CMN 572 - UNIT 3 (ENDOCRINE) QUESTIONS
Long term use of metformin is associated with what deficiency? - Answer -Vitamin B12
ADA Guidelines, notes from "Lessons"
Contraindications to use of metformin - Answer -Creatinine (McPHee p 1234)
> 1.4 mg/dL for ♀
> 1.5 mg/dL for ♂
eGFR < 30 (ADA, p 26)
Pre-meal fasting glucose target range - Answer -90 - 130 mg/dL (McPhee p 1247)
80 - 130 mg/dL (ADA, p 22, Table 6)
ADA recommendations for ASA use? - Answer -PRIMARY PREVENTION
+ Pts with T1DM or T2DM at increased risk for CVD. (This includes ♂ and ♀ > 50 yrs
with at least ONE other risk factor for ASCVD -- that is, family hx of premature ASCVD,
HTN, dyslipidemia, smoking or albuminuria).
SECONDARY PREVENTION
+ All patients with diabetes AND hx of ASCVD
(ADA p 29)
ADA definition of T1DM - Answer -Due to immune ß-cell destruction, usually leading to
absolute insulin deficiency
(ADA p 15)
ADA definition of T2DM - Answer -Due to progresive loss of ß-cell insulin secretion,
frequently on background of insulin resistance.
(ADA p 15)
ADA definition of gestational diabetes - Answer -Diabetes diagnosed in 2nd or 3rd
trimester of pregnancy, which was not clearly overt diabetes prior to gestation.
(ADA p 15)
Criteria for diagnosis of diabetes -- FPG - Answer -≥ 126 mg/dL
(Note: In the absence of OVERT hyperglycemia, results should be confirmed by repeat
testing.)
,(ADA p 15)
Criteria for diagnosis of diabetes -- OGTT - Answer -≥ 200 mg/dL
(Note: In the absence of OVERT hyperglycemia, results should be confirmed by repeat
testing.)
(ADA p 15)
Criteria for diagnosis of diabetes -- A1C - Answer -≥ 6.5%
(Note: In the absence of OVERT hyperglycemia, results should be confirmed by repeat
testing.)
(ADA p 15)
When is a random plasma glucose (RPG) > 200 mg/dL diagnostic of diabetes? -
Answer -ONLY if patient has classic symptoms of hyperglycemia or hyperglycemic crisis
(ADA p 15)
ADA criteria for testing for diabetes or prediabetes in asymptomatic adults - Answer -1)
*Adults of ANY age who are overweight/obese* (e.g. BMI ≥ 25 kg/m²) AND who have
any of these *risk factors*:
- 1st degree relative with DM
- Race (African-american, latino, native american, asian american, pacific islander)
- Hx of CVD
- HTN (≥ 140/90) OR on tx for HTN
- HDL < 35 mg/dL and/or triglycerides > 250 mg/dL
- ♀ with PCOS
- Physical inactivity
- Other conditions associated wtih insulin resistance (e.g. extreme obesity, acanthosis
nigricans)
2) *YEARLY for patients with prediabetes* (A1C ≥ 5.7%)
3) *EVERY 3 YEARS for ♀ dx with GDM*
4) Test *ALL PATIENTS starting at age 45 yrs*
NOTE: If results are normal, repeat testing at least every 3 years; more frequently
based on initial results and risk status
(ADA p 16, table 3)
Which tests are appropriate for identifying pre-diabetes? - Answer -A1C, FPG, 2-hour
PG during 75 g OGTT are all equally appropriate.
, (ADA p 16)
ADA criteria for testing for diabetes or prediabetes in asymptomatic adolescents or
children - Answer -*Overweight* (BMI > 85th percentile for age and sex, weight for
height > 85th percentile, OR weight > 120% of ideal for height)
PLUS one or more of the following risk criteria:
+ Maternal hx of GDM during child's gestation
+ Family hx of T2DM in 1st or 2nd degree relative
+ Race
+ Signs of insulin resistance
(ADA p 16)
What are some signs of insulin resistance? - Answer -+ Acanthosis nigricans
+ Hypertension
+ Dyslipidemia
+ PCOS
+ Small-for-gestational-age birth weight
(ADA p 16)
Immunizations recommended by the CDC for diabetic adults? - Answer -+ Influenza
+ Pneumococcal
+ Hep B
+ Zoster (for shingles)
+ TdaP
(CDC website)
Which types of cancer is diabetes associated with? - Answer -Diabetes is associated
wtih increased risk of these types of cancers:
+ Liver
+ Pancreas
+ Endometrium
+ Colon/rectum
+ Breast
+ Bladder
NOTE: Association may result from shared risk factors between T2DM and cancer (e.g.
older age, obestity, physical inactivity).
(ADA p 17)
When are the 4 critical times to evaluate the need for diabetes self-management
education and support (DSMES)? - Answer -1) At diagnosis
Long term use of metformin is associated with what deficiency? - Answer -Vitamin B12
ADA Guidelines, notes from "Lessons"
Contraindications to use of metformin - Answer -Creatinine (McPHee p 1234)
> 1.4 mg/dL for ♀
> 1.5 mg/dL for ♂
eGFR < 30 (ADA, p 26)
Pre-meal fasting glucose target range - Answer -90 - 130 mg/dL (McPhee p 1247)
80 - 130 mg/dL (ADA, p 22, Table 6)
ADA recommendations for ASA use? - Answer -PRIMARY PREVENTION
+ Pts with T1DM or T2DM at increased risk for CVD. (This includes ♂ and ♀ > 50 yrs
with at least ONE other risk factor for ASCVD -- that is, family hx of premature ASCVD,
HTN, dyslipidemia, smoking or albuminuria).
SECONDARY PREVENTION
+ All patients with diabetes AND hx of ASCVD
(ADA p 29)
ADA definition of T1DM - Answer -Due to immune ß-cell destruction, usually leading to
absolute insulin deficiency
(ADA p 15)
ADA definition of T2DM - Answer -Due to progresive loss of ß-cell insulin secretion,
frequently on background of insulin resistance.
(ADA p 15)
ADA definition of gestational diabetes - Answer -Diabetes diagnosed in 2nd or 3rd
trimester of pregnancy, which was not clearly overt diabetes prior to gestation.
(ADA p 15)
Criteria for diagnosis of diabetes -- FPG - Answer -≥ 126 mg/dL
(Note: In the absence of OVERT hyperglycemia, results should be confirmed by repeat
testing.)
,(ADA p 15)
Criteria for diagnosis of diabetes -- OGTT - Answer -≥ 200 mg/dL
(Note: In the absence of OVERT hyperglycemia, results should be confirmed by repeat
testing.)
(ADA p 15)
Criteria for diagnosis of diabetes -- A1C - Answer -≥ 6.5%
(Note: In the absence of OVERT hyperglycemia, results should be confirmed by repeat
testing.)
(ADA p 15)
When is a random plasma glucose (RPG) > 200 mg/dL diagnostic of diabetes? -
Answer -ONLY if patient has classic symptoms of hyperglycemia or hyperglycemic crisis
(ADA p 15)
ADA criteria for testing for diabetes or prediabetes in asymptomatic adults - Answer -1)
*Adults of ANY age who are overweight/obese* (e.g. BMI ≥ 25 kg/m²) AND who have
any of these *risk factors*:
- 1st degree relative with DM
- Race (African-american, latino, native american, asian american, pacific islander)
- Hx of CVD
- HTN (≥ 140/90) OR on tx for HTN
- HDL < 35 mg/dL and/or triglycerides > 250 mg/dL
- ♀ with PCOS
- Physical inactivity
- Other conditions associated wtih insulin resistance (e.g. extreme obesity, acanthosis
nigricans)
2) *YEARLY for patients with prediabetes* (A1C ≥ 5.7%)
3) *EVERY 3 YEARS for ♀ dx with GDM*
4) Test *ALL PATIENTS starting at age 45 yrs*
NOTE: If results are normal, repeat testing at least every 3 years; more frequently
based on initial results and risk status
(ADA p 16, table 3)
Which tests are appropriate for identifying pre-diabetes? - Answer -A1C, FPG, 2-hour
PG during 75 g OGTT are all equally appropriate.
, (ADA p 16)
ADA criteria for testing for diabetes or prediabetes in asymptomatic adolescents or
children - Answer -*Overweight* (BMI > 85th percentile for age and sex, weight for
height > 85th percentile, OR weight > 120% of ideal for height)
PLUS one or more of the following risk criteria:
+ Maternal hx of GDM during child's gestation
+ Family hx of T2DM in 1st or 2nd degree relative
+ Race
+ Signs of insulin resistance
(ADA p 16)
What are some signs of insulin resistance? - Answer -+ Acanthosis nigricans
+ Hypertension
+ Dyslipidemia
+ PCOS
+ Small-for-gestational-age birth weight
(ADA p 16)
Immunizations recommended by the CDC for diabetic adults? - Answer -+ Influenza
+ Pneumococcal
+ Hep B
+ Zoster (for shingles)
+ TdaP
(CDC website)
Which types of cancer is diabetes associated with? - Answer -Diabetes is associated
wtih increased risk of these types of cancers:
+ Liver
+ Pancreas
+ Endometrium
+ Colon/rectum
+ Breast
+ Bladder
NOTE: Association may result from shared risk factors between T2DM and cancer (e.g.
older age, obestity, physical inactivity).
(ADA p 17)
When are the 4 critical times to evaluate the need for diabetes self-management
education and support (DSMES)? - Answer -1) At diagnosis
