Clinical Diabetes

Question 1

What is the diagnostic criteria for diabetes in terms of:
Fasting Blood Glucose (or FBS-fasting blood sugar)

Symptoms with Random Blood sugar

HbA1c

2hr. oral glucose tolerance test

Answer 1

FBS: greater than 126mg/dL on 2 occasions
or
Diabetes symptoms with random blood sugar over 200mg/dL
or
HbA1c greater than 6.5%
or
2 hour oral glucose tolerance test greater than 200mg/dL

Question 2

What is impaired fasting glucose?

Answer 2

Range between normal fasting glucose (less than 100mg/dL) and diagnosed DM (greater than 126mg/dL)

Question 3

Name the 3 types of insulin treatment for Type 1 DM.

Answer 3

Short Acting: Lispro
Intermediate: NPH
Long Acting: Glargine

Question 4

What is the honeymoon phase of Type 1 DM?

Answer 4

Patient usually presents with emergent diabetic ketoacidosis (DKA). Upon insulin therapy they magically regain the ability to secrete their own insulin. Lasts only a few weeks and they still require moderate exogenous insulin therapy

Question 5

What is the Dawn Phenomenon?

Answer 5

Early morning diurnal hormones (GH, cortisol, catecholamines) cause the liver to release glucose. In Type 1 DM the lack of insulin leads to hyperglycemia

Question 6

What is the Somogyi Effect?

Answer 6

Night time hypoglycemia causes a nocturnal glucose release by the liver

Question 7

Hallmark of Type 2 DM.

Answer 7

Insulin Resistance

Question 8

Best initial treatment for Type 2 DM.

Answer 8

Weight loss, diet, exercise

Question 9

Name the 3 sulfonylurea drugs.

Answer 9

Glyburide
Glipizide
Glimeperide

Question 10

Name the two Meglitinides and when they are taken.

Answer 10

Repaglinide
Nateglinide

Taken only pre-prandial

Question 11

Biggest side effects of Metformine.

Answer 11

Lactic Acidosis, diarrhea, abdominal discomfort

Question 12

MOA of alpha glucosidase inhibitors.

Answer 12

Slows carbohydrate uptake by the GI tract.

-leads to excessive flatulence leading to poor compliance

Question 13

Name the 2 Alpha Glucosidase Inhibitors

Answer 13

1. Acarbose

2. Miglitol

Question 14

Name the 2 Thiazolidinediones.

Answer 14

1. Rosiglitazone

2. Pioglitazone

Question 15

Effect of Thiazolidinediones in Type 2 DM.

Answer 15

Insulin sensitization
Decrease TGs
Increases HDL and LDL

Question 16

Name the two Incretin Mimetics and the MOA.

Answer 16

Exenatide
Liraglutide

MOA: GLP-1 analog that mimics endogenous insulin

Question 17

What are the goals for DM treatment regarding
FBS
HS
HbA1c

Answer 17

FBS: 80-120mg/dL
HS: 100-140 mg/dL
HbA1c: less than 7%

Question 18

What are the microvascular and macrovascular complications of DM 1 and 2?

Answer 18

Micro: retinopathy, neuropathy, nephropathy
Macro: coronary artery disease, peripheral vascular disease, stroke

Question 19

Treatment of orthostasis seen in DM.

Answer 19

Midodrine

Question 20

Main two sequelae from Peripheral Sensory neuropathy caused by DM.

Answer 20

Foot Ulcers
Carcot Deformity

(check feet every visit)

Question 21

Tx for gastroparesis caused by DM.

Answer 21

Erythromycin

Question 22

Best two targets for treatment of Nephropathy in DM.

Answer 22

Glycemic Control: lifestyle changes

HTN control: ACE-Is and ARBs

Question 23

What are the targets to reduce risk of CAD in DM patients and the respective goal levels?

Answer 23

Total Cholesterol: less than 200
LDL: less than 100
HDL: greater than 60
TGs: less than 150
BP less than 120/80

Question 24

What 4 things should be included in every check up in a patient w/ DM?

Answer 24

1. Eye exam
2. Foot Exam
3. Lipid Panel
4. Microalbumin

Flu Vaccine annually

Question 25

Describe how to diagnose Gestational DM.

Answer 25

Oral Glucose Tolerance Test (OGTT) Administration of 100g of Glucose If two are (+) then positive diagnosis 1. Fasting Glucose greater than 95 mg/dL 2. 1hr post prandial greater than 180mg/dL 3. 2hr post prandial greater than 155 4. 3hr post prandial greater than 140

Question 26

Tx for GDM.

Answer 26

Insulin Therapy Sulfonylureas Metformin

Question 27

Pathology of MODY.

Answer 27

Impaired glucokinase function in pancreatic beta cells. Inability to trap glucose. (other mutations do occur but this is most common)

Question 28

Major fuel source leading to diabetic ketoacidosis (DKA).

Answer 28

Fatty Acids (FA)

Question 29

What is the biochemical definition of DKA?

Answer 29

Blood Sugar: greater than 250 pH: less than 7.3 Bicarb: less than 18 Ketonuria or ketonemia

Question 30

Name the major Ketone Bodies that accumulate and the one that exacerbates nausea and vomiting.

Answer 30

Acetone Acetoacetic Acid Beta-hydroxyl butyric acid (N/V)

Question 31

Body's attempt to correct the metabolic acidosis of DKA.

Answer 31

Kussmaul Breathing

Question 32

Describe the general mechanism of DKA.

Answer 32

1. Lack of insulin causes accumulation of glucose in blood 2. Counter regulator hormones think the body is starving and influence the liver to make more glucose and induce lipolysis. 3. Ketones are made from the fat and used as energy causing acidosis 4. Glucose is filtered by the kidneys and they use water to remove the excess glucose causing dehydration

Question 33

Main cause of DKA.

Answer 33

It is the first presentation of undiagnosed diabetes patients

Question 34

Primary infectious organism that causes DKA.

Answer 34

Klebsiella pneumonia

Question 35

Biggest component of DKA treatment.

Answer 35

Fluid replacement | isotonic saline

Question 36

Describe Hyperosmolar Nonketotic State.

Answer 36

State of hyperglycemia (greater than 600) with no rise in ketone bodies. Altered mental status, dehydration, basic pH More common in Type 2 DM, often preceded by some illness (MI, CVA, infection)

Question 37

Tx for Hyperosmolar Nonketotic State.

Answer 37

Fluid replacement Correct hyperglycemia with insulin Treat the underlying cause

Question 38

What is Whipple's Triad

Answer 38

Seen in hypoglycemia 1. Documented low blood sugar 2. signs and symptoms of hypoglycemia 3. Reversal of symptoms with glucose administration