Diabetes

Question 1

What is the definition of “impaired fasting glucose”?

Answer 1

Fasting plasma glucose 100-125 (126 or higher is diagnostic of diabetes)

Question 2

What is the definition of “impaired glucose tolerance”?

Answer 2

Plasma glucose after 2 hour OGGT 140-199 (200 or higher is diagnostic of diabetes)

Question 3

What is the criteria for “metabolic syndrome”?

Answer 3

BP>130/85
Fasting glucose>100
TG>150
HDL40 inches (>35 inches in women)

(remember HTN, HLD, DM, and big waist)

Question 4

What are 5 secondary causes of diabetes?

Answer 4

1. Pancreatitis (acute or chronic
2. Cushings
3. Acromegaly
4. Pancreatic cancer
5. Drugs

Question 5

Why are sulfonylureas not first line?

Answer 5

Side effects of hypoglycemia + weight gain

Question 6

What diabetic medications cause weight gain and hypoglycemia (these side effects go hand in hand)

Answer 6

“TIMS”

1. Thiazolidediones
2. Insulin
3. Meglitinides (non-sulfonylurea things…)
4. Sulfonylurea

Question 7

What should you do for hospitalized patients with uncontrolled blood sugars?

Answer 7

Basal insulin nightly + rapid acting insulin before meals (NOT sliding scale. NOT continues insulin infusion unless super sick in the ICU)

Question 8

Diabetic retinopathy can be nonproliferative or proliferative. What are the signs of proliferative retinopathy (and thus loss of vision)?

Answer 8

cotton-wool spots

neovascularization

Question 9

Pathogenesis of diabetic proliferative retionpathy

Answer 9

Changes in retinal blood flow -> ischemia -> growth factors -> new blood vessels -> scarring, fibrosis -> retinal detachment -> vision loss

Also, new vessels -> leaky -> macular edema

Question 10

Treatment of diabetic retinopathy

Answer 10

photocoagulation

Question 11

What tests should you order when suspecting DKA?

Answer 11

Serum glucose
Electrolytes
Ketones
Arterial blood gas

Question 12

What is the course of DKA, usually?

Answer 12

• Several days of polyuria, polydipsia, blurred vision.
• Then nausea, vomiting, abdominal pain. Kussmaul respirations. Fruity breath odor. Tachycardia, hypotension.
• Then dyspnea, altered mental status
• Then coma

Question 13

List 3 precipitants of DKA?

Answer 13

1. Infections (flu, pneumonia, gastroenteritis)
2. Acute MI
3. Insulin pump malfunction/med non-adherence

Question 14

Diagnostic criteria for DKA?

Answer 14

1. Blood sugar >250

2. pH

Question 15

Diagnostic criteria for hyperglycemic hyperosmolar syndrome (HHS)?

Answer 15

1. Blood sugar >600
2. Serum pH > 7.30
3. Serum HCO3 > 15 (so not very acidic)
4. Serum Osm >320 mosm/kg
5. No urine or serum ketones

Question 16

Tx of HHS?

Answer 16

• FIRST, normal saline to replenish volume. Replace 50% of TBW deficit within 24 hours, then 50% in next 2-3 days
• Once fluids given, can give insulin drip. Check blood glucose every 1-2 hrs to adjust. Don’t give insulin first, or else taking up glucose will decrease osmotic pressure in the vessels, so fluid will flow out of the vessels and end organs could get non-perfused.
• Once BP+ urine output are normal, can use slower infusion hypotonic solution.
• Once patient is making urine, can give potassium if K+ levels are falling on labs. Try to keep it between 4.0 and 5.0.
• Once metabolically normal and patient is eating, can start subQ insulin. Should overlap with drip by a few hours.

Question 17

In DKA: Is Na+ high or low? Is K+ high or low?

Answer 17

Na+: Lab values is low, because glucose in vessels pulls fluid into vessels and dilutes sodium

K+: Lab value is high, because body is acidic and tries to put more H+ away into cells, causing K+ to come out of cells. But TOTAL BODY potassium is usually low.

Question 18

How acidic does DKA have to be in order to consider giving HCO3- to a patient?

Answer 18

pH