diabetes

Question 1

DM therapy goals

Answer 1

alleviation of symptoms
achievement of glycemic, BP, & lipid targets
prevention of acute/chronic complications

Question 2

leading cause of death in diabetics

Answer 2

macrovascular

Question 3

DM diagnosis

Answer 3

fasting BGL >126 mg/dL x2 occasions

Question 4

expected insulin requirements for type 1

Answer 4

0.5-0.8 units/kg/day

Question 5

somogyi effect

Answer 5

low 0300 BG
high pre breakfast BG

decrease HS dose

Question 6

dawn phenomenon

Answer 6

insulin desensitization at night

high 0300 BG
high pre breakfast bg

increase HS dose

Question 7

DKA hallmarks

Answer 7

hyperglycemia (>250)
ketoacidosis (pH <7.3, bicarb <15)
ketonuria

Question 8

DKA s/s

Answer 8

dry skin, mucous membranes, decreased skin turgor
kussmaul respirations
ketotic breath
s/s of infection - tachycardia, hypotension, tachypnea, hypothermia, fever
AMS
abd tenderness

Question 9

DKA diagnostics

Answer 9

ABG - pH <7.3, pCO2 decreased
CMP - bicarb <15, BG >250, hyperK (initially), hypoNa, elevated BUN/Crt
Serum osmolality - elevated
Serum ketones - positive
Beta-hydroxybutyrate - 3-8
UA - + glucose, + ketones
fluid deficit - 100ml/kg
imaging - CXR, HCT
EKG

Question 10

DKA fluid requirements

Answer 10

0.9% NS or LR

1-3L hr in first hour
1 L hour 2
2 L hours 3-4
1L q4 hours

change to D5 0.45% when BG <250

Question 11

adolescent DKA fluids

Answer 11

10-20 ml/kg in first 1-2 hours

total volume 40-50 ml/kg in first 4 hours

Question 12

DKA insulin regimen

Answer 12

start 1h after IVF, K recheck

initial bolus 0.1 unit/kg
cont infusion 0.1 unit/kg/hr

optimal BG decline is 100 mg/dL/h - 10% in first hour

Question 13

DKA K repletion

Answer 13

K >6 - do not replete
K 4.5-6 - 10 mEq/h
3-4.5 - 20 mEq/h

Question 14

DKA bicarb repletion

Answer 14

only if the patient is decompensating
pH <7.0
1.2 amps Na bicarb in 1L 0.45% saline

can cause worsened hypokalemia
can cause cerebral edema

Question 15

additional DM diagnostics

Answer 15

RBG >200 w symptoms
BG >200 2 h after 75 g glucose challenge
HgbA1c >6.5

Question 16

insulin durations

Answer 16

lispro, aspar, glulisine (rapid) - 3-4 h
regular (short) - 6-8h
NPH (intermediate) - 10-20h
Glargine (long) - 24h
Detemir (long) - 17h

Question 17

metformin

Answer 17

first line for T2DM
biguanide
CI in eGFT<45
AE - diarrhea, lactic acidosis

Question 18

sick day insulin dosing

Answer 18

cut long acting insulin in 1/2

Question 19

beta-hydroxybutyrate requiring hospitalization

Answer 19

> 3

Question 20

Dm therapy goals

Answer 20

fasting BG 80-130
postprandial <180
A1c<7

BP <130/80

LDL<70
total cholesterol <150

Question 21

exam findings for T2DM

Answer 21

obesity
hirsutism
acanthios nigricans

Question 22

most commonly prescribed diabetic agent

Answer 22

sulfonylureas (G-ide)
2nd line after metformin
hypoglycemia, weight gain