Diabetes Flashcards
- In patients with acquired generalized lipodystrophy (aka Lawrence syndrome), what do you test?
- what is the drug approved for treatment?
- Leptin and adiponectin (both suppressed)
- metreleptin (a recombinant human methionyl leptin)
- In asymptomatic adults, diabetes screening should be considered in patients who are? 2. Testing in patients with prediabetes should be done? 3. Women diagnosed with gestational diabetes should have lifelong testing at least every how many years?
- overweight or obese or who have 1 or more of the following risk factors: first-degree relative with diabetes, high-risk race/ethnicity, history of CVD, HTN, HLD < 35, and/or TG >250, PCOS, physical inactivity 2. yearly 3. at least every 3 years
The ADA criteria for the diagnosis of diabetes are? (4 total)
- hgb A1c > or equal to 6.5% OR 2. Fasting plasma glucose > or equal to 126 mg/dl OR 3. Two-hr OGTT plasma glucose > or equal to 200 mg/dL after a 75 g load OR 4. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose value > or equal to 200 mg/dL *In the absence of unequivocal hyperglycemia, criteria 1 to 3 should be confirmed by repeat testing
In patients with hemoglobinopathies (such as sickle cell disease or other causes or increased RBC turnover), what should be measured?
Fructosamine (which is a measure of glycosylated plasma proteins, proportional to the mean blood glucose over the previous 2 weeks)
Case: A patient with T1DM develops unpredictable blood glucose measurements and recurrent episodes of hypoglycemia. What to test for?
TTg IgA (Celiac disease) = causes erratic intestinal absorption of nutrients
Risk of T1DM in the following: 1. No family hx 2. offspring of an affected parent 3. offspring of BOTH affected parents
- 0.4% 2. 4-8% (having an affected father confers a higher risk than having an affected mother) 3. up to 30%
calculations for conversion from MDI to insulin pump: 1. How to calculate pump TDD using MDI TDD 2. How to calculate pump TDD using weight based 3. Calculation for basal rate? 4. Calculation for ICR? 5. Calculation for ISF?
- pre-pump TDD x 0.75 2. weight: kg x 0.5 or lb x 0.23 3. basal rate: (pump TDD x 0.5)/24 h Start with one basal rate. Adjust according to glucose trends over 2-3 days. Adjust to maintain stability in fasting state (between meals and during sleep). Add additional basal according to diurnal variations (dawn phenomenon) 4. ICR = 450/TDD Adjust based on low-fat meals with known CHO content. Acceptable 2-hr postprandial rise is ~60 mg/dL above preprandial BG. Adjust CR in 10-20% increments based on post-prandial BG. alternative = fixed meal bolus = (TDD x 0.5)/3 meals when not carb counting. Continue existing CR approach from MDI regimen 5. ISF = 1700/Pump TDD To assess sensitivity factor, BG should be checked 2 h after correction: if BG is within 30 mg/dL of target range, sensitivity is correct. Make adjustments in 10-20% increments if 2-h post correction BGs are consistently above or below target
The mechanism of action of SGLT2-inhibitors is?
To reduce filtered glucose reabsorption, therefore lowering the renal threshold for glucose excretion from 220 mg/dL to less than 100 mg/dL
What intervention will most likely result in complete resolution of diabetes-related necrobiosis lipoidica?
Pancreas transplant +/- a kidney transplant
Case: Findings on abdominal CT of significant subcutaneous air and edema in the left lateral anterior abdominal wall tracking into the left groin and extending into the perineum. an aggressive form of necrotizing fasciitis due to mixed aerobic and anaerobic organisms that affects the perineal and genital region. What this called?
Fournier gangrene uncontrolled diabetes, immunosuppressed states, and obesity often contribute to its rapid progression.
- Diabetes-related muscle infarction is also known as? 2. symptoms? 3. lab findings? 4. MRI findings? 5. Pathogenesis? 6. Treatment?
- muscle ischemia or spontaneous myonecrosis 2. acute or subacute pain, swelling, and tenderness, typically in the thigh or in the calf. 3. nonspecific and normal. Some may have elevated CK, ESR, and WBC. 4. high intensity T2, and hypointense/isointense T1 5. Vasculopathy associated with longstanding, suboptimally controlled diabetes 6. symptomatic management with rest, optimal glycemic control, analgesia, and low-dosage aspirin.
- Acquired partial local lipodystrophies include? 2. Treatment and MOA?
- lipoHYPERertrophy and lipoAtrophy at insulin injection sites. Insulin absorption from these sites is unpredictable and can lead to erratic glycemic control and an increased predisposition to severe hypoglycemia. Mast cells overproduce cytokines and TNF which inhibit adipocyte differentiation. Failure to rotate insulin injection sites and reuse of needles are associated with risk for lipoatrophy. 2. sodium cromolyn, which is a mast-cell stabilizer
In unprovoked hypoglycemia in patients with preexisting autoimmune disease (such as Graves disease), the possibility of what disease should be considered?
insulin autoantibody syndrome (Hirata disease) : autoantibodies (IgG) are produced that bind insulin with variable affinity, which may result in glucose intolerance. Sudden dissociation of prebound insulin from the antibody results in unpredictable episodes of hypoglycemia. Can be a rare adverse reaction to methimazole, and almost all cases of methimazole-induced insulin autoimmune syndrome are reported in East Asia, especially in Japan. Due to the DRB1*0406 genotype. Measure both C peptide and insulin levels
In a patient with diabetes, arterial calcification makes the diagnosis of peripheral arterial disease by ankle brachial index alone less reliable, so the diagnosis should be confirmed by sending this patient to?
vascular lab to have vascular segmental pressures and pulse volumes checked
Treatment for insulinoma (immediate then maintenance)
- diazoxide: directly inhibits insulin production and secretion. Adverse effects include GI, edema, hirsutism 2. mainstay of therapy: short-acting somatostatin-based treatments (such as octreotide TID).
