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CANADIAN DIABETES EDUCATOR EXAM QUESTIONS WITH COMPLETE SOLUTIONS GRADED A+ PASS. CANADIAN DIABETES EDUCATOR EXAM QUESTIONS WITH COMPLETE SOLUTIONS GRADED A+ PASS.
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Diagnosis of Diabetes (FPG, A1C, 2hPG in a 75g OFTT, random PG) - ANSWERS-FPG
/=7mmol/ml A1c >/= 6.5% 2h PG in a 75g OGTT >/= 11mmol/L random PG >/= 11.1mmol/L Prediabetes (i.e. at high risk for developing diabetes) - A1C - ANSWERS-6-6.4% what medical conditions can cause A1C results to be misleading? - ANSWERS-- hemoglobinopathies -iron deficiencies -hemolytic anemia -severe hepatic or renal disease Impaired Fasting glucose (IFG) - ANSWERS-FPG - 6.1-6.9mmol/L Impaired glucose tolerance (IGT) - ANSWERS-OGTT (w/ 75g of glucose) 7.8- 11mmol/L Screening for T1D is .... - ANSWERS-NOT recommended Screening recommendations for T2D - ANSWERS-use FPG and/or A1c every 3 years in individuals >/=40yo or in individuals at high risk (using risk calculator) macrosomic infant - ANSWERS-infant that weighs over 8lbs at birth microvascular complications - ANSWERS-retinopathy, neuropathy, nephropathy
macrovascular complications - ANSWERS-coronary, cerebrovascular, peripheral Pharmacological therapies for PREVENTION of T2D (include by how much % it is reduced by) - ANSWERS-1. Metformin (~30%)
intake saturated fats <7% of total daily what type of fats are preferred? - ANSWERS-monounsaturated fats (MUFA) polyunsaturated fats (PUFA) long chain omega 3 FA included up to 10% of total energy intake Recommendation for proteins? - ANSWERS-1-1.5g/kg body weight per day -15- 20% of total energy intake What are dAGEs? Good / bad? - ANSWERS-dietary advanved glycation endpoints BAD - increases markers for endothelial and adipocyte dysfunction and impairs vascular function Alcohol recommendations - ANSWERS-</=2 drinks per day OR <10 drinks per week for women </= 3 drinks per day OR <15 drinks per week for men main bad effect of alcohol - ANSWERS-HIDES and DELAYS hypoglycemia Name the diets that can improve glycemic control (i.e. decreases A1c) (4) - ANSWERS-1. Mediterranean diet
Short Acting insulin - ANSWERS-Insulin regular (Humulin R and Novolin ge Toronto) Intermediate acting insulin - ANSWERS-Insulin NPH (Humulin-N, Novolin ge NPH) Long acting insulin - ANSWERS-Detemir (Levemir) Glargine (Lantus, Tuojeo (highconc), Basaglar) Ultra-long acting insulin - ANSWERS-Degludec (Tresiba) Pre-mixed regular insulin NPH - ANSWERS-insulin NPH + insulin regular Humulin 30/ Novolin ge 30/70, 40/60, 50/ Premixed insulin analogues - ANSWERS--Aspart30%/aspart protamin 70% (NovoMix 30) -Lispro25%/lispro protamine 75% (Humalog Mix 25) -Lispro50%/lisproprotamine 50% (Humalog Mix 50) What is the honeymoon period? - ANSWERS-Time when insulin therapy is just started - requirements of insulin will be low but this is a transient state and requirements will increase Hypoglycemia unawareness - ANSWERS-happens when the threshold for the development of autonomic warning symptoms is close to or lower than the threshold for neuroglycopenic symptoms = i.e. first symptoms are CONFUSION or LOSS OF CONSCIOUSNESS Neuroglycopenic symptoms (really bad) (8) - ANSWERS-Difficulty concentrating confusion weakness drowsiness
Metformin contraindications - ANSWERS-liver and renal failure due to lactic acidosis 2 classes of incretin agents - ANSWERS-DPP-4 inhibitors GLP-1 receptor agonists DPP-4 inhibitors - ANSWERS-Linagliptin (Trajenta) , Saxagliptin (Onglyza), Sitagliptin (Januvia) DPP-4 - inhibitory incretin mechanism of GLP1 = these drugs prolongs the activity of GLP1 incretin GLP-1 Receptor agonists - ANSWERS-Exenatide (Byetta), Liraglutide (Victoza) incretins = hormones that directly stimulate insulin release and inhibit glucagon Sulfonylureas - ANSWERS-gliclazide (diamicron), glyburide (diabeta), Glimepiride (Amaryl) inhibit potassium channels causing depolarization f cell membrane = calcium release and therefore insulin release Which T2D antihyperglycemics can cause HYPOglycemia - ANSWERS- Sulfonylureas, Incretin analogues (DPP4 antagonist and GLP1 receptor agonist) Meglitinides - ANSWERS-Nateglinide (Starlix), Repaglinide (GlucoNorm) stimulate insulin release at potassium channel (diff site than sulfonylureas) - works faster than sulfonylureas Thiazolidinediones - ANSWERS-Pioglitazone (Actos), Rosiglitazone (Avandia) increases insulin sensitivity (indirectly) via transcription factor PPAR - at adipose and muscle tissue Thiazolidinediones Side effect - ANSWERS-increases cardiovascular risk esp CHF Recommended time frame to reach target after diagnosis? - ANSWERS-3 TO 6 MONTHS
If at diagnosis A1C </=8.5% (T2D) what is the recommended initial therapy? - ANSWERS-Lifestyle changes and then see after 2-3 mo if there are any changes and maybe start metformin? OR start metformin If at diagnosis A1C >/= 8.5% (T2D) what is the recommended initial therapy? - ANSWERS-START metformin AND consider adding another therapy (combo therapy) to decrease A1c by >/=1.5% possibly When is metformin + insulin indicated/recommended? - ANSWERS-symptomatic hyperglycemia (polyuria, polydypsia, weight loss, volume depletion) metabolic decompensation When should 30/70 insulin (pre mixed with regular insulin) be given? When should Humalog 25 or Novomix 30 (premixed with insulin analogues) be given? - ANSWERS-30/70 about 30-45min BEFORE meals Insulin analogues = immediately before eating Hypoglycemia - ANSWERS-<4mmol/L Severity of Hypoglycemia - ANSWERS-Mild: autonomic symptoms, can still self treat Moderate: autonomic AND neuroglycopenic symptoms but individual is still able to self treat Severe: unconscious or requires help from another person - PG<2.8mmol/L Treatment of mild/moderate hypoglycemia - ANSWERS-fast / simple carbohydrate 15g -glucose tablets -3 tsp or 3 packets of sugar dissolved in water
How much weight must be lost in order to have beneficial effects on metabolic parameters? What are the benefits? - ANSWERS-5-10% weight loss Benefits: insulin sensitivity, glycemic control, blood pressure, lipids Waist circumference thresholds (men and women) - ANSWERS-men (caucasian/african): >/=94cm men (Asian, south or central american): >/=90cm women: >/=80cm What is the rate of weight loss that is reasonable? - ANSWERS-1-2 lbs per week Which antihyperglycemic drugs can cause WEIGHT GAIN? - ANSWERS-insulin, TZDs, Sulfonylureas, meglitinides Which antihyperglycemic drugs are WEIGHT NEUTRAL or help with WEIGHT LOSS?
What is recommended if a person is taking antipsychotics (esp 2nd generation)? - ANSWERS-regular metabolic monitoring as they cause adverse metabolic changes Need for Antiplatelet therapy in diabetes? Medications? - ANSWERS-yes, as diabetes causes increased platelet reactivity and aggregation Meds: ASA (Secondary prevention), clopidogrel Recommended antihypertensive for diabetes? - ANSWERS-ACEI/ARBs->/=55yo OR macrovascular disease OR microcvascular disease Statin therapy recommendation in diabetes - ANSWERS->40yo OR macrovascular disease OR microvascular disease OR DM >15y and >30yo OR warrants therapy based on 2012 canadian cardiovascular society lipid guidelines ABCDES of Vascular protection in Diabetes - ANSWERS-A - A1C (usually </=7%) B- BP (<130/80) C-cholesterol (</=2mmol/L IF deciding to treat) D - Drugs (ACEI/ARB, Statins, ASA (if indicated)) E- Exercise / Eating healhy S-smoking cessation How does Diabetes affect CV risk? - ANSWERS-increases the CV age by 10-15y which worsens prognosis and can reduce life expectancy by 12y Multifaceted treatment strategy includes? the study that determined this? - ANSWERS-1. glucose, lipid and BP control
ASA (selective use/secondary prevention) Vascular protective drugs AND pregnancy - ANSWERS-STOP using prior to conception (statins and ACEI/ARB) - should only be used in proper preconception ACEI/ARBs shown to have vascular protection (strength too pls) - ANSWERS- perindopril 8mg (EUROPA), ramipril 10mg (HOPE), telmisartan 80mg (ONTARGET) Screening for CAD in diabetes checklist (3) - ANSWERS-1. Screen with baseline ECG (select patients)
creatinine >150micromol/L or creatinine clearance <30mL/min for control of volume Diabetic undergoing PCI (percutaneous coronary intervention) what is/are the antiplatelet(s) of choice? - ANSWERS-prasugrel or ticagrelor Choose prasugrel if... (5)-reversible? - ANSWERS--about to go into PCI -clopidogrel naiive -<75yo ->65kg -no history of stroke not reversible Choose ticagrelor if.. (2) - reversible? - ANSWERS--no history of hemorrhagic stroke -no extreme bradycardia yes, reversible BG target for a patient coming in with MI and BG levels of >11mmol/L - ANSWERS- target to 7-10mmol/L Risk factors for stroke in diabetics (4) - ANSWERS-o Insulin resistance o Central obesity o Impaired glucose tolerance o Hyperinsulinemia Three typical signs of Heart failure - ANSWERS-peripheral edema, SOB, and fatigue in CHF and eGFR <60mL/min - ANSWERS-start dosing ACEi/ARB should be 1/2 with gradual up titration
Monitor electrolytes, creatinine, BP, weight (within 7-10days of starting) Systolic heart failure - drug class of choice - ANSWERS-beta blockers Treatment for mild to moderate hyperkalemia (3) - ANSWERS-1. low potassium diet
2 main screening tests for CKD? - ANSWERS-ACR and eGFR Prevention of CKD - ANSWERS-1. proper glycemic control
o Proteinuria o Severe retinopathy What is the pharmacological option for delaying onset of retinopathy? - ANSWERS-adding a fibrate to statin therapy (specifically fenofibrate to simvastatin- reduced by 40% as per ACCORD eye study) Retinopathy increases morbidity and mortality via... (4) - ANSWERS-falling hip fractures 4-fold increase in mortality early death in T1D Name the 3 types of retinopathy - ANSWERS-1. Macular edema