyle behavior change is an essential component of management of GDM and may suffice as treatment”

Answer 22

TRUE

Question 23

____ is the preferred over metformin or glyburide in GDM

Answer 23

Insulin

Question 24

True or False: Metformin or glyburide should NOT be used as first line agents in GDM

Answer 24

TRUE

Question 25

When can metformin be used in GDM?

Answer 25

Can be used for PCOS and to induce ovulation, but must be discontinued by the end of the 1ST Trimester

Question 26

True or False” Telehealth visits for pregnant women with GDM improve outcomes compared with standard in person care”

Answer 26

TRUE

Question 27

SE of Sulfonylureas in GDM

Answer 27

- neonatal hypoglycemia -macrosomia - increased neonatal abdominal circumference

Question 28

How often & when should pts on insulin check BG?

Answer 28

-3-4 times/day - check fasting and premeal BG

Question 29

How often & when should pts on oral therapy check BG?

Answer 29

- 1-3 times/day - Fasting & Premeal BG

Question 30

What are advantages of SMBG?

Answer 30

- Detects glycemic excursion - quick feedback - helpful for sick days

Question 31

What are disadvantages of SMBG?

Answer 31

- cost - discomfort from finger stick

Question 32

Hypoglycemia definition

Answer 32

Blood glucose < 60 mg/dL (but symptoms may be felt at higher levels)

Question 33

Symptoms of Hypoglycemia (5):

Answer 33

Anxious Hungry Headache Thirsty palpitations

Question 34

Hypoglycemia Level 1 BG

Answer 34

<70

Question 35

Hypoglycemia Level 1 Signs and Symptoms (6):

Answer 35

Neurogenic: Palpitations Tremor Hunger Sweating Anxiety Paresthesia

Question 36

Hypoglycemia level 2 BG

Answer 36

<54

Question 37

Hypoglycemia level 2 signs and symptoms (4):

Answer 37

Neuroglycopenic: Behavioral changes Emotional liability Difficulty thinking Confusion

Question 38

Hypoglycemia level 3 BG

Answer 38

**** Severe event

Question 39

Hypoglycemia level 3 signs & symptoms: (5)

Answer 39

Severe confusion Unconsciousness Seizure Coma Death *** requires help from another individual

Question 40

What is the treatment for severe hypoglycemia treatment BG <54?

Answer 40

Glucagon (Glucagen)

Question 41

Glucagon pen dosing

Answer 41

1 mg SQ (may dose again in 15 minutes)

Question 42

CI of Glucagon pen?

Answer 42

Hypersensitivity to glucagon, lactose, or any other components of the pen

Question 43

ADEs of Glucagon pen?

Answer 43

Vomiting (especially if rapid and frequent administration)

Question 44

Chronic hyperglycemia BG

Answer 44

>126

Question 45

Chronic hyperglycemia symptoms (5)

Answer 45

Polydipsia Polyphagia Polyuria Blurry vision Palpations

Question 46

T1DM Complication (acute)

Answer 46

Diabetic Ketoacidosis

Question 47

T2DM complication (acute)

Answer 47

Hyperglycemic hyperosmolar state

Question 48

Most important sick day rule for insulin therapy?

Answer 48

NEVER STOP INSULIN

Question 49

Assess urinary albumin yearly, except when urinary albumin >______, then assess______

Answer 49

30, twice yearly

Question 50

Test eGFR yearly, except when eGFR < _____, then assess ____

Answer 50

60, twice yearly

Question 51

In T2DM when should an eye examination be done?

Answer 51

At dm diagnosis. If += annual exam If -= 1-2 years

Question 52

In T1DM when should an eye exam be done?

Answer 52

Within 5 years of T1DM diagnosis

Question 53

Diabetic autonomic neuropathy

Answer 53

Gastroparesis Urinary retention Erectile dysfunction

Question 54

Cardiovascular neuropathy

Answer 54

Silent angina Resting tachycardia Orthostatic hypotension

Question 55

DM marcovascular complications

Answer 55

Coronary artery disease Cerebrovascular disease PAD (leading cause of non traumatic lower limb amputations)

Question 56

What are the ABC’S of Diabetes?

Answer 56

A: A1C + anti-platelet therapy B: blood pressure control + blood glucose monitoring C: cholesterol + cessation of smoking

Question 57

Anti platelet recommendation for DM+ H/O ASCVD

Answer 57

Aspirin 75-162 mg/day

Question 58

Antiplatelet recommendation for pts with ASCVD and aspirin allergy

Answer 58

Clopidogrel 75 mg/day

Question 59

BP goal in DM

Answer 59

<130/80

Question 60

BP goal in GDM?

Answer 60

110-135/85

Question 61

When is CGM used?

Answer 61

In pts who are experiencing: - frequent hypoglycemia - nocturnal hypoglycemia - unawareness

Question 62

What does CGM measure?

Answer 62

Interstitial glucose rather than capillary bs

Question 63

Statin recommendation for: 40-75 years DM W/O ASCVD

Answer 63

Moderate intensity

Question 64

Statin recommendation for 20-39 yrs DM W/ ASCVD risk factors

Answer 64

May initiate statin therapy

Question 65

Statin recommendation: 40-75 yrs DM w/ 1 or more ASCVD risk factors

Answer 65

High intensity

Question 66

Cholesterol new goal

Answer 66

Reduce LDL by ≥ 50% of baseline or LDL <70

Question 67

Statin recommendation: 40-75 yrs DM w/ multiple ASCVD risk factors

Answer 67

In addition to high intensity and LDL ≥70 may add ezetimibe or PCSK9i

Question 68

Statin recommendation: >75yrs + DM

Answer 68

May initiate moderate intensity

Question 69

High intensity statins

Answer 69

Rosuvastatin 20/40 Atorvastatin 40/80

Question 70

Moderate intensity statins:

Answer 70

*** RASP LF Rosuvastatin 5-10 Atorvastatin 10-20 Simvastatin 20-40 Pravastatin 40-80 Lovastatin 40 Fluvastatin 80 Pitavastatin 1-4

Question 71

Statin secondary prevention: pt of all ages DM + ASCVD

Answer 71

High intensity

Question 72

Secondary prevention: pt of all ages w/ DM +ASCVD considered very high risk

Answer 72

If LDL ≥70 (max dose statin): consider adding ezetimibe or PCSK9i