Diabetes

Question 1

threshold to start insulin in critically ill pts

Answer 1

180

Question 2

for pts on insulin, target sugar goal is

Answer 2

140-180

Question 3

pre meal and random goal for pts not critically ill

Answer 3

pre-meal < 140

random < 180

Question 4

PO agent that can be used in acute illness/hospitalization

Answer 4

-glitazone

Question 5

how does renal failure impact inpatient hypoglycemia

Answer 5

leads to dec insulin clearance and dec gluconeogenesis –> both inc risk of low sugars

Question 6

how to adjust insulin dose based on gfr

Answer 6

GFR > 30 … no change
GFR 15-29… dec by 30% (give 70%)
GFR < 15 or pt on dialysis…cut in half

Question 7

how do glucocorticoids effect fasting sugars

Answer 7

inc hepatic gluconeogenesis gives inc fasting glucose

Question 8

how do glucocorticoids effect post-prandial sugars

Answer 8

dec glucose uptake in adipose leads to inc post-prandial sugars

Question 9

what is main effect of glucocorticoids on glucose control

Answer 9

post-prandial effect leads to inc sugars during day

Question 10

what procedure/surgery requires most peri-operative insulin

Answer 10

CABG

Question 11

for post-op pt with A1c of 6.8 who was on NPH insulin, keep this regimen or switch to basal-bolus?

Answer 11

switch to basal-bolus

Question 12

if pts on tube feeds, how often do u check sugars? what do you do for insulin?

Answer 12

check sugars q6hrs

basal insulin only

Question 13

insulin to carb ratio for clear liquid diet or tube feeds

Answer 13

1 unit insulin for 15 grams carbs

Question 14

if pt was on tube feeds and they are stopped what do you do regarding sugar management?

Answer 14

give IV fluids that have same amount of glucose

Question 15

acid base status for dka

Answer 15

anion gap metabolic acidosis, ph < 7.3, bicarb < 15, ketones present

Question 16

acid base status for hyperosmolar hyperglycemic non-ketosis

Answer 16

pH > 7.3, bicarb > 15, hyperosmolarity > 320 Osm

Question 17

sugar levels for DKA vs HHS

Answer 17

> 450 for DKA

> 900 for HHS

Question 18

tx of DKA

Answer 18

insulin, IV fluids, potassium

Question 19

tx of HHS

Answer 19

low-dose insulin, aggressive IV fluids

Question 20

sxs of DKA

Answer 20

altered mental status, kussmaul respirations, fruity odor breath

Question 21

dehydration is seen in dka or hhs

Answer 21

BOTH but HHS more

Question 22

infection can cause dka or hhs?

Answer 22

dka

Question 23

if you just give insulin to pt in DKA, can have

Answer 23

low sugars
low K
low phos

Question 24

what to give a pt in dka

Answer 24

insulin
glucose 5-10g/hr
20 mEq K+

Question 25

insulin administration for DKA

Answer 25

initial IV bolus of 0.1 unit/kg then insulin drip at 0.1 unit/kg/hr

Question 26

if sugars dont dec after 1 hr of insulin for DKA pt…then?

Answer 26

re-bolus, increase rate by 50% of initial dose

Question 27

IV fluids for DKA tx

Answer 27

Normal saline if normal cardiac fxn (otherwise 1/2 NS)

Question 28

if pt is not oliguric, how much K given for DKA pt?

Answer 28

added to IV at 40mEq/L

Question 29

when do you switch to D5NS for DKA tx?

Answer 29

when sugars < 200

Question 30

when do you switch to subq insulin for DKA tx?

Answer 30

after 12-16 hrs

Question 31

insulin functions

Answer 31

1. vasodilation
2. metabolic modulation
3. inc cell survival
4. restrain platelets
5. promote fibrinolysis
6. enhance granulocyte fxn
7. potent anti-inflammatory

Question 32

do you give insulin to pts in ICU who aren’t eating/not eating much?

Answer 32

yes - give continuous IV insulin

Question 33

how to go from IV insulin to subq - conversion factor

Answer 33

multiply last drip dose x 20 (this is how much glargine to give). turn off IV drip 2 hrs later

Question 34

basal bolus split

Answer 34

50% basal

50% bolus (divided by 3 meals)

Question 35

how to calculate total daily dose of insulin

Answer 35

pt’s weight:
x .4 for type 1 DM
x .6 for new onset or lean type 2 DM
x .8 for type 2 DM

Question 36

in pts on glucocorticoids - basal bolus split?

Answer 36

more than 50% can be given as bolus

Question 37

for short acting glucocorticoids, which insulin to give?

Answer 37

can consider NPH instead of glargine

Question 38

if pt on continuous tube feed and glucose less than 120, how do you adjust insulin dosing?

Answer 38

dec by 10%

Question 39

if pt on continuous tube feed and glucose less than 80, how do you adjust insulin dosing?

Answer 39

dec by 20%

Question 40

how to calculate total daily dose of insulin if on tube feeds

Answer 40

pt’s weight:
x .5 for type 1 DM
x .8 for new onset or lean type 2 DM
x 1 for type 2 DM

Question 41

in pt with tube feeds, how do you adjust basal to account for previous day’s correction factor?

Answer 41

add the basal to the amount of correction given and make that the new basal

Question 42

how do you adjust basal-bolus to account for previous day’s correction factor

Answer 42

half of correction factor is added to give new basal value and the other half is split up into the TID prandial bolus

Question 43

what med would you start in a diabetic pt to improve creatinine clearance and decrease proteinuria?

Answer 43

ACEI

Question 44

hypothermia in a diabetic pt can suggest?

Answer 44

hypothyroidism

sepsis

Question 45

type 1 DM and hyperinsulinemia both lead to inc risk of

Answer 45

coronary dz