CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
Diagnosis of Diabetes (FPG, A1C, 2hPG in a 75g OFTT, random PG) - ANSWER 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 - ANSWER 6-6.4%
what medical conditions can cause A1C results to be misleading? - ANSWER -hemoglobinopathies
-iron deficiencies
-hemolytic anemia
-severe hepatic or renal disease
Impaired Fasting glucose (IFG) - ANSWER FPG - 6.1-6.9mmol/L
Impaired glucose tolerance (IGT) - ANSWER OGTT (w/ 75g of glucose) 7.8-11mmol/L
Screening for T1D is .... - ANSWER NOT recommended
Screening recommendations for T2D - ANSWER use FPG and/or A1c every 3 years in individuals >/=40yo
or in individuals at high risk (using risk calculator)
macrosomic infant - ANSWER infant that weighs over 8lbs at birth
microvascular complications - ANSWER retinopathy, neuropathy, nephropathy
,CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
macrovascular complications - ANSWER coronary, cerebrovascular, peripheral
Pharmacological therapies for PREVENTION of T2D (include by how much % it is reduced by) - ANSWER
1. Metformin (~30%)
2. Acarbose (~30%)
3. Thiazolidinediones (~60%)
ACCORD, ADVANCE and VADT were the three major trials that concluded what? - ANSWER intensive
glycemic control - lowering A1C <6% resulted in higher mortality, severe episodes of hypoglycemia -
therefore targets should individualized!!
TARGET for A1C, FPG and RPG for MOST Diabetic (T1D and T2D) patients? - ANSWER A1c <7mmol/L
FPG 4-7mmol/L
PPG 5-10mmol/L (5-8mmol/L if A1c target not achieved)
Who should have target of A1c <6.5% - ANSWER in T2D to further decrease risk of nephropathy and
retinopathy (ensure there is a balance so as not to cause HYPOGLYCEMIA)
Who should have target of 7.1-8.5% (7) - ANSWER 1. limited life expectancy
2. High level of functional dependency
3. severe coronary artery disease/ increased risk for ischemic events
4. multiple comorbidities
5. HX of recurrent severe hypoglycemic episodes
6. hypoglycemic unawareness
7. Long standing diabetes that is difficult to reduce A1c<7% - despite appropriate treatments
How and when should verification of the accuracy of SMBG monitors be done? What is the acceptable
difference? - ANSWER When: annually or when A1C results do not match
,CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
How: comparing FPG machine results with FPG from lab measurements
acceptable difference is 20%
If on insulin and planning exercise. What is the BG to watch out for to prevent HYPOglycemia? What
should be done if BG is at or past cut off? - ANSWER BG < 5.5mmol/L
Take 15-30g of carbs PRE-exercise
exercise recommendation for diabetes? - ANSWER 150min/week of moderate intensity aerobic exercise
spread over 3 days with no more than 2 days of sedentary
2-3 times per week of resistance training
How well can nutrition therapy reduce A1C? - ANSWER Can reduce A1C by 1-2%
carbohydrates recommendation - ANSWER no less than 130g/d (to maintain glucose to brain)
no less than 45% of energy (60% if high in fibre and low glycemic index)
Dietary fiber recommendation - ANSWER 25-38g for women
21-30g for men
>51yo w/ diabetes
Recommended added sugars intake? - ANSWER no more than 10% of total daily energy (aka. 50-65g/day
for a 2000-2600kcal/day diet)
Eating Well with Canada's Food Guide recommendation for fruit and veggies ? - ANSWER 7-10 servings /
day
Recommendation for Fat intake? saturated fats? - ANSWER 20-35% of energy intake
saturated fats <7% of total daily
, CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
what type of fats are preferred? - ANSWER monounsaturated fats (MUFA)
polyunsaturated fats (PUFA)
long chain omega 3 FA
included up to 10% of total energy intake
Recommendation for proteins? - ANSWER 1-1.5g/kg body weight per day -15-20% of total energy intake
What are dAGEs? Good / bad? - ANSWER dietary advanved glycation endpoints
BAD - increases markers for endothelial and adipocyte dysfunction and impairs vascular function
Alcohol recommendations - ANSWER </=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 - ANSWER HIDES and DELAYS hypoglycemia
Name the diets that can improve glycemic control (i.e. decreases A1c) (4) - ANSWER 1. Mediterranean
diet
2. vegan/vegetarian diet
3. incorporation of dietary pulses (beans, peas, chickpeas, lentils)
4. DASH
Rapid Acting Insulin Analogues? - ANSWER Aspart (NovoRapid)
Glulisine (Apidra)
Lispro (Humalog)
Short Acting insulin - ANSWER Insulin regular (Humulin R and Novolin ge Toronto)
Intermediate acting insulin - ANSWER Insulin NPH (Humulin-N, Novolin ge NPH)
EXAM 214 Complete solutions.
CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
Diagnosis of Diabetes (FPG, A1C, 2hPG in a 75g OFTT, random PG) - ANSWER 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 - ANSWER 6-6.4%
what medical conditions can cause A1C results to be misleading? - ANSWER -hemoglobinopathies
-iron deficiencies
-hemolytic anemia
-severe hepatic or renal disease
Impaired Fasting glucose (IFG) - ANSWER FPG - 6.1-6.9mmol/L
Impaired glucose tolerance (IGT) - ANSWER OGTT (w/ 75g of glucose) 7.8-11mmol/L
Screening for T1D is .... - ANSWER NOT recommended
Screening recommendations for T2D - ANSWER use FPG and/or A1c every 3 years in individuals >/=40yo
or in individuals at high risk (using risk calculator)
macrosomic infant - ANSWER infant that weighs over 8lbs at birth
microvascular complications - ANSWER retinopathy, neuropathy, nephropathy
,CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
macrovascular complications - ANSWER coronary, cerebrovascular, peripheral
Pharmacological therapies for PREVENTION of T2D (include by how much % it is reduced by) - ANSWER
1. Metformin (~30%)
2. Acarbose (~30%)
3. Thiazolidinediones (~60%)
ACCORD, ADVANCE and VADT were the three major trials that concluded what? - ANSWER intensive
glycemic control - lowering A1C <6% resulted in higher mortality, severe episodes of hypoglycemia -
therefore targets should individualized!!
TARGET for A1C, FPG and RPG for MOST Diabetic (T1D and T2D) patients? - ANSWER A1c <7mmol/L
FPG 4-7mmol/L
PPG 5-10mmol/L (5-8mmol/L if A1c target not achieved)
Who should have target of A1c <6.5% - ANSWER in T2D to further decrease risk of nephropathy and
retinopathy (ensure there is a balance so as not to cause HYPOGLYCEMIA)
Who should have target of 7.1-8.5% (7) - ANSWER 1. limited life expectancy
2. High level of functional dependency
3. severe coronary artery disease/ increased risk for ischemic events
4. multiple comorbidities
5. HX of recurrent severe hypoglycemic episodes
6. hypoglycemic unawareness
7. Long standing diabetes that is difficult to reduce A1c<7% - despite appropriate treatments
How and when should verification of the accuracy of SMBG monitors be done? What is the acceptable
difference? - ANSWER When: annually or when A1C results do not match
,CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
How: comparing FPG machine results with FPG from lab measurements
acceptable difference is 20%
If on insulin and planning exercise. What is the BG to watch out for to prevent HYPOglycemia? What
should be done if BG is at or past cut off? - ANSWER BG < 5.5mmol/L
Take 15-30g of carbs PRE-exercise
exercise recommendation for diabetes? - ANSWER 150min/week of moderate intensity aerobic exercise
spread over 3 days with no more than 2 days of sedentary
2-3 times per week of resistance training
How well can nutrition therapy reduce A1C? - ANSWER Can reduce A1C by 1-2%
carbohydrates recommendation - ANSWER no less than 130g/d (to maintain glucose to brain)
no less than 45% of energy (60% if high in fibre and low glycemic index)
Dietary fiber recommendation - ANSWER 25-38g for women
21-30g for men
>51yo w/ diabetes
Recommended added sugars intake? - ANSWER no more than 10% of total daily energy (aka. 50-65g/day
for a 2000-2600kcal/day diet)
Eating Well with Canada's Food Guide recommendation for fruit and veggies ? - ANSWER 7-10 servings /
day
Recommendation for Fat intake? saturated fats? - ANSWER 20-35% of energy intake
saturated fats <7% of total daily
, CANADIAN DIABETES EDUCATOR
EXAM 214 Complete solutions.
what type of fats are preferred? - ANSWER monounsaturated fats (MUFA)
polyunsaturated fats (PUFA)
long chain omega 3 FA
included up to 10% of total energy intake
Recommendation for proteins? - ANSWER 1-1.5g/kg body weight per day -15-20% of total energy intake
What are dAGEs? Good / bad? - ANSWER dietary advanved glycation endpoints
BAD - increases markers for endothelial and adipocyte dysfunction and impairs vascular function
Alcohol recommendations - ANSWER </=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 - ANSWER HIDES and DELAYS hypoglycemia
Name the diets that can improve glycemic control (i.e. decreases A1c) (4) - ANSWER 1. Mediterranean
diet
2. vegan/vegetarian diet
3. incorporation of dietary pulses (beans, peas, chickpeas, lentils)
4. DASH
Rapid Acting Insulin Analogues? - ANSWER Aspart (NovoRapid)
Glulisine (Apidra)
Lispro (Humalog)
Short Acting insulin - ANSWER Insulin regular (Humulin R and Novolin ge Toronto)
Intermediate acting insulin - ANSWER Insulin NPH (Humulin-N, Novolin ge NPH)
