Diabetes

Question 1

How do you determine type 1 vs type 2 diabetes?

Answer 1

C peptide is one way

Anti glutamic decarboxylase (GAD)

EGAD he has DM1!! Needs insulin what

Anti tyrosine phosphatase

Question 2

Kid with nausea, vomiting and no diarrhea?

Answer 2

He doesn’t have gestro, he might have DM

Question 3

DM dx? only need one or 2

Answer 3

Fasting glucose 126 or more twice.

Or 200 after GTT (MOST COMMON)

Or A1c over 6.5

Question 4

Why more symp tone in hypoglycemia?

Answer 4

B/c epi is released in response to low glucose.

Weakness, diaphoresis, palpitations

Question 5

Risk of Beta blockers in DM?

Answer 5

Block symptoms of hypoglycemia!

Question 6

Tx of insulinoma? There are two of them

Answer 6

Surgical or diazoxide or octreotide

Question 7

How does pituitary insuffciency cause hypoglycemia?

Answer 7

Need cortisol for hepatic gluconeogenisis (think, its opposite of cushings)

Question 8

Treat of ADHD if stimulants fail?

Answer 8

CLONIDINE

TCA
bupropion

Question 9

Acute complications of DM 1 and 2?

Answer 9

DM is DKA

HHNS hyperosmolar hyperglycmic… state

Question 10

4 star dm2 tx!

Initially? KNOW THAT

Answer 10

Initially, Lifestyle and then metformin

START METFORMIN IMMEDIATELY

Question 11

Met syndrome dx? need 3 of them

Answer 11

Waist circumferance
Trig
HDL
BP
Fasting Glucsose

Question 12

What are symptoms of dumping syndrome?

Answer 12

Bloating and cramping. After gastric bypass and food not processed in stomach and dumped downstream

Question 13

Rapid insuline? Remember how?

Answer 13

NO LAG

Lispro
Aspart
Glulisine

Question 14

NPH insulin used how?

Answer 14

About 2 times per day. Works longer than regular

Regular is used with food if can’t afford very rapid

Question 15

!!Metformin adverse effects?

Answer 15

DIARRHEA (remember that?) and lactic acidosis

Metal by kidney

HOLD BEFORE IV CONTRAST GIVEN!!

Can be b12 malabsorption

Question 16

Sulfonylurea drug names? Mechanism? Side effect?

Careful with what populations?

Answer 16

Glyburide, glimepiride, glipizide.

Increase insulin release by activating channel.

HYPOGLYCEMIA

Hep or renal failure

Question 17

What are thiazolidiones? Mechanism? Side effect and avoid in who??

Answer 17

Glitazones!

Increase insulin sensitivity!!!

Weight gain! duh. Fluid retention so bad if CHF!!

Question 18

What are DPP4 inhibitors?

Answer 18

Prevents breakdown of incretins.

They are the gliptens (as they prevent breakdown of gliptens)

Question 19

GLP 1 agonists? Side effect?

Answer 19

Tides (like exanetide)

Increase glucose stimluated insulin release, decrease glucagon, slow gastric emptying

Side effect: nausea (b/c slow gastric emptying)

Question 20

SGLT2 inhibitors?

Answer 20

___agliflozin

Its in kidney and blocks reabsorption

think urine is FLOZIN through kdneys

Question 21

Acarbose?

Answer 21

Alphaglucosidease inhibitor. Decreases GI absorption so you get gassy and diarrhea

Question 22

Pramlintide?

Answer 22

Analog of amylin

Question 23

What antiDM med can’t be used in chf?

Answer 23

Glitazones (their mechanism is increase insulin sensitivity)

Question 24

DM at risk for silent MI why?

Answer 24

B/c low sensation

Question 25

DM patient needs what?

Answer 25

Lifestyle. 150 min a week
Healthy diet
Glucose lower med
Exam 3-6 months
BP goal
HBA1C less than 7
Micro albumin annually
Lipids annually
Flu
PNEUMONIA
ASPIRIN ACE AND STATIN

Question 26

gastric paresis tx?

Answer 26

Metaclopramide or gabapentin