Type 2 DM

Question 1

risk factors for T2DM

Answer 1

1. over 40
2. first degree relative
3. high risk pop
4. imparied glucose
5. complications assoc. with DM
6. vascular disease
7. overweight

Question 2

what is reccomended screening

Answer 2

• annually in high risk

- /3years in over 40

Question 3

what is prediabetes

Answer 3

impaired glucose tolerance/impaired fasting glucose

• risk of pregression to DM
• alsocassociated with CVD on it’s own

Question 4

what are 2 treatments for prediabetes

Answer 4

1. lifestyle - 60% RRR – implement this!

2. metformin - 30% RRR

Question 5

5 complications of DM (2 cats)

Answer 5

Microvascular
1. retinopathy
2. neuropathy
3. nephropathy
Macro
4. MI
5. stroke

Question 6

3 main defects in T2

Answer 6

1. pancreas - insulin def.
2. liver - excess glucose output
3. muscle and fat - insulin resistance

Question 7

** 3 treatment priorities

Answer 7

1. aim for excellent glycemic control
2. address CV risk factors
3. screen and test for complicaitons

Question 8

where should blood sugars be at

Answer 8

HbA1C -

Question 9

what happens as A1C rises

Answer 9

retinopathy increases

Question 10

how to match meds to patho

Answer 10

1. pancreas - insulin def. : insulin, sulfonourea
2. liver - excess glucose output : metformin
3. muscle and fat - insulin resistance : metformin, incretins, lifestyle
   4: gut - alpha- glucosidase inhib

Question 11

2 actions of metformin

Answer 11

increases glusose sens.

1. reduces glucise from liver
2. increases glucose uptake in tissues

Question 12

what is effect and SE of sulfonoureas

Answer 12

1. more insulin out

SE - causes weight gain

Question 13

what are incretins

Answer 13

GLP-1 - gut hormone released due to glucose in gut

• new drug target
• insulin better with food

Question 14

what does does incretin do

Answer 14

stop degradation of GLP-1 in body

Question 15

what is MOA of sodium glucose co-trnaporter

Answer 15

causes excretion of glucose in the nephron so pee out glucose

Question 16

** 2 vascular protection measures

Answer 16

1. BP target of 130/80 (ACE/ARBs)

2. lipid lowering (statins)

Question 17

who needs statins

Answer 17

nearly everyone
>40 or
micro disease or 
macro or
DM over 15years

Question 18

what is leading cause of kidney failure in canada

Answer 18

chronic kidney disease of DM

Question 19

what is screening for kidney disease

Answer 19

1. urine albumin/creatinine ratio

2.

Question 20

** why screen for nephropathy

Answer 20

1. progression can be slowed w/ glucose control, BP and ACE ARB
2. those with microalbumenuria should get ACE/ARB even without hypertnesion

Question 21

3 phases of diabetic retinopathy

Answer 21

1. macular edema
2. non-proliferative retinopathy
3. proliferative retinopathy

Question 22

why screen for retinopathy

Answer 22

there is good treatment

- lasers

Question 23

4 types of diabetic neuropathy

Answer 23

1. symmetric peripheral neuropathy - gloves
2. autonomic - GI, CV, bladder
3. mononeuropathy - cranial N, peripheral ne
4. polyradiculopathy