16. Clinical Approach to DM and Hypoglycemia

Question 1

What presentations are similar with diabetes and syphilis

Answer 1

Thirst and frequency of urination

Question 2

What is the most common cause of hyperthyroidism in the elderly **

Answer 2

Toxic nodular goiter

Question 3

What is the more aggressive form of thyroid papillary ca?

Answer 3

Tall cell papillary ca

Question 4

What does MODY stand for? and LADA?

Answer 4

MODY = maturity onset Diabetes of Youth
LADA = Latent Autoimmune Adult Diabetes - patients who have antibodies and low C peptides (usually in adults)

Question 5

Diagnosis of diabetes (lab values - 4)

Answer 5

Random plasma glucose >200mg/dL on 2 separate occasions + symptoms
FPG > 126mg/dL on 2 separate occasions
2hr plasma glucose > 200mg/dL
Hb A1C >6.5% ***

Question 6

How long does the HbA1C give an avg gluocse for?

Answer 6

3 months

Question 7

Natural hx of T2DM (course of disease)

Answer 7

Insulin resistance present in obese or people with impaired fasting glucose levels
Insulin levels increase to overcome resistance
B-cell function declines, can’t produce enough insulin to overcome the resistance –> blood glucose levels rise

Question 8

What is the antibody seen in T1DM?

Answer 8

IA-2 antibody (islet antigen 2)

Question 9

What reduces Hb A1C the most?

Answer 9

insulin

Question 10

What is the first line of therapy in individuals with T2DM?

Answer 10

Lifestyle modifications

Question 11

Long lasting insulin that is given is called what?

Answer 11

Glargine (Think: Garg’s mom takes this)

Question 12

What is the no. 1 cause of blindness in US?

Answer 12

Diabetic retinopathy

Question 13

Diabetic nephropathy has what clinical effects?

Answer 13

hypertension, proteinuria, nephrotic syndromes, and renal failure
No. 1 cause of end stage renal failure

Question 14

What are the clinical effects of diabetic neuropathy?

Answer 14

Pain, paresthesia (pins and needles), hyperesthesia (excessive sensation), and weakness

Question 15

Classifications for diabetic neuropathies

Answer 15

1. acute
2. predominately motor
3. assymetrical neuropathy - symptoms in one hip due to encroachment of lateral femoral cutaneous n.
4. cranial neuropathy - can cause double vision
5. Chest pain from intercostal neuropathy

Question 16

Autonomic diabetic neuropathy is acute or insidiuous

Answer 16

insidious

Question 17

Effects of exercise (3)

Answer 17

1. reduce hyperglycemia
2. enhance insulin sensitivity
3. increase caloric expenditure, promote weight loss, reduce hyperglycemia

Question 18

What percent of body weight does a ptient need to lose to see a change in metabolism?

Answer 18

5% of body weight

Question 19

DKA requres 3 thing:

Answer 19

hyperglycemia
ketosis
acidosis

Question 20

How to tx DKA

Answer 20

fluids and insulin

Question 21

Hyperosmolar nonketotic coma (HHNKC) and tx

Answer 21

Small amount of ketones
Hyperosmolar due to very high glucose (>800)
VERY DEHYRDATED

Tx with fluids

Question 22

Difference in tx for DKA and Hyperosmolar nonketotic coma

Answer 22

DKA: insulin and fluids

Hyperosmolar nonketotic coma: fluids

Question 23

Why are ACE inhibitors used in patients with DM?

Answer 23

prevent or delay microalbuminuria