Diabetes Clinical Flashcards
Normal HbA1c
< 5.7%
How can you prevent contrast nephropathy?
adequate hydration
LDL cholesterol goal of a patient with diabetes
< 100
cause of type 1 diabetes melitus?
pancreatic B cells destruction by autoimmune process
What values will be low in DKA?
plasma bicarbonate
PCO2
hyponatremia
Drug effective in treating diabetic gastroparesis
metoclopramide
major cause of death in T1DM
chronic kidney disease
partial or relative insulin deficiency may initiate the syndrome by reducing glucose utilization of muscle, fat, and liver while inducing hyperglucagonemia and increasing glucose output → obligatory water loss ensues → kidney function becomes impaired → hyperosmolality
hyperglycemic hyperosmolar state
Type 2 diabetic patients have mild type 1 form
latent autoimmue diabetes or adulthood (LADA)
an oral glucose tolerance test is normal if the fasting venous plasma glucose value is ____ and the 2 hour value falls below
<100
<140
HbA1c in patient with Diabetes Melitus
> 6.5%
lab values for hyperglycemic hyperosmolar state (HHS): glucose serum osmolality pH serum bicarb
glucose → > 600
serum Osm → > 310
no acidosis (>7.3)
Bicarb → > 15
In sibling studies, which instance would result in the greatest chance that the sibling would take type 1 DM?
identical twins → 25-50%
how will the breathe of a patient in DKA be?
fruity smell → acetone
which cranial nerves are most often involved in mononeuropathy?
CN III, IV, VI
A patient with HbA1c >6.5% has a substantially increased risk of ?
retinopathy
acids that you can measure in diagnosing DKA
acetoacetic acid
B-hydroxybutyric acid
Most important factor causing insulin resistance
obesity
circulating endogenous insulin is sufficient to prevent ketoacidosis but not in preventing hyperglycemia in the face of increased needs owing to tissue insensivity (insulin resistance)
Type 2 Diabetes Melitus
what gene locus is involved in T1DM?
Specifically?
HLA
HLA DR3 and DR4
Criteria for Metabolic Syndrome/Syndrome X
elevated triglycerides elevated LDL lower HDL high BP hyperuricemia abdominal obesity
signs and symptoms of DKA
polyuria
polydipsia
fatigue, nausea, vomiting
mental stupor
Your T1DM patient is experiencing unexpected fluctuations and variability in their blood glucose levels after meals - you should consider?
gastroparesis
Type 1 diabetes is more common in what countries?
Scandanavian
key issues with healing of neuropathic ulcers in a foot with good vascular supply is
mechanical unloading
treatment for DKA
IV insulin
potassium replacement
Symptoms and signs of T2DM
neuropathic or cardiovascular complications, chronic skin infections (pruritus or vaginitis), overweight/obese (increased waist circumference), mild hypertension
what will be elevated in DKA patient?
urine glucose urine ketones plasma glucose plasma ketones hyperkalemia and hyperphosphatemia BUN and SCr acidotic
What is a fasting place glucose level that would indicated diabetes mellitus?
> 126
which test generally reflects state of glycemic control for preceding 1-2 weeks and is good to use if patient has abnormal hemoglobin or hemolytic states?
serum fructosamine
growth of new capillaries and fibrous tissue within the retina and into the vitreous chamebr
proliferative retinopathy
what is a normal fasting plasma glucose?
< 100
First thing you want to do in treating HHS?
fluid replacement
What do you use to examine a patient with sensory neuropathy?
5.08 Semmes-Weinstein filament
A fasting value of ___ or a 2 hour value of ____ during oral glucose tolerance test would indicated diabetes mellitus
> 125
> 200
nonenzymatic glycosylation of the lens protein is 2x as high in diabetic patients than non-diabetics and causes _____
diabetic cataracts
radioactive contrast material should not be given to a patient with serum creatinine
greater than 3 mg/dL
lab values of of DKA patient:
glucose
pH
serum bicarb
> 250
< 7.3
< 15
patient presents with pain and swelling with “rocker bottom” deformity and ulceration → osteoclastic destruction leading to deranged and unstable joints in the midfoot
Charcot foot arthopathy
pharmacotherapy that can decrease microalbuminuria
antihypertensive → ACE inhibitors
diabetic ketoacidosis in T2DM is most likely due to
severe stress → sepsis or trauma, broken insulin pump
Clinical manifestations of peripheral vascular disease
ischemia of LE, ED, intestinal angina
three other things associated with hypoglycemic coma
severe insulin deficiency (DKA)
mild-moderate insulin deficiency (HHS)
lactic acidosis
denervation of small muscles of foot → clawing of toes and displacement of submetatarsal fat pads anteriorly leads to ____
increased plantar pressures → lead to calluses and ulcerations
proliferative retinopathy most commonly occurs in ___
type 1 DM
2 types of nerves most commonly involved in isolated peripheral neuropathy
cranial nerves and femoral nerves
two main categories of diabetic retinopathy
proliferative and nonproliferative
diabetics with history of MI or stroke should take ____
aspirin
Autoimmune markers for Type 1 DM
ICA (islet cells) GAD65 (glutamic acid decarboxylase) IAA (insulin) IA-2 (tyrosine phosphatase) ZnT8 (zinc transporter 8)
microaneruysms, dot hemorrhages, exudates, and retinal edema
nonproliferative “background” retinopathy
diabetic nephropathy is initially manifested by ____
albuminuria
skin manifestation associated with significant insulin resistance → axilla, groin, and back of neck
acanthosis nigricans
major cause of death in T2DM
macrovascular disease → MI and stroke
syndrome characterized by symmetric peripheral neuropathy associated with profound weight loss and painful dysesthesias affecting the proximal lower limbs, hands or lower trunk
diabetic neuropathic cachexia
Why is motor and sensory nerve conduction delayed in peripheral nerves?
longer nerves are more vulnerable
In a diabetic patient, excessive doses of insulin or oral hypoglycemic can result in
hypoglycemic coma
diabetic ketoacidosis in T1DM is most commonly due to
increased insulin requirements during an event such as infection, trauma, MI or surgery
Cause of proliferative retinopathy
small vessel occlusion → retinal hypoxia → stimulate new vessel growth
heart disease in diabetics is due to
coronary atherosclerosis
what occurs first in distal symmetric pilyneuropathy?
sensory involvement
goal BP of patient with diabetes
<140/<90 → target is <130/<80
what drug is safe for diabetes in pregnancy?
glyburide
onset before age 25, nonobese, hyperglycemia is due to impaired glucose-induced secretion of insulin
MODY (Maturity onset diabetes of the young)
what can falsely lower HbA1c?
any condition that shortens the erythrocte survival or decreases mena erythrocyte age
Pros of using HgA1c to diagnose DM?
no need to fast
less variation
estimates glucose control for previous 2-3 months
How do you differentiate HHS from DKA?
HHS will not have elevated ketones
untreated T1DM is usually associated with ____
ketosis
Symptoms and signs of T1DM
polyuria, polydipsia, blurred vision, weight loss, increased appetite, paresthesia → hyperosmolality and hyperketonemia
“normotensive” diabetic patients with microalbuminuria have slightly elevated
nocturnal systolic blood pressure
