Approach To Endocrine Complaints1: Metabolic Syndrome, Obesity, Diabetes

Question 1

Reason fro excess H

Answer 1

Neoplasm
Autoimmune
Excess H administration

Question 2

Reason for H Deficiency

Answer 2

Autoimmune destructions, surgery, infection, inflammation, hemorrhage

Question 3

How to treat H resistance

Answer 3

Decrease H. Levels

Question 4

How many Americans have BMI over 25

Answer 4

70% (overweight)

Question 5

Metabolic Syndrome
(Insulin Resistance Syndrome)
Sx to Dx this

Answer 5

33% USA (any 3 of the following)

1. Central Obesity (waist is >40in M or >35in W)
2. High TAGs, or HDL low
3. BP : > 130/85mmHg
4. Fasting Glucose : >100mg/dL

Question 6

How to Manage MS

Answer 6

1. Diet : Mediterranean + DASH (stop HTN)
2. Exercise (150min/week)
   * reduce weight
3. Metformin : treat high fasting glucose

Question 7

Diabetes Type 2

What is happening

Answer 7

1. Insulin Resistance (high glucose levels in BVs)
2. Impaired insulin secretion
3. Increased Hepatic Glucose production
   =hyperglycemia + organ damage

Question 8

Diabetes Mellitus

Reason many are undiagnosed

Answer 8

Long asymptotic period of up to 10years(25% of people with diabetes dont know)
9.4% of USA has this

Question 9

How to Dx DM

Answer 9

elevated hemoglobin A1C (see average Blood level the past 3 months)

Question 10

Common side Sx of DM

Answer 10

1. Blurred vision
2. Focus problems
3. High thirst + urination (polydypsia + polyuria)
4. Slow sore healing
5. Neuropathy
6. Polyphagia (eat more)
7. Weight loss

Question 11

DM common things on PE

Answer 11

1. Acanthosis Nigricans
2. Foot Ulcer
3. Retinopathy, hemorrhage or aneurysm, cotton wool spots

Question 12

Dx DM you need 4 things

Answer 12

1. A1C > 6.5%
2. Fasting Glucose > 126
3. 2hr glucose > 200 (oral)
4. Random Glucose > 200 (+ hyperglycemia sx)

Question 13

How to do PE for DM

Answer 13

Inspect, Palpate
Pedal pulse, capillaries refill, temperature
10g monofilament Test
128g tuning fork Test

Question 14

DM management

Answer 14

1. nutrition therapy
2. Self-management
3. Metformin
4. Insulin (if high end of diabetes)

Question 15

Organs that DM most Targets

Answer 15

1. Kidneys
2. Eyes
3. NS
4. CVS
5. Skin
6. Teeth
7. Genitourinary System

Question 16

In the next 5 years how many is world will have DM

Answer 16

43%

Question 17

First step of DM

Answer 17

Insulin resistance

Insulin rises

Question 18

Second step of DM

Answer 18

Glucose rise also

Question 19

3rd step of DM

Answer 19

Glucose increases more
Insulin cant be made anymore
Still high insulin resistance

Question 20

What genetic factor is involved in T1D

Answer 20

A type of HLA allele (common in Scandinavia)

Immune response is triggered by an environmental tigger ——> destroys B-cells

Question 21

Sx of T1D

Answer 21

1. Weigh loss more then weight gain
2. DKA (25% only have this)
3. Fatigue
4. Polyuria, Polydipsia,
5. NORMAL insulin sensitivity

Question 22

What 3 autoimmune disease can cause T1D

Answer 22

1. Autoimmune Thyroiditis
2. Celiac Disease
3. Addison’s Disease : adrenal gland destroyed

Question 23

Hyperglycemia in T2D and T1D

Answer 23

Higher in T1D

Question 24

DKA

Answer 24

Insulin deficiency + increase glucagon released (even more glucose)
= ketone bodies form in liver -> highly acidemic +dehydration
*seen in T1D

Question 25

HHS (Hyperglycemic Hyperosmolar State

Answer 25

Insulin deficiency + low fluid intake, = sever dehydration + electrolyte loss (urine a lot also) * for T2D

Question 26

What should DKA and HHS patients do

Answer 26

Go to hospital IV Fluids IV insulin K replacement

Question 27

Hypoglycemia in DM

Answer 27

Usually due to medication 70% of pts 6-10% die from this in T1D *PEARL = confusion, altered mental state, seizure, low consciousness = check BLOOD GLUCOSE (usually when blood is below 70 or can be in higher ranges)

Question 28

Reason for hypoglycemia Sx when brain is trying to get enough glucose energy

Answer 28

1. ACH SYMPATHETIC: sweating ,higher, paresthesia 2. Adrenal Gland EPI + NORE + CORTISOL : palpitations, tremor, anxiety * can be very serious and lead to hypoglycemic unawareness —-> unconscious immediately

Question 29

Where is acanthosis Nigricans is found in

Answer 29

T2D

Question 30

Poor skin turgor is

Answer 30

In t1d

Question 31

Hallmark t1d

Answer 31

Dehydrated and poor skin turgor, and ketogenic, weight loss | Poor skin turgor happens from dehydration