Diabetes

Question 1

Which are the clinical manifestations of DM1?

Answer 1

3P -> polyuria              
             Polydipsia.                       
             Polyphagia.               
          - weight loss
          - early onset

Question 2

Which are the clinical manifestations for DM2 ?

Answer 2

• overweight
  - asymptomatic
  - polyphagia
  - polyuria
  - polydipsia
  - > 40y.o

Question 3

Diagnostic criteria for DM.

Answer 3

1. Fasting glycose test >126
2. Symptoms+ Random glucose test >200
3. OGTT >200 + 75g glucose ingestion
4. HbA1c > 6,5% (glucosylated hemoglobin)

Question 4

Diagnostic criteria for diabetic patient with multiple sclerosis

Answer 4

1. Hypertriglyceridemia >150
2. Hypo HDL <40 m, <50 w
3. Hypertension
4. Abdominal obesity

Question 5

Risk factors for DM1.

Answer 5

Genetics
Family history
Geography
Age

Question 6

Risk factors for DM2

Answer 6

Family history 
Obesity (>25)
Physical inactivity 
Hypertension >140\90
Polycystic ovary syndrome

Question 7

Which are the chronic complications for DM?

Answer 7

1. Neuropathy
2. Nephropathy
3. Retinopathy
4. Cardiomyopathy
5. Skin manifestation

Question 9

Etiology of DKA.

Answer 9

Infection
Infarction
Intoxication
Inadequate insulin

Question 10

Signs & Symptoms of DKA.

Answer 10

3P
Weight loss 
Abdominal pain 
Nausea 
Vomiting 
Kussmalls breathing
Ketones breath
Tachycardia 
Tachypnea
Dehydration 
Confusion 
Muscular weakness 
Dry skin

Question 11

Diagnostic criteria for DKA.

Answer 11

Cbc -> hyperglycemia, hyperketonemia, WBC high
Urinalysis-> ketonuria, glucosuria
ABG -> ph low, HCO3 low
Ecg -> arrhythmia

Question 12

Management of DKA

Answer 12

1. Fluid + electrolytes
2. Insulin
3. Sodium bicarbonate
4. Infection

Question 13

Diagnostic criteria for HHS.

Answer 13

Osmolarity >360mosm/l
Glucose >360
Ph >7.5
Extreme dehydration

Question 14

Signs & symptoms of hhs

Answer 14

Lethargy 
Polyuria 
Polydipsia 
Weakness 
Confusion 
Coma

Question 15

Causes of hypoglycemia.

Answer 15

1. Too much insulin intake
2. Not eating enough
3. Skipping meals
4. Increasing exercise

Question 16

Treatment of hypoglycemia in conscious person.

Answer 16

Oral sugar administration (simple carbohydrates)
Retest in 15’ to ensure Glucose >4.0 mmol + 15g carbohydrates
Eat usual snacks/meals with carbo and protein

Question 17

Treatment of hypoglycemia in unconscious patient.

Answer 17

1mg glycagon SC/IM

Call

Question 18

Symptoms of hypoglycemia

Answer 18

Neurogenic: tremor, sweating, hunger, nausea, palpitations
Neuroglycopenic: confusion, weakness, drowsiness, vision changes, dizziness, difficulty of speaking

Question 19

Metabolic syndrome: Definition

Answer 19

A cluster of conditions that may cause heart disease, seizures

Question 20

Causes of MS

Answer 20

Insulin resistance
Obesity
Inactivity

Question 21

Diagnostic criteria for MS.

Answer 21

• abdominal obesity ( waist >40 m, >35 f inches )
• fasting glucose >100
• BP > 130/80
• triglycerides >150
• HDL <40 m, <50 f

Question 22

Treatment for obesity

Answer 22

Lifestyle management
Orlistat drug (Xenical 120mg)
Bariatric surgery when bmi >40kg/m2

Question 23

Treatment for dyslipidemia

Answer 23

Lifestyle adjustment
Statins (simvastatin 20-40mg, rosuvastatin -> crestor 20-40mg)
Nicotinic acid
Fibrates (fenofibrat lph 200mg)

Question 24

Diagnosis for obesity

Answer 24

Height measurement
Weight measurement
Waist circumference
BMI

Question 25

Diabetic retinopathy: pathology

Answer 25

High blood flow
High capillary permeability (leakage)
Basement membrane thickening

Question 26

Signs of diabetic retinopathy

Answer 26

Neovascularization
Micro aneurysm
Edema
Cotton wool spots

Question 27

Screening for Diabetic retinopathy

Answer 27

Visual acuity
Digital fundus photography
Exam fundus through dilated pupil

Question 28

Treatment of diabetic retinopathy

Answer 28

Glucose control 
Htn control
Ace inhibitors (captopril 12,5-25,50 mg) (lisinopril 10-20-40)
Early detection 
Laser photo coagulation

Question 29

Which are the acute complications for DM?

Answer 29

1. Diabetic ketoacidosis
2. Lactic acidosis
3. Hyperglycemic hyperosmolar nonketonic state
4. Hypoglycemia

Question 30

Which is the first line treatment of DM2 + its side effects.

Answer 30

Metformin (biguanides) -> improves peripheral glucose uptake, high insulin sensitivity, low hepatic glucose production

Side effects: nausea, vomiting, flatulence, diarrhea, abdominal pain, lactic acidosis, weight loss

Question 31

Side effects + mechanism of sulfanylureas + examples.

Answer 31

Increase the pancreatic secretion of insulin

Side effects: hypoglycemia, weight gain, renal impairment

1st: chlopropamide
2nd: glibenclamide, gliquidone, gliclazide
3rd: glimepiride

Question 32

Meglitinides: side effects +mechanism

Answer 32

Repaglinide + nateglinide

Increased secretion if insulin
Side effects: hypoglycemia, weight gain

Question 33

Thiazoladinediones: side effects, mechanism.

Answer 33

Decrease insulin resistance

Pyoglitazone + rosigitazone

Side effects: weight gain, hypoglycemia, heart failure, edema

Question 34

Alpha glucosidase inhibitors: side effects, mechanism.

Answer 34

Acarbose

Blocks glucose absorption in the bowel
Take it before every meal

Side effects: flatulence, diarrhea, abdominal pain

Question 35

Glucagon like peptide-1 : everything

Answer 35

Exenatide 2 injection/day

Mechanism: decrease glucagon release, decrease gastric emptying, improves insulin sensitivity

Side effects: weight loss, pancreatitis, nausea, vomiting, dyspepsia

Question 36

SGLT-2: everything

Answer 36

Canagliflozin, dapagliflozin

Reduces renal tubular glucose re absorption

Side effects: polyuria, urinary infection, yeast infection, polydipsia

If kidney impairment, NOT recommended

Question 37

Which of the drugs have as side effects weight loss?

Answer 37

Biguanides

GLP-1