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DIVINE

Terms in this set (47)

Values to diagnose diabetes:
FPG of ___________________
2 hour GT of ___________________
A1C of ___________________
Symptoms + RPG ___________________
FPG: 126 mg/dL or higher
2 hour GT: 200 mg/dL or higher
A1C: 6.5% or more
RPG: 200 mg/dL
True or False: A second test is required for confirmation of diabetes diagnosis.
True
True or False: It is recommended that the same test be repeated or a different test be performed without delay using a new blood sample for confirmation.
True
True or False: If a patient has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with consideration of the A1C assay interference.
True
In what conditions should only plasma blood glucose criteria be used to diagnose diabetes?
Those in which there is increased red blood cell turnnover.... sickle cell disease, pregnancy, hemodialysis, recent blood loss or transfusion, or erythropoietin therapy
Testing for diabetes should be considered in overweight or obese patients (BMI of 25 or more or 23 or more in asians) who have one or more of these risk factors:
first degree relative with diabetes
high risk race/ethnicity
CVD history
Hypertension
HDL cholesterol level (<35 mg/dL)
Triglyceride level (>250 mg/dL)
Polycystic ovary syndrome
Physical inactivity
What other criteria is there for testing for diabetes or prediabetes in asymptomatic adults?
patients with prediabetes, test yearly
women with history of GDM, test q 3 years
any patient 45 or older
If results are normal, testing should be repeated at a minimum of ___________________ intervals, with consideration of more frequent testing depending on initial results and risk status.
3 year
True or False: Type 2 diabetes goes undiagnosed for many years because hyperglycemia develops gradually and at earlier stages, is often not severe enough for the patient to notice the classic diabetes symptoms.
True
True or False: Insulin resistance will not improve with weight reduction and or pharmacologic treatment.
False- resistance may improve but is seldom restored to normal
True or False: Age is a major risk factor for diabetes.
True
True or False: A BMI of 20 or more kg/m^2 is a risk factor for diabetes.
False-A BMI of 25 or more
Most patients using intensive insulin regimen should perform ___________________ prior to meals and snacks, at bedtime, occasionally postprandial, prior to exercise, when they suspect hypoglycemia, after treating low glucose until they are normal, and prior to critical tasks such as driving.
self-monitoring of blood glucose (SMBG)
If a patient is meeting treatment goals, an A1C test should be done at least ____________ a year.
2 times
An A1C test should be performed ___________ in patients whose therapy has changed or who are not meeting glycemic goals.
quarterly
What is a reasonable A1C goal for most nonpregnant adults?
<7%
Achieving A1C targets of <7% has been shown to reduce ___________________ complications of diabetes.
microvascular
___________________ is a more common cause of death than microvascular complications in populations with diabetes.
CV disease
For nonpregnant adults with diabetes, peak postprandial capillary plasma glucose should be _____________.
<180 mg/dL
For nonpregnant adults with diabetes, preprandial capillary plasma glucose should be ___________________.
80-130 mg/dL
Patients with long duration of diabetes, a known history of ___________________, advanced ___________________, or advanced age/frailty may benefit from less aggressive targets.
hypoglycemia
atherosclerosis
True or False: Hypoglycemia should be asked about at every encounter.
True
True or False: Glucose (15-20 g) is the preferred treatment for the conscious individual with a blood glucose of 70 mg/dL or less. Repeat in 15 minutes if needed.
True
What are symptoms of hypolgycemia?
shakiness
irratibility
confusion
tachycardia
hunger
In hypoglycemic treatment, added _____________ may retard and then prolong the acute glycemic response.
fat
Once the glucose returns to normal, the individual should be counseled to ___________________.
eat a meal or snack to prevent recurrent hypoglycemia
___________________ is first line therapy for diabetes.
Metformin
Long term use of metformin may be associated with ___________________ deficiency.
B12
In patients with an A1C of _______________ or blood glucose levels, consider initiating insulin therapy.
>10%
>300 mg/dL
Lifestyle management is a fundamental aspect of diabetes care, this includes:
DSME/DSMS
Medical Nutrition therapy/weight managemetn
physical activity
smoking cessation
psychosocial care
True or False: The ADA recommends a trial with lifestyle therapy alone before adding pharmacologic therapy.
False- lifestyle + medication is the recommended treatment
How is Metformin dosed?
Start with 500 mg, increase by 500 mg weekly to 2000 mg/day. Reduce dose if GI symptoms occur.
When should metformin not be initiated?
<45 ml/min CrCl
When should metformin be discontinued?
<30 mL/min CrCl
A BMI of 25-29.9 is ___________________. A BMI of 30 and above is ___________________.
overweight
obese
What is ASCVD?
Atherosclerotic cardiovascular disease means you have existing heart or vessel disease caused by atherosclerosis.
What is atherosclerosis?
plaque build up on the walls of the arteries
What conditions are indicative of ASCVD?
CAD--heart attack
ischemic stroke
peripheral artery disease
What are CV risk factors?
HTN
dyslipidemia
FM of early heart disease (<55 males, <65 females)
smoking
obesity
sedentary lifestyle
You should consider dual therapy in patients with newly diagnosed diabetes who have an A1C of ___________________.
9% or more
In patients without ASCVD, if mono or dual therapy does not achieve or maintain A1C goal over 3 month...
add an additional agent
Which two drugs are proven to reduce adverse cardiovascular events?
liraglutitide
empagliflozin
What things are considered when choosing T2DM therapy?
comorbidities
side effects
effects on weight
risk of hypoglycemia
What are symptoms of hypoglycemia?
shaky
sweaty
dizzy
hungry
confusion and difficulty speaking
weak or tired
headache
nervous or upset
Who should receive glucagon as a prescription?
those at increased risk of clinically significant hypoglycemia
Rule of 15
Eat or drink 15g carbs
wait 15 minutes
check blood
less than 70 mg/dL
repeat
Consider initiating insulin therapy in patients with newly diagnosed diabetes who are symptomatic and who have an A1C of __________________ and or blood glucose of __________________.
10% or more
300 mg/dL or more
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