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Esmond Wong is inviting you to a scheduled Zoom meeting.

Topic: Q and A with Esmond
Time: May 26, 2021 05:00 PM Mountain Time (US and Canada)

Here is the YouTube link to the 2021 May 26 Q and A session with Esmond

Esmond Wong is inviting you to a scheduled Zoom meeting.

Topic: Question and Answer session with Dr Sue Pedersen and Laurel
Time: May 27, 2021 05:00 PM Mountain Time (US and Canada)

Note that questions must be emailed to cdestudycourse@gmail.com by May 19. C-Endo and Dr Pedersen does not allow recording at their clinic so this presentation will not be uploaded onto YouTube afterwards. I have a Zoom account limit of 100 PARTICIPANTS.  First come, first serve.

For the Question and Answer session with Esmond

Esmond Wong is inviting you to a scheduled Zoom meeting.

Topic: Question and Answer session with Esmond
Time: May 28, 2021 05:00 PM Mountain Time (US and Canada)

Join Zoom Meeting
https://us02web.zoom.us/j/82685629405?pwd=cVhCRDFqbWRjUTlieHhqZGtwSmQzZz09

Meeting ID: 826 8562 9405
Passcode: 2021exam

This presentations will be uploaded onto YouTube afterwards. Note that to upload an hour video onto YouTube requires several hours and may not be up before the exam.

Here is the YouTube link for the 2021 May 28 Q and A session with Esmond

 

 

Hi Edmond,

Please can you confirm if Forxiga also has cardiac benefits or it only Jardiance and invokana.

Thank you

Latoya

Esmond: Hi Latoya this is a common question that I am getting.

A myocardial infarction is different from heart failure which is different from atrial fibrillation but all of the above affect the heart. So you have to be able to specify what type of cardiac benefit as the treatments are different i.e. myocardial infarctions with ASA, heart failure with diuretics and atrial fibrillation with warfarin.

If MACE then Forxiga did not show significant benefit. If heart failure then yes all 3 showed benefit. Review the 2020 Pharmacological update recommendations for details.

Esmond

Hi Esmond,

I have a few questions that I am hoping you can address in your Friday  Q/A.

– Is there a time when insulin dose (ie. levemir) should be split (ie. taken in the morning and HS)?
–  Can you address which oral medications can be used with basal/bolus insulin and which are contraindicated? I believe TZD’s and insulin secretagogues would be contraindicated.
– Are there any resources you would recommend when transitioning from one insulin regimen to another (ie. premixed to basal/bolus).

Thank you!
Kim

Hello Edmond,

Can you please explain how alcohol can causes hypoglycaemia in regards to pathophysiology?

Brittany

For the new 2020 guidelines (and for the exam), is Canagliflozin no longer considered to be a risk for amputations, due to the newer study?

Hi Esmond, I was wondering about the age consideration for those with CV risk factors and medications. In the table it says > 60, but in the summary of recommandations at the end of the chapter, it says 60 and above. Can you clarify? Thanks!

Mariam

Hi Esmond, I’m wondering whether you could explain the etiology of chronic liver disease decreasing A1C? I was going through the tables to remember last minute and realized that the factor listed was erythropoeisis… used to think it’s related to glycation??

Joy

 

Just a clinical question if a patient has metabolic decompensation and they are being started on Basaglar insulin does it make sense to start metformin at the same time, C-peptide testing has not been completed yet

Noor

People who hates monitor blood glucose which is the minimum recommended interval for Type 1 and 2 ?

Carolina

 

I am a bit confused about the carbs for the different items. For instance, 1 slice of bread, I found to be 15g, 12g, and 11g! Which one we should stick with?

Norah

 

If a patient is on basal insulin only and oral medications and is not at target what is the minimum amout of SMBG they need to do?

Noor

 

For Ramadan if person decides to go ahead and fast even though is CI which recommendation we can give?

Carolina

 

Can you review the legacy effect

Sally

15 grams of carbohydrates is equal to 175 ml of juice or soft drinks or 150 mls or 125 mls to treat hypoglycemia in adults?

Noor

Glucagon question
can you please explain the dose children

Carolina

difference between insulin analogs and mixed again? I probably missed it..

Marwa

 

will there be questions on oral semaglutide and nasal glucagon

Doris

Beta-blockers cause hypoglycemia or mask symptoms of hypoglycemia

Noor

If you have to change toujeo or Trsiba to nph, do decrease by 20%

Doris

If someone have a Hypoglycemic event, and his blood pressure was too high right after, could that be a reaction yo the hypoglycemic event?

marwa

 

I noticed there are different serving recommendations for treating hypos with juice – the hypo chapter suggests 2/3 cup and the chapter on T1 in children (and Beyond the Basics) suggests 1/2 cup is equal to 15g CHOs. Can you clarify this?

rebecca

For patients with T1DM do you consider ketone testing when BG >14 mmol/

Can you briefly discuss Somogyi effect and Dawn’s phenomenon?

Noor

 

When starting someone on MDI – you split the insulin 60/40 (bolus/basal) and divide the 60 into 3 meals (20-20-20). What do you do if the patient only has 2 meals? Do you just omit the 3rd 20% or would you split that 60% into 2 doses of 30%?

Carina

question about TMI. from essentials

Doris

would you start Forxiga if egfr is 32? A Dr insisted on starting a patient of ours on it. Upon several communications he agreed to do a follow-up egfr a month later. It dropped down to 26 & he increased forxiga dose to 10

Eman

What is the bedtime blood glucose target?

4-7 mmol/L

Kirolos

I believe in the Essentials, they list different a1c & BG targets for patients with diabetes & CKD (diabetic nephrophathy, pre-dialysis, dialysis, renal transplant). E.g. if on dialysis, A1c target is 7.5-8, FBG target is 5.6-7.8, 2hr pc is <11.1. I don’t think I’ve read this anywhere in CPG and I don’t think I’ve seen it in your cheat sheets. I just want to clarify that this is valid for the exam and in real life clinical practice, too.

Helen

Protease inhibitor increase blood glucose. Antiretroviral decrease A1C. kind of contradicting ?

Kirolos

Hi. Could you please clarify Basal insulin self titration… 10 units then increase 1-2 units each day until AC 4-7? Or increase every week instead?

Ali

What is the onset and peak of mixed insulins?

Kirolos

8. Which one of the following gastrointestinal conditions is associated with diabetic autonomic neuropathy? A. Gastric ulcer. B. Diverticulosis. C. Gastroparesis. D. Irritable bowel syndrome.

Sally

converting insulin dose regimen to U-500? do we convert unit by unit and divide 60%/40% or 35%, 30%, 35%

Doris

Which of the following is most likely to be interfering factor that may affect the accuracy of A1C result? a.Low Hematocrit. b.High doses of asa c.chemotherapeutic agents. d. sickle cell anemia

Kirolos

In regards to the CDECB practice questions – when they asked about the patient ~30yrs old who has irregular periods and on metformin – which would you warn her about, the answer was birth control and not alcohol. Can you explain that please? Metformin is safe in preg, why would pregnancy be your concern before alcohol

Clinical

 

Can you go over the research on the effect of cannabis on diabetes

Deb

 

To clarify, in patients with initial A1c <1.5% above target, it seems to suggest that we should start with lifestyle, and then add metformin if not at target within 3 months, but it also says to “start/INCREASE” metformin in the algorithm. In real life, I would probably be adding metformin initially, but is there a preferred approach if they asked this type of question on the exam? (like what you would start with as initial approach). Thanks

Jade

Is there a document highlighting to most salient features in the 2020 update? Feeling there may be a few questions around that.

George

Do they generally include both generic and brand names of medication on the exam?

Kelly

sorry I logged in late. Could you go over question 97 and 98 in the essentials?

Marian

Would the Libre system be adequate to look at Somogyi vs. Dawn effect overnite/early morning?

George

Isn’t toujeo a slower titration as well? Like q3-4 days

Jade

 

do we need to know dosages of all the AHA’s, titration schedules, max dosages for the exam?

Does someone who is 61 and smokes need to be on ASA? Does it count as CVD? Or CVD Risk and therefore it’s not needed?

Carina

f they ask us what type of insulin can be used in a pump, would the answer be rapid analogues only, or R and rapid analogues? I think in the essentials is says R can be used but just isn’t really recommended anymore

Jade

Is pancreatic cancer now a caution in DPP4i ? in 2020 update

Doris

I’m confused for when we would start an ACE-inhibitor/ARB. If a patient is <55 years old and has additional CV risk factor/end organ damage, would it be recommended to start an ACE-i/ARB?

Carmen

do we need to know dosages of all the AHA’s, titration schedules, max dosages for the exam?

Leslie