Diabetes

Question 1

Diabetes Mellitus

Answer 1

In metabolic disease resulting from the breakdown in the ability of the body to either produce and or utilize insulin, resulting in inappropriate hyperglycemia

Question 2

DM1

Pathology

Answer 2

Strongly associated with the presence of human leukocyte antigens (HLA-DR3 or HLA-DR4; antibodies against **glutamic acid decarboxylase are found in 80% patients with type 1)

Islet cell antibodies

** Ketone development usually occurs

Believed to be the result of an infectious or toxic environmental insult to pancreatic B cells genetically predisposed persons

Question 3

DM1 signs and symptoms

Answer 3

Polyuria
Polydipsia
Polyphagia
Nocturnal enuresis
Weight loss
Weakness

Question 4

Lab diagnostics for DM 1 and 2

Answer 4

** Serum fasting BG >= 126 on more than one occasion
Random plasma BG >= 200 with signs of hyperglycemia
Plasma glucose >= 200 measured two hours after a glucose load
A1C >=6.5%

Question 5

DM1 Managment

Answer 5

Analyze baseline studies

Optimal insulin regimen: basal insulin + mealtime blouses of rapid acting or short acting insulin

Question 6

Somogyi Effect

Answer 6

Nocturnal hypoglycemia develop stimulating a surge of counter regulatory hormones which raise blood sugar. Note that the patient is hypoglycemic at 3 AM but rebounds with an elevated blood glucose at 7 AM

Tx: Reduce or omit the at bedtime dose of insulin

Question 7

Dawn Phenomenon

Answer 7

Results when the tissue becomes desensitized to insulin nocturnally. Note that the blood glucose become progressively elevated throughout the night resulting in elevated glucose levels at 7 AM

Tx: add or increase the bedtime dose of insulin

Question 8

DM2 Pathology

Answer 8

Circulating insulin exists enough to prevent ketoacidosis but is inadequate to meet the patient’s insulin needs

Is caused by either tissue in sensitivity to insulin or an insulin secretory defect resulting in resistance and or impaired insulin production

Associated with obesity and syndrome X

Question 9

Syndrome X

Answer 9

Obesity
HTN
Abnormal lipid panel ( low HDL, High Triglycerides)

Question 10

Metabolic Syndrome

Answer 10

Waist Circumference: Men >= 40, Women >= 35 inches
BP>= 130/85
Triglycerides >= 150
FBG >= 100
HDL: men < 40 women <50

Question 11

DM2 signs and symptoms

Answer 11

Insidious onset
Polyuria
Polydipsia
Recurrent vaginitis
Peripheral neuropathies
Blurred vision
Chronic skin infections

Question 12

DM2 Management

Answer 12

Obtain baseline data
Therapy should begin with weight control for obese patients
Dietary treatment with guidelines
Exercise

Common drugs:
Metformin “starter”

Question 13

Metformin

Answer 13

Lowers basal and posprandial glucose levels by affective glucose absorption and hepatic gluconeogenesis

May cause weight loss and refuses LDLs;

Black box warning: may cause lactic acidosis “muscle pain”

Question 14

Trulicity

Answer 14

Mimic endogenous incretin glucagon-like-peptide (GLP-1); stimulate glucose dependent insulin release, reduce glucagon, and slow gastric emptying

Use with metformin may cause modest weight loss

Question 15

Exenatide

Answer 15

Stabilizes both fasting plasma glucose and A1C in patients with fewer GI side effects; administered SQ inj

Question 16

Liraglutide

Answer 16

dosed once a day without regard to meals

Question 17

Dulaglutide and semaglutide

Answer 17

Dosed once weekly

All drugs may causes GI disturbances and slight risk for pancreatitis

Question 18

DKA Pathology

Answer 18

A state of intracellular dehydration as a result of elevated blood glucose levels

Often, it is an acute complication of type one diabetes

Maybe the presenting sign of diabetes

Question 19

DKA Signs and Symptoms

Answer 19

Polyuria
Polydipsia
Weakness
N/V
Kussmaul’s breathing
LOC
Fruity breath
Orthostatic hypotension with Tachycardia 
Poor skin turgor

Question 20

DKA Lab and Diagnostics

Answer 20

Hyperglycemia >250
*** Ketonemia and/or ketonuria
Marked Glysuria
Acidosis pH <7.30
Low bicarbonate 
Elevated HCT, BUN/Creatinine
Hyperkalemia
Leukocytosis
Hyper osmolality

Question 21

Osmarilarity formula

Answer 21

2[Na + K +glucose /18]

Question 22

DKA Management

Answer 22

Protect airway
Administer O2
Isotonic fluids NS at least 1L in the first hour; Then 500ml/hr. If glucose > 500, use 1/2 NS after first hour (as water deficit exceeds sodium loss). When glucose falls <250 change to D51/2NS

0.1units/kg insulin IV bolus follow by 0.1 U/kg/hr. If glucose does not fall by at least 10% after the first hour, repeat bolus

Correct acidosis with bicarbonate gtt if <7.1

Do not treat initial hyperkalemia

Hourly urinary output monitoring

Supportive care

Question 23

HHNK Pathology

Answer 23

State of greatly elevated serum glucose, hyperosmolality, and severe intracellular dehydration without ketone production

Usually occurs as a complication of type two diabetes

Patients cannot produce enough insulin to prevent severe hyperglycemia, osmotic diuresis an extra cellular fluid depletion

Mortality rate 30-50%

Question 24

HHNK Signs and Symptoms

Answer 24

Polyuria
Weakness
Changes in LOC
Hypotension
Tachycardia
Poor skin turgor
Other signs of dehydration

Question 25

HHNK Labs and Diagnostics

Answer 25

Greatly elevated serum glucose >= 600 commonly >1000

Hyper osmolality >310

Elevated BUN/Cr

Elevated A1C

Relatively normal pH

Normal anion gap

Question 26

HHNK Management

Answer 26

Protect airway
Administer O2

Isotonic fluids at least 1 L in the first hour; then 500 mL per hour. If glucose greater than 500 use half normal sailing after first hour. When glucose levels fall less than 250 change to D5 half normal saline to prevent hypoglycemia

0.1U/kg bolus followed by 0.1u/kg/hr if glucose does not fall by at least 10% in the first hour repeat bolus