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56 Cards in this Set
- Front
- Back
what percent of Australians are estimated to have diabetes?
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7.5% (half are undiagnosed)
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list five risk factors for diabetes (or more!)
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genetic susceptibility, sedentary lifestyle, obesity, visceral adiposity, inflammation, dyslipidaemia, hypertension, age > 55, FHx, GDM, PCOS, prior IGT/IFG
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what percent of diabetics are Type 1?
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15-20%
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which are T2DM more susceptible to: MiV or MaV complications?
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Macrovascular complications
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when should screening for end-organ complications begin in T2DM?
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at diagnosis, as complications are usually already present
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when should screening for end-organ complications begin in T1DM?
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from 5 years after onset
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what is the primary determinant of end-organ complications in diabetes?
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Blood Glucose Levels
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in diabetes mellitus, what is the target level for LDL-C?
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<2.6 mmol/L
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in diabetes mellitus, what is the target level for HDL-C?
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>1.0 mmol/l
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in diabetes mellitus, what is the target level for TGs?
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<1.7
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in diabetes mellitus, what is the target level for total-cholesterol?
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<4.0
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what is the most common cause of death in T2DM?
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cardiovascular disease
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what is the most common cause of vision loss in the working age?
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T2DM
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how many amputations per year (in Australia) are attributed to T2DM?
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3000
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physical activity and diet can reduce HbA1c by how much?
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1.50%
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by the WHO's definition, what Fasting Plasma Glucose level is considered 'Diabetic'?
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≥ 7.0 mmol/L
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by the WHO's definition, what 2-hour OGTT level is considered 'Diabetic'?
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≥ 11.0 mmol/L
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by the WHO's definition, what Fasting Plasma Glucose level is 'normal'?
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≤ 6.1 mmol/L
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by the WHO's definition, what 2-hour OGTT level is considered 'normal'?
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≤ 7.8 mmol/L
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what are the three cornerstones of treating T2DM?
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education, diet & exercise (and the fourth one is 'love')
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poor glycaemic control of T2DM with oral medication is an indication for augmenting treatment with?
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insulin injections
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Actrapid, Humulin R, Novorapid, Humalog, Apidra are examples of what medication?
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rapid acting insulins (to be taken prior to meals)
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Protaphane, Humilin NPH, Lente, UltraLente, Monotard, Lantus, Levemir are examples of what medications?
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Long-acting insulins (to be taken prior to bedtime)
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Mixtard, Humulin, Humalog Mix25, Novomix 30 are examples of what medications?
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Pre-mixed insulin combinations
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what is the target HbA1c level for T2DM?
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< 7.0%
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what is first line management for T2DM?
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lifestyle intervention, then metformin
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what are the three options that should be considered if diabetes is not controlled with lifestyle & metformin?
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1) basal insulin, 2) sulfonylurea, 3) glitazone
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what is the benefit of adding basal insulin to poorly controlled T2DM?
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it is the most effective option for obtaining control
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what is the benefit of adding sulfonylurea to poorly controlled T2DM?
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it is the least expensive option to add on, of second line options
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what is the benefit of adding glitazone to poorly controlled T2DM?
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there is no increased risk of hypoglycaemia
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what patients with T2DM are considered 'high risk' and should be screened for ischaemic heart disease?
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those with: a) dyslipidaemia, b) hypertension, c) family history
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what investigations should be considered for IHD, in T2DM patients?
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stress ECG, stress echo, stress nuclear scan, hi-res CT
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what management options should be considered for IHD, in T2DM patients?
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anti-hypertensives, statins, aspirin, stenting/CABG
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in detection of nephropathy, what levels are considered 'microalbuminuria'?
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20-200ug/min
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how is microalbuminuria detected?
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urinalysis: albumin/creatinine ratio
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how long does it take for microalbuminuria to commence in DM, typically?
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10-15 years
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how long does it take for macroalbuminuria to commence in DM, typically?
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15-20 years
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what is the definition of macroalbuminuria?
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> 200ug/min
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how is macroalbuminuria detected?
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urine dipstick
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which is a more sensitive indicator of renal function decline: serum or urine creatinine?
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urine; serum creatinine rises late in renal impairment
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how many times is it necessary to measure proteinuria to diagnosis nephropathy?
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2 or more times
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what is the antihypertensive of choice to protect the kidneys in diabetes?
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ACE-I/ARB
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callus formation is typically found where on diabetic feet?
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the tarsal heads
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what are risk factors for foot ulceration in diabetes?
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ischaemia, infection, patient compliance, neuropathy, deformity
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in testing diabetics for peripheral neuropathy, what is the best predictor of ulceration in the following year?
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insensate to monofilament
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how should peripheral neuropathy (the feet) of diabetics be managed?
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proper foot wear, podiatry care, pressure offloading, dress/debride
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how should moderate diabetic retinopathy be managed?
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no immediate treatment; increase frequency of checks, to annual
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diabetic retinopathy which demonstrates small haemorrhages and hard exudate, but no new vessels is classified as?
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'mild' to 'moderate'
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diabetic retinopathy which demonstrates large haemorrhages, soft exudates and dilated/tortuous veins is classified as?
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'severe', or 'pre-proliferative'
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what is the management strategy for severe diabetic retinopathy?
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increase frequency of checkups (from annual)
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diabetic retinopathy which demonstrates new vessels on the disc/elsewhere (NVD/NVE) is classified as?
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proliferative'
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what is the management strategy for proliferative diabetic retinopathy?
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Pan-retinal laser treatment (often curative)
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T1DM patients are afflicted primarily with what type of retinopathy?
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Proliferative retinopathy
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T2DM patients are afflicted primarily with what type of retinopathy?
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Macular oedema
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diabetic retinopathy which demonstrates increased diameter of the macula, proximal exudates, and haemorrhages is classified as?
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Macular oedema
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what is the management for macular oedema?
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laser treatment (though not definitive; often recurs)
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