RxPrep Diabetes Part 1 (Background/Types/Screening & Diagnosis/Lifestyle Modifications/Comprehensive Care/Natural Products)

decreased insulin secretion and/or sensitivity

The central problem in all types of diabetes is that blood glucose remains high due to ________.

hyperglycemia

Chronic ________ can lead to damage throughout the body, including organ and nerve damage.

beta-cells; pancreas

Insulin is a hormone produced by ________ in the ________.

insulin

________ is responsible for moving glucose out of the blood into body cells to be used as energy.

glycogen

Glucose removed from the blood is either moved to muscle cells for immediate use or store for later use by liver or fat cells as ________, the quick glucose reserve.

alpha cells; pancreas

Glucagon is produced by ________ in the ________.

glucagon

(Glucagon/Insulin) works when blood glucose is low.

glucagon

pulls glucose back into circulation by releasing glucose from glycogen

ketones

If glycogen is depleted, glucagon will signal fat cells to make ________ as an alternative energy source.

type 1 diabetes

________ is caused by an autoimmune destruction of beta-cells in the pancreas.

true

True or False: Once the beta-cells are destroyed, insulin cannot be produced.

diabetic ketoacidosis

Very high ketone levels can cause ________.

children

Most type 1 diabetes is diagnosed in (adults/children).

C-peptide

What test is used to determine if a patient is still producing insulin?

low

Type 1 diabetes is diagnosed when the C-peptide level is very (high/low).

insulin

Patients with type 1 diabetes must be treated with ________.

type 2 diabetes

________ is due to both insulin resistance and insulin deficiency.

family history, obesity, physical inactivity

Type 2 diabetes is strongly associated with what 3 things?

lifestyle modifications; medications

Type 2 diabetes is usually diagnosed in older patients and can be managed with ________ alone or in combination with ________.

prediabetes

increased risk of developing diabetes; blood glucose is high than normal but not high enough for diabetes diagnosis

dietary and exercise

Following ________ recommendations reduces the risk of progression from prediabetes to diabetes.

metformin

What drug can be used to help improve blood glucose levels in patients with prediabetes?

<60 YO, BMI ≥35, gestational diabetes history

Metformin can be especially helpful in patients with prediabetes in what 3 patient demographics?

yearly

How often should patients with prediabetes be monitored for development of diabetes?

gestational diabetes

Diabetes that develops during pregnancy is known as ________.

more

Blood glucose goals during pregnancy are (less/more) stringent than the non-pregnant population with diabetes.

larger; diabetes, obesity

Babies born to mothers with hyperglycemia during pregnancy are (larger/smaller) than normal and are at high risk for developing ________ and ________ later in life.

macrosomia

large-bodied baby commonly seen in diabetic pregnancies

oral glucose tolerance test

What test is used to check for gestational diabetes?

lifestyle modifications

What is first line for hyperglycemia treatment in gestational diabetes?

insulin

What drug is preferred when treating gestational diabetes?

A1C ≥5.7 (5.7-6.4 = prediabetes),

BMI ≥25 ( ≥23 for asians)

1st degree relative w/ diabetes,

gestational diabetes history,

physical inactivity,

race/ethnicity

What are 6 major risk factors for prediabetes and type 2 diabetes?

≥23

What BMI in Asian-Americans is considered a risk factor for prediabetes and type 2 diabetes?

polydipsia, polyphagia, polyuria

What are the 3 classic symptoms of hyperglycemia?

polyuria

excessive urination

polyphagia

excessive hunger or increased appetite

polydipsia

excessive thirst

fatigue

What is a common, non-classical symptom of hyperglycemia?

diabetic ketoacidosis

What is commonly the initial presentation of type 1 diabetes?

increases

Risk for diabetes (decreases/increases) with age.

35 years

Everyone, even those with no other risk factors, should be tested for diabetes beginning at ________ old.

overweight; 1

All asymptomatic children, adolescents, and adults who are ________ with at least ________ other risk factor(s) should be tested for diabetes.

hemoglobin A1C

fasting plasma glucose,

oral glucose tolerance test

What are 3 tests used to identify if prediabetes or diabetes is present?

A1C

diabetes diagnostic test that indicates the average blood glucose over approximately the past 3 months

fasting plasma glucose

diabetes diagnostic test that gives the blood glucose at the moment

≥8 hours

Fasting plasma glucose is taken after fasting for ________.

oral glucose tolerance test

diabetes diagnostic test that determines how well glucose is tolerated by measuring the blood glucose level 2 hours after drinking a liquid that's high in sugar

false (needs to be confirmed w/ second abnormal test result from either the same sample or a new sample, unless there's a clear clinical diagnosis)

True or False: Only 1 positive test is needed to diagnose diabetes.

≥200

There's a clear clinical diagnosis of diabetes when classic symptoms of hyperglycemia are present, as well as a random blood glucose of ________ mg/dL.

≥6.5

An A1C of ________% indicates diabetes.

5.7-6.4

An A1C of ________% indicates prediabetes.

≥126

A fasting plasma glucose of ________ mg/dL indicates diabetes.

100-125

A fasting plasma glucose of ________ mg/dL indicates prediabetes.

≥200

An oral glucose tolerance test 2-hour blood glucose of ________ mg/dL indicates diabetes.

140-199

An oral glucose tolerance test 2-hour blood glucose of ________ mg/dL indicates prediabetes.

<7%

What is the target A1C in non-pregnant patients with diabetes?

80-130 mg/dL

What is the target preprandial glucose in non-pregnant patients with diabetes?

≤95 mg/dL

What is the target preprandial glucose in pregnant patients with diabetes?

≤140 mg/dL

What is the target 1-hour postprandial glucose in pregnant patients with diabetes?

<180 mg/dL

What is the target 2-hour postprandial glucose in non-pregnant patients with diabetes?

≤120 mg/dL

What is the target 2-hour postprandial glucose in pregnant patients with diabetes?

point-of-care

________ A1C test kits provide immediate results and can be used to assess blood glucose control but are not typically recommended for diagnosis.

continuous glucose monitoring device, glucose meter

What are 2 ways patients can measure their own blood glucose?

every 3 months

How often should glycemic control be assessed if patients with diabetes are not yet at goal?

every 6 months

How often should glycemic control be assessed if patients with diabetes are at goal?

estimated average glucose

interpretation of the A1C value that makes it appear similar to a glucose meter value

126

An A1C of 6% is equivalent to an estimated average glucose of ________ mg/dL.

28

Each additional 1% increase of A1C past 6% increases the estimated average glucose by ~________ mg/dL.

154

126 + (28 x 1) = 154

What is the estimated average glucose of a patient with an A1C of 7%?

126 + [28 x (A1C - 6)]

What equation can be used to calculate estimated average glucose?

<35; <40

The goal waist circumference is ________ inches for females and ________ inches for males.

carbohydrate; prandial

Patients with type 1 diabetes should use ________-counting, where the ________ insulin dose is adjusted to the carbohydrate intake.

15

A carbohydrate serving is measured as ________ g, which is approximately 1 small piece of fruit, 1 slice of bread, or 1/3 cup of cooked rice/pasta.

150; week

Patients should perform at least ________ minutes of moderate-intensity aerobic activity per ________.

30 minutes

Patients should reduce sedentary habits by standing every ________, at a minimum.

blindness, kidney failure, lower-extremity amputations

Diabetes is the top cause of what 3 things?

autonomic neuropathy,

diabetic kidney disease,

foot infections/amputations,

peripheral neuropathy,

retinopathy

What are 5 microvascular complications of diabetes?

nephropathy

What is an example of diabetic kidney disease?

loss of sensation often in the feet

What is an example of peripheral neuropathy?

erectile dysfunction, gastroparesis, loss of bladder function

What are 3 examples of autonomic neuropathy?

cerebrovascular disease, coronary artery disease, peripheral artery disease

What are 3 macrovascular complications of diabetes?

atherosclerotic cardiovascular

Macrovascular disease is the same as ________ disease.

aspirin 81 mg

What drug/dose is recommended for ASCVD secondary prevention in patients with diabetes?

true

True or False: Aspirin 81 mg is not recommended for the primary prevention of ASCVD in most patients with diabetes.

preeclampsia

Aspirin is used in pregnant patients with diabetes to decrease the risk of ________.

eye exam w/ dilation

What test should be performed at type 2 diabetes diagnosis to check for diabetic retinopathy?

annually

How often should an eye exam with dilation be performed in patients with diabetes when diabetic retinopathy is present at diagnosis?

flu, hepatitis B, pneumococcal

What 3 vaccines are required, in addition to all childhood vaccines, in patients with diabetes?

10-g monofilament test

What test is used to check for neuropathy in patients with diabetes?

annually

How often should a patient with diabetes receive a comprehensive foot exam?

duloxetine, gabapentin, pregabalin

What are 3 drugs that can be used to treat diabetic neuropathy?

false (not between the toes)

True or False: Patients with diabetes should be counseled to moisturize the top and bottom of their feet, as well as in between their toes.

high-intensity statin

What drug should be used for cholesterol control in patients with diabetes and comorbid ASCVD?

moderate-intensity statin

What drug should be used for cholesterol control in patients with diabetes who are 40-75 years old with no comorbid ASCVD?

<55

The LDL goal for patients with diabetes and comorbid ASCVD is ________ mg/dL.

<70

The LDL goal for patients with diabetes and no comorbid ASCVD is ________ mg/dL.

ezetimibe, PCSK9 inhibitor

What are 2 add-on treatment options to a maximally tolerated statin when cholesterol control is still needed in patients with diabetes?

annually

How often should a patient with diabetes have a lipid panel checked?

<60; ≥30; ≥30

Diabetic kidney disease is defined as an eGFR of ________ mL/min/1.73 m^2 and/or a urine albumin of ________ mg/24 hrs or UACR of ________ mg/g.

annually

How often should urine albumin and eGFR be monitored in a patient with diabetes if they have normal kidney function?