DB Lecture

Question 1

criteria for impaired fasting glucose

Answer 1

HgbA1C between 5.7% and 6.4%

Question 2

i. An autoimmune disease that destroys the pancreatic beta cells that results in the body not producing sufficient insulin
1) Requires exogenous insulin to survive
2) Usually does not present until about 90% of the beta cells have been destroyed

Answer 2

T1DM

Question 3

ii. Faster onset usually in ages of 20 or younger
1) Usually a thin body habitus
2) Ketosis is very common

Answer 3

T1DM

Question 4

i. Body is not responding to insulin
1) Have an over abundance of glucose and free fatty acid fail to stimulate the pancreas to secrete insulin
ii. Slower gradual onset in adults
1) Frequently obese
2) Rarely have ketosis
3) Risk factors: obesity (greatest risk factor), genetics, age (insulin production decreases with age)

Answer 4

T2DM

Question 5

i. Body has a surge of hormones, growth hormone included, and the body cannot release insulin/respond with insulin sufficiently to respond to the increase in blood sugar
ii. See hyperglycemia in the morning and NO hypoglycemia through the night
iii. Management:
1) Increase evening insulin

Answer 5

Dawn phenomenon

Question 6

i. Rebound response to nocturnal hypoglycemia that results in hyperglycemia in the AM
ii. Patient does have low sugars through the night
iii. Management:
1) Eat a snack before bed
2) Decrease evening insulin

Answer 6

Somogyi Effect

Question 7

a. Symptoms + random glucose of > 200 mg/dL
b. Fasting plasma glucose of > 126 mg/dL on two separate occasions
c. Plasma glucose of > 200 mg/dL two hours after a 75-g glucose load during an oral glucose tolerance test
d. A1C > 6.5%

Answer 7

diagnostic criteria for diabetes mellitus

Question 8

Other than the following sx, what are other common sx of DB?

i. Polydipsia
ii. Polyuria
iii. Polyphagia

Answer 8

iv. Fatigue
v. Weight loss
vi. Blurred vision
vii. Fungal infections
viii. Numbness, tingling of hands and feet

Question 9

MCC of death in diabetic patients is

Answer 9

CAD

Question 10

manifestations regarding macrovascular complications associated with diabetes mellitus

Answer 10

i. Main problem is accelerated atherosclerosis
1) Increased risk for stroke, MI, heart failure
2) Renal disease
ii. Increased peripheral vascular disease, cerebrovascular disease (strokes)

Question 11

Macrovascular complications treatments in general

Answer 11

Smoking cessation, daily aspirin, BP control, lipid-lowering agents, strict glycemic control

Question 12

MCC of end stage renal disease

Answer 12

Diabetic nephropathy

Question 13

hyaline deposition in one area of the glomerulus —> pathognomonic for DM

Answer 13

Nodular glomerular sclerosis of Diabetic nephropathy

Question 14

Screening test: Diabetic nephropathy

Answer 14

Microalbuminuria –> shows up in the urine about a year before you’ll find proteinuria on the dipstick
a) Usually see HTN develop between the microalbuminuria to proteinuria stages

Question 15

Diabetic nephropathy Treatment

Answer 15

1) ACE-inhibitor or ARB –> renal protective as dilates the efferent arteriole of the glomerulus as well to prevent increased glomerular pressure and prevent spillage of proteins

Question 16

Diabetic retinopathy

Answer 16

1) Microvasculature damages to the vasculature in the eye results in:
a) Cotton-wool spots
b) Hard exudates
c) Retinal hemorrhages
d) Venous dilations
2) Can also see cataracts, retinopathy, and glaucoma show up in these patients
3) Serious complications
a) Vitreal hemorrhage
b) Retinal detachment

Question 17

MCC of blindness

Answer 17

Diabetic retinopathy - Edema of the macula in the eye

Question 18

Diabetic retinopathy - Diagnostics

Answer 18

Require ophthalmologist screening yearly

Question 19

Diabetic retinopathy - Treatment

Answer 19

Laser photocoagulation

Question 20

1) Usually affects sensory nerves in a “stocking/glove pattern”
2) Usually begins in feet, later involves the hands (longest nerves are always affected first)
3) Lose sensory function of feet and unable to feel pain or ischemia in the feet

Answer 20

Peripheral neuropathy of DB:

Pathophysiology/Clinical manifestations

Question 21

1) Numbness and paresthesias are common
2) Hypersensitivity to light touch
3) Severe “burning” pain that is worse at night and intolerable

Answer 21

Peripheral neuropathy of DB

Question 22

Tx of Peripheral neuropathy of DB

Answer 22

1) NSAIDs
2) Gabapentin
3) Pregabalin
4) Duloxetine
5) TCAs

Question 23

1) Impotence in men is the most common presentation

2) Gastroparesis resulting in chronic nausea and vomiting with early satiety

Answer 23

Autonomic neuropathy of DB:

Pathophysiology/Clinical manifestations

Question 24

Treatment of gastrparesis

Answer 24

pro-motility agents (metoclopramide)

Question 25

1) Impaired leukocyte function, reduced blood supply, and neuropathy
2) Impaired wound healing

These are all common complications of what in DB?

Answer 25

Increased susceptibility for infection

Question 26

Common infections of DB?

Answer 26

a) Cellulitis, candidiasis, pneumonia, osteomyelitis, polymicrobial foot ulcers
b) Increased levels of sugars bring in more yeast/bacteria

Question 27

1) Secondary to insulin deficiency and glucagon excess that cause accelerated severe hyperglycemia and accelerated ketogenesis
2) Severe hyperglycemia leads to osmotic diuresis = dehydration and volume depletion

Answer 27

DKA

Question 28

1) Respiratory alkalosis
2) Fruity (acetone) odor on breath
3) Kussmaul’s respirations
4) Volume depletion
5) Polydipsia, polyphagia, polyuria
6) LOC, frank coma

Answer 28

DKA presentation

Question 29

1) Hyperglycemia: > 450 to 850
2) Metabolic acidosis
3) Ketonemia
4) Hypokalemia (esp. with infusion of insulin due to K+ shift to depolarize the beta cells)
5) Can see falsely negative ketones in urine and serum due to circulatory collapse

Answer 29

DKA diagnostics

Question 30

1) Insulin
a) DOUBLE CHECK K+
2) Fluids
3) Electrolytes –> potassium
Start 1 to 2 horus after insulin

Answer 30

DKA Tx

Question 31

1) Low insulin levels lead to hyperglycemia
2) Severely elevated glucose levels cause an osmotic diuresis with ensuing dehydration
a) Prevent ketogenesis through release of low levels of insulin
3) Severe dehydration due to the osmotic diuresis of hyperglycemia

Answer 31

Hyperosmolar hyperglycemic nonketotic syndrome (HHKS) pathophysiology

Question 32

1) CNS findings and focal neurologic signs are common
2) Seizures
3) Thirst, polyuria
4) Hypotension, tachycardia

Answer 32

Hyperosmolar hyperglycemic nonketotic syndrome (HHKS) presentation

Question 33

1) Serum glucose > 900
2) Hyperosmolarity with serum osmolarity > 320 mOsm/L
3) NO ACIDOSIS

Answer 33

Hyperosmolar hyperglycemic nonketotic syndrome (HHKS) diagnostics

Question 34

1) Fluid replacement with normal saline
a) When glucose gets to around 250, add in D51 (glucose water)
2) Insulin IV bolus and then low dose infusion

Answer 34

Hyperosmolar hyperglycemic nonketotic syndrome (HHKS) Treatment

Question 35

Insulin levels are usually ___ to ____ with T2DM

Answer 35

Insulin levels are usually normal to high with T2DM