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CDCES Exam - Misc.
Questions/Solutions
What exam is recommended annually for diabetics? ✔ Ans - foot exam (pcp) dilated eye exam (specialist) What is a sign of hyperosmolar hyperglycemic state that differs it from diabetic ketoacidosis? ✔ Ans - absence of ketosis according to the ADA standards of care, at what A1c value should practitioners consider insulin as the preferred initial injectable agent? ✔ Ans - > 10% according to the ADA standards of care, criteria for diagnosis of diabetes are: ✔ Ans - A1C >/= 6.5% Fasting glucose >/= 126 mg/dL 2 hour post-75g OGTT >/= 200 mg/dL Normal albumin/creatinine ratio ✔ Ans - <30 mg/g At what GFR should GLP-1RA require dose adjustment? ✔ Ans - Fructosamine measures glycemic stability over what time range? ✔ Ans - past 2-3 weeks How much does 30 min aerobic exercise daily reduce systolic BP by? ✔ Ans - by 4 - 9 mm Hg How much does does 20# weight loss reduce systolic BP by? ✔ Ans - 5-20 mm Hg What is the recommended level for triglycerides? ✔ Ans - less than 150 mg/dL What is the recommended level for HDL in women? What is the desirable level? ✔ Ans - > 50 mg/dL
desirable: > 60 how long does the fed state last? ✔ Ans - 0-3.9 hours after eating when does post-absorptive state start? ✔ Ans - 4 hours , lasts from 4-15.9 hours after eating woman reports late onset hypoglycemia following morning dose of regular insulin. what do you suggest? ✔ Ans - switch to rapid-acting insulin such as aspart insulin to provide mealtime coverage without hypoglycemia what is aldosteronism? ✔ Ans - Hyper-secretion of aldosterone (either via a tumor, or secondarily caused by something else) Aldosterone controls Na+ and K+ levels in the blood.
- results in elevation in Na+ --> results in Hypertension and edema due to excessive Na+
- results in body losing excess K+ leading to HTN, abnormal function of neuron and muscle Varenicline is what? ✔ Ans - first-line treatment for smoking cessation. Nicotine replacement therapy (NRT) is also a 1st line treatment option. Varenicline is also known as Chantix What is stage 1 HTN? ✔ Ans - 130-139 over 80- What is stage 2 HTN? ✔ Ans - > 140/ An A1C of 9% correlates to an eAG of ___ ✔ Ans - 212 mg/dL Is it kidney or liver function that you need to monitor with empagliflozen? ✔ Ans - kidney function.
(there are 4) ✔ Ans - Fasting plasma glucose (FPG) value >/= 126 2-h plasma glucose (2-h PG) value during a 75-g oral glucose tolerance test (OGTT) of >/= 200 A1C >/= 6.5% Random plasma glucose value of >/= 200 WITH hyperglycemia symptoms What test should be used for conditions associated with increased red blood cell turnover (such as sickle cell disease, pregnancy in the 2nd and 3rd trimesters, glucose-6-phosphate dehydrogenase deficiency, hemodialysis, recent blood loss or transfusion, or erythropoietin therapy)? ✔ Ans - only plasma glucose should be used why is A1C falsely low for those on hemodialysis? ✔ Ans - because of increased red blood cell turnover Fasting and carbohydrate restriction can falsely elevate glucose level with an oral glucose challenge. People should consume a mixed diet with at least ___ grams of carbohydrate on each of the 3 days prior to oral glucose tolerance testing ✔ Ans - 150g Your 48-year-old female patient was screened for diabetes and found to have a fasting glucose of 85 mg/dL and A1C of 5.1%. Her mother has type 2 diabetes. Given this patient's family history and BMI of 36 kg/m2, when should her testing be repeated? ✔ Ans - testing should be repeated every three years at a minimum but sooner if
symptoms or changes in risk occur (e.g., significant weight gain). True/False: Point-of care A1C should only be utilized for monitoring of A1C and not diagnostic testing ✔ Ans - True Diagnostic testing should use a method that is certified by the NGSP and standardized to the Diabetes Control and Complications Trial (DCCT) assay What is the insulin sensitivity factor? ✔ Ans - amount of BG reduced by 1 unit of rapid or short-acting insulin typical ISF = 50 (meaning 1 unit of insulin reduces BG by 50 mg/dL) According to Gestational Diabetes Mellitus Evidence-Based Nutrition Practice Guidelines, women diagnosed with GDM should be referred to an RDN within what time frame? ✔ Ans - Within 48 hours of diagnosis According to Gestational Diabetes Mellitus Evidence-Based Nutrition Practice Guidelines, women diagnosed with GDM should receive MNT within what time frame? How many visits are required? ✔ Ans - women diagnosed with GDM should receive MNT: within 1 week of diagnosis Visits required: minimum 3 visits What islet cell antibody test is the best predictor for future of T1DM? ✔ Ans - GAD (Glutamic acid decarboxylase) What are diagnostic levels for a 100g oral glucose tolerance test? ✔ Ans - If fasting ≥ 95 If 1 hr ≥ or equal to 180 If 2 hr ≥ or equal to 155 If 3 hr ≥or equal to 140 According to standards of care, who should be screened for prediabetes and diabetes? ✔ Ans - - Anyone over age > 35
T/F: Heart failure and peripheral arterial disease are the most common initial manifestations of cardiovascular disease in type 2 diabetes. ✔ Ans - True with impaired kidney function, is the duration of action of insulin faster or prolonged compared to normal? ✔ Ans - prolonged. (watch out for nocturnal hypoglycemia in folks taking insulin w poor kidney fx) Jeff is a 67 man who is in your clinic for a follow-up visit after his hospitalization for a myocardial infarction (non-ST elevation, ejection fraction= 46%) a few weeks ago. He has type 2 diabetes (diagnosed 10 years ago). He shares that he was started on metformin on diagnosis and during his hospitalization, he was started on a basal-bolus insulin regimen and discharged home on it. His diabetes is complicated by nephropathy (UACR = 390 mg/g creatinine). His current medication list includes: Lisinopril 40 mg per day Hydrocholthiazide 12.5 mg per day Atorvastatin 40 mg per day Clopidogrel 75 mg per day Metoprolol 100 mg BID Glargine 42 units at night Aspart with meals 7-12 units On examination: BMI= 35 kg/m2, BP= 139/85 mmHg, HR= 66/ min. He is in no apparent distress, has a normal heart examination, clear lungs and his distal pulses are normal. Laboratory tests: A1C = 9.0 %, Creatinine = 1.3 mg/dL, EGFR > 60 , UACR = 390 Which of the following choices is the best next step in the management of his diabetes? A- start lixisenatide
B- start empagliflozen C- start a sulfonylurea D- increase insulin by 10-15% ✔ Ans - B- start empagliflozen This agent is an SGLT-2 inhibitor that promotes renal loss of glucose by inhibition of the SGLT-2 receptors with a consequent reduction in plasma glucose levels and improvement of renal hemodynamics and cardiovascular outcomes. In clinical trials, empagliflozin reduced cardiovascular events including mortality in patients with type DM2 and established cardiovascular disease. Empagliflozin also was shown to slow the progression of kidney disease and lower rates of clinically relevant renal events than was placebo when added to standard care.Increasing insulin by 10-15% could be a treatment option but it will offer no cardiovascular or renal benefit to this patient. Sulfonylurea in a patient already on insulin is not of much benefit and it has no known cardiac or renal benefits.GLP-1 receptor agonists liraglutide, dulaglutide, and semaglutide have shown a reduction in cardiovascular events in people with diabetes. However, that is not the case with lixisenatide. T/F: Statin plus niacin combination therapy has been shown to provide incremental cardiovascular benefit above statin therapy and is generally recommended. ✔ Ans - false sources of foods/oils high in PUFAS ✔ Ans - Walnuts. Sunflower seeds. Flax seeds or flax oil. Fish, such as salmon, mackerel, herring, albacore tuna, and trout. Corn oil. Soybean oil. sources of foods/oils high in MUFAS ✔ Ans - olive oil canola oil peanut oil olives
Note, d would have been a valid answer too if it had said moderate or large ketones Appropriate sick day management for preventing DKA in someone with Type 1 DM Let's say Type 1 pt has the flu, glucoses are reading 250-280 which is higher than usual, she reports vomiting once but now tolerates fluids well. she has ketone test strips at home. When should she contact her healthcare team> ✔ Ans - If she vomits more than once If she has diarrhea more than 5 times for longer than 6 hours When BG > 300 on two consecutive measurements that are not responsive to insulin and fluids When moderate or large amounts of urinary or blood ketones are present What is an important consideration regarding potassium for someone who is being treated for DKA? ✔ Ans - Insulin administration in someone with DKA will drive K to leave the plasma and enter the cell, potentially resulting in hypokalemia. K supplementation may be needed. Differences between DKA and HHS? ✔ Ans - HHS:
- will normally have more server hyperglycemia (BG > 600)
- occurs primarily in undiagnosed or elderly individuals with T2DM
- minimal ketone formation
- bicarbonate levels will either be normal or mildly low DKA
- bicarbonate levels very low (bicarbonate < 15mEq/L) Ways they are similar:
- Serum osmolality will be high in BOTH HHS and DKA use book to add more info to this card! how can large doses of aspirin affect insulin? ✔ Ans - can cause increased basal and stimulated release of insulin
for those with severe peripheral neuropathy, what style of exercise is discouraged? ✔ Ans - high impact weight bearing activities such as aerobics class are discouraged for adults with DM, _____ dose(s) of PPSV23 is recommended between age of 19-64, with a second dose at 65 if it has been more than 5 years since their last dose) this vaccine is to protect against pneumococcal infections ✔ Ans - For adults with DM, ONE dose of PPSV23 is recommended between age of 19- A second dose at 65 is recommended if it has been more than 5 years since their last dose is shoulder dystocia a common complication of GDM? yes or no ✔ Ans - yes T/F: Saxaglipton and pioglitazone are associated with an increased risk of heart failure ✔ Ans - true What is the DRI for carbohydrates for pregnant women? What is the DRI for carbohydrates for non-pregnant women? ✔ Ans - pregnant- 175g/day non-pregnant- 130g/day What are the eligibility requirements for Medicare Diabetes Prevention Program? What differs it from the requirements for the CDC Diabetes Prevention Program? ✔ Ans - - Fasting BG of 110-
- BMI ≥ 25 The CDC DPP recognizes hx of GDM as an eligibility criterion, whereas the Medicare DPP does not The CDC DPP has a different fasting BG criteria (100-125) The CDC DPP has accepts someone's self report of GDM history and blood based test results
What is insulin sensitivity factor? ✔ Ans - It predicts how much 1 unit of insulin will lower blood glucose by how much does medicare part b cover for test strips? ✔ Ans
- Medicare Part B covers up to 100 strips every THREE MONTHS for noninsulin users after meeting their deductible, but someone can get an extension if they need more. For insulin users, Medicare covers up to 100 strips per MONTH. these drugs increase the risk of which cancers? Pioglitazone- Liraglutide- Sitaglipton- ✔ Ans - Pioglitazone- bladder cancer Liraglutide- thyroid tumor Sitaglipton-pancreatic cancer T/F: should you be worried about metformin in folks at risk of heart failure? ✔ Ans - Yes, because of lactic acidosis Pioglitazone is associated with what side effects? ✔ Ans - wt gain bladder cancer heart failure exacerbation osteoporosis increased fracture risk which statin is the least potent? ✔ Ans - fluvastatin Normal creatinine levels ✔ Ans - generally, you can remember 0.6-1.3 (remember the image of the weird picmonic video) Describe how insulin requirements change during pregnancy ✔ Ans -
For an emergency kit for someone with DM, what is the minimum amount of non-perishable food and water it should have (name days) ✔ Ans - 2 days of non-perishable food 3 days of water This is the MINIMUM If someone is on basal and you want to add bolus insulin. What thoughts go through your head regarding dosing? ✔ Ans - Step 1: If A1C <8%, then consider decreasing the basal dose by 4 units when you add bolus Step 2: The dose for bolus will generally either be 4 units or 10% of the basal dose Let's say a T2 is on basal and you've added bolus insulin. Now it's time to titrate. How do you do that? ✔ Ans - Increase the bolus dose by 1-2 units OR increase by 10-15% twice weekly in general, when you add insulin and there's hypoglycemia...if there's no clear cause for the hypo then you lower the corresponding insulin dose by _____ ✔ Ans - 10-20% diabetes meds associated with varying degrees of weight loss include: ✔ Ans - Metformin GLP1-RA Alpha-Glucosidase Inhibitors SGLT-2i Amylin Mimetics *note that DPP4i are weight neutral Phentermine is indicated for how long? ✔ Ans - ≤ 12 weeks (short-term) Medications FDA approved for long-term treatment of obesity (>12 weeks) are: ✔ Ans - Orlistat, phentermine/topamax ER, naltrexone/bupropion ER, Liraglutide 3mg, and Semaglutide 2.4mg
in critically ill is persistent hyperglycemia of 180 and then glucose should be maintained in a range of 140-180. la range lower than that may cause hypos what is the minimum amount of medication to include in an emergency kit? ✔ Ans - 1-week supply T/F: bedtime intermediate-acting insulin has been shown to reduce nocturnal hypoglycemia and allow for better glucose control in the morning, compared to intermediate-acting insulin given before dinner) ✔ Ans - true Labs indicating DKA ✔ Ans - glucose > 250 low bicarb (<18) elevated anion gap normal bicarbonate levels ✔ Ans - 22-29 mEq/L normal anion gap ✔ Ans - 8- The overall objectives of DSMES are: ✔ Ans - - informed decision making
- self-care behaviors
- problem solving
- active collaboration with the healthcare team to identify individualized, targeted needs and to improve clinical outcomes, health status, and quality of life What are the AADE7 self-care behaviors? ✔ Ans - Healthy Coping•Healthy Eating•Being Active•Taking Medication•Monitoring•Reducing Risk•Problem Solving. Describe the bargaining stage ✔ Ans - The bargaining stage is characterized by inaccurate explanations and/or erroneous cures. The patient "makes a deal" with self, provider, God, or others to get rid of the diabetes.
Which theoretical approach to learning and health behavioral change theory maintains that individuals learn from their personal experiences as well as from observing the action and experiences of others. ✔ Ans - SOCIAL COGNITIVE THEORY What model predicts that someone's decision to change a health habit depends on: their belief of the seriousness of the problem, belief in the effectiveness of the change, associated costs of the change, and level of self-efficacy. ✔ Ans - Health Belief Model Describe the Theory of Planned Behavior ✔ Ans - What do diminished or absent pedal pulses indicate? ✔ Ans
- indicates poor circulation in lower extremities what is a normal and abnormal ankle-brachial index score? ✔ Ans - for how long following intense, extended exercise should a person be concerned with the possibility of activity-related hypoglycemia, assuming the person uses insulin? ✔ Ans - 24 hours Consider initiating insulin therapy (with or without other agents) in pts with newly diagnosed T2DM who are symptomatic, or have A1C > 10%, or have blood glucose levels of ______________ ✔ Ans - > 300 You should consider initiating dual therapy in pts newly diagnosed with type 2 diabetes who have A1C of _________ ✔ Ans - > 9% T/F: Rapid improvement in glucose control has not been associated with a temporary worsening of diabetic retinopathy ✔ Ans - False! Rapid improvement in glucose control HAS BEEN associated with a temporary worsening of diabetic retinopathy
