In my last installment I did a pretty good job of belly aching about what a pain preparing for the CDE exam was for me. Kind of like an experience with oral surgery, now that I am a couple of months “post-exam”, all of that preparation didn’t seem so bad. In this installment I share some of the cool things that I learned as I prepared to take the CDE exam.
Concepts extracted from Diabetes Self-Management Education Desk Reference, 2nd Ed., 2011
Chapter 1- The Art & Science of Disease Management
Incidence = Risk of getting a condition
Prevalence = People who have the condition
Chapter 5- Being Active
Exercise Kcals Expended per Week
- 1000 exercise kcals = reduction in all-cause mortality
- 2000 exercise kcals = maximal health benefits and wt loss
Peripheral Neuropathy (PN)
- Moderate intensity walking does not increase risk for foot ulcers and reulceration
- Mild to moderate exercise can prevent the onset of PN
- Avoid jogging (3x increase in foot pressure compared to walking)
Chapter 12- Pathophysiology of the Metabolic Disorder
Type 1
- Hyperglycemia and DM symptoms only develop after 90% of beta cells are destroyed
Type 2
- 70% of beta cell function has been lost when oral glucose tolerance test reaches 120-140 mg/dL
- People with Pre-DM also have decreased beta cell mass
- Adipocytes become resistant to the antilipolytic effect of insulin and pour fat into bloodstream increasing free fatty acids (FFAs)
- Elevated FFAs exacerbate liver and muscle insulin resistance, drive hepatic gluconeogenesis and impair beta cell insulin secretion
DM & CAD
- Hyperglycemia = proinflammatory, prothrombotic, causes platelet aggregation, impairs endothelial function and left ventricular function, and increases FFAs
Chapter 13- Type 1 DM Throughout the Life Span
Missing Meal Insulin Bolus
- Every 4-5 missed boluses correlates with an increase in A1C of 1%
Chapter 15- Medical Nutrition Therapy
Fructose/Galactose
- Metabolized by liver into glycogen and/or triglycerides (fructose elevates TGs); very little is converted to glucose
Chapter 16- Exercise Rx
Exercise CBG Guidelines
- Medication with hypoglycemia side effects: Keep CBG > 90
- Insulin: Keep CBG > 110
- Non-hypoglycemic oral agents: No threshold
Chapter 17- Pharmacotherapy for Glucose Management
Metformin
- If started w/in 3 months of dx may preserve beta cell function
Normal Insulin Secretion
- Healthy non-pregnant, non-obese adult = 0.5-0.7 U/Kg per day
Chapter 18- Pharmacotherapy: Dislipidemia & HTN
Typical DM Dyslipidemia
- Increased TG/low HDL with LDL similar to non-DM, but LDL is smaller, denser and more atherogenic (secondary to increased TGs)
Statins
- Increase buoyancy or particle size of LDL molecules
Chapter 19- Biologically-based Practices: A Focus on Dietary Supplements for Diabetes
Alpha Lipoic Acid (ALA)
- Found in spinach, broccoli, potatoes, yams, carrots, organ meat
- May help improve insulin sensitivity
- May help with neuropathy (600-1200 mg per day)
Chapter 20- Combating Clinical Inertia through Pattern Management and Intensifying Therapy
Dawn Phenomenon = Morning hyperglycemia secondary to overnight growth hormone secretion
Somogi Phenomenon = Exaggerated counterregulatory response to early morning hypoglycemia resulting in a “rebound” hyperglycemia
Chapter 24- Macrovascular Disease in Diabetes
Is it Peripheral Artery Disease (PAD) or Peripheral Neuropathy (PN)?
- PAD: Pain comes with walking and is relieved by rest
- PN: Pain exacerbated by rest and relieved by walking
Chapter 26- Diabetic Kidney Disease
Risk of Cardiovascular Disease (CVD) with Chronic Kidney Disease (CKD)
- 30 times the norm
- Primary cause of death in CKD is CVD
Chapter 27- Diabetic Neuropathies
Glycemic Control
- Can improve/reverse symptoms
- Symptoms may get worse before they get better (during early phase of glycemic control, blood is shunted away from damaged area. Later body adapts with vasodilatation)
Gastropathy
- CBG > 240 mg/dL impairs gastric emptying
Glucagon Response in Type 1
- Impaired with DM 1-5 years
- 14-31 years with DM almost undetectable