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Diabetes Mellitus > Diabetes Clinical > Flashcards

Diabetes Clinical Flashcards

1
Q

Normal HbA1c

A

< 5.7%

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2
Q

How can you prevent contrast nephropathy?

A

adequate hydration

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3
Q

LDL cholesterol goal of a patient with diabetes

A

< 100

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4
Q

cause of type 1 diabetes melitus?

A

pancreatic B cells destruction by autoimmune process

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5
Q

What values will be low in DKA?

A

plasma bicarbonate
PCO2
hyponatremia

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6
Q

Drug effective in treating diabetic gastroparesis

A

metoclopramide

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7
Q

major cause of death in T1DM

A

chronic kidney disease

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8
Q

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

A

hyperglycemic hyperosmolar state

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9
Q

Type 2 diabetic patients have mild type 1 form

A

latent autoimmue diabetes or adulthood (LADA)

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10
Q

an oral glucose tolerance test is normal if the fasting venous plasma glucose value is ____ and the 2 hour value falls below

A

<100

<140

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11
Q

HbA1c in patient with Diabetes Melitus

A

> 6.5%

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12
Q 
lab values for hyperglycemic hyperosmolar state (HHS):
glucose
serum osmolality
pH
serum bicarb
A

glucose → > 600
serum Osm → > 310
no acidosis (>7.3)
Bicarb → > 15

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13
Q

In sibling studies, which instance would result in the greatest chance that the sibling would take type 1 DM?

A

identical twins → 25-50%

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14
Q

how will the breathe of a patient in DKA be?

A

fruity smell → acetone

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15
Q

which cranial nerves are most often involved in mononeuropathy?

A

CN III, IV, VI

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16
Q

A patient with HbA1c >6.5% has a substantially increased risk of ?

A

retinopathy

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17
Q

acids that you can measure in diagnosing DKA

A

acetoacetic acid

B-hydroxybutyric acid

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18
Q

Most important factor causing insulin resistance

A

obesity

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19
Q

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)

A

Type 2 Diabetes Melitus

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20
Q

what gene locus is involved in T1DM?

Specifically?

A

HLA

HLA DR3 and DR4

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21
Q

Criteria for Metabolic Syndrome/Syndrome X

A 
elevated triglycerides
elevated LDL
lower HDL
high BP
hyperuricemia 
abdominal obesity
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22
Q

signs and symptoms of DKA

A

polyuria
polydipsia
fatigue, nausea, vomiting
mental stupor

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23
Q

Your T1DM patient is experiencing unexpected fluctuations and variability in their blood glucose levels after meals - you should consider?

A

gastroparesis

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24
Q

Type 1 diabetes is more common in what countries?

A

Scandanavian

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25
Q

key issues with healing of neuropathic ulcers in a foot with good vascular supply is

A

mechanical unloading

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26
Q

treatment for DKA

A

IV insulin

potassium replacement

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27
Q

Symptoms and signs of T2DM

A

neuropathic or cardiovascular complications, chronic skin infections (pruritus or vaginitis), overweight/obese (increased waist circumference), mild hypertension

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28
Q

what will be elevated in DKA patient?

A 
urine glucose 
urine ketones 
plasma glucose 
plasma ketones 
hyperkalemia and hyperphosphatemia
BUN and SCr 
acidotic
29
Q

What is a fasting place glucose level that would indicated diabetes mellitus?

A

> 126

30
Q

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?

A

serum fructosamine

31
Q

growth of new capillaries and fibrous tissue within the retina and into the vitreous chamebr

A

proliferative retinopathy

32
Q

what is a normal fasting plasma glucose?

A

< 100

33
Q

First thing you want to do in treating HHS?

A

fluid replacement

34
Q

What do you use to examine a patient with sensory neuropathy?

A

5.08 Semmes-Weinstein filament

35
Q

A fasting value of ___ or a 2 hour value of ____ during oral glucose tolerance test would indicated diabetes mellitus

A

> 125

> 200

36
Q

nonenzymatic glycosylation of the lens protein is 2x as high in diabetic patients than non-diabetics and causes _____

A

diabetic cataracts

37
Q

radioactive contrast material should not be given to a patient with serum creatinine

A

greater than 3 mg/dL

38
Q

lab values of of DKA patient:
glucose
pH
serum bicarb

A

> 250
< 7.3
< 15

39
Q

patient presents with pain and swelling with “rocker bottom” deformity and ulceration → osteoclastic destruction leading to deranged and unstable joints in the midfoot

A

Charcot foot arthopathy

40
Q

pharmacotherapy that can decrease microalbuminuria

A

antihypertensive → ACE inhibitors

41
Q

diabetic ketoacidosis in T2DM is most likely due to

A

severe stress → sepsis or trauma, broken insulin pump

42
Q

Clinical manifestations of peripheral vascular disease

A

ischemia of LE, ED, intestinal angina

43
Q

three other things associated with hypoglycemic coma

A

severe insulin deficiency (DKA)
mild-moderate insulin deficiency (HHS)
lactic acidosis

44
Q

denervation of small muscles of foot → clawing of toes and displacement of submetatarsal fat pads anteriorly leads to ____

A

increased plantar pressures → lead to calluses and ulcerations

45
Q

proliferative retinopathy most commonly occurs in ___

A

type 1 DM

46
Q

2 types of nerves most commonly involved in isolated peripheral neuropathy

A

cranial nerves and femoral nerves

47
Q

two main categories of diabetic retinopathy

A

proliferative and nonproliferative

48
Q

diabetics with history of MI or stroke should take ____

A

aspirin

49
Q

Autoimmune markers for Type 1 DM

A 
ICA (islet cells)
GAD65 (glutamic acid decarboxylase)
IAA (insulin)
IA-2 (tyrosine phosphatase)
ZnT8 (zinc transporter 8)
50
Q

microaneruysms, dot hemorrhages, exudates, and retinal edema

A

nonproliferative “background” retinopathy

51
Q

diabetic nephropathy is initially manifested by ____

A

albuminuria

52
Q

skin manifestation associated with significant insulin resistance → axilla, groin, and back of neck

A

acanthosis nigricans

53
Q

major cause of death in T2DM

A

macrovascular disease → MI and stroke

54
Q

syndrome characterized by symmetric peripheral neuropathy associated with profound weight loss and painful dysesthesias affecting the proximal lower limbs, hands or lower trunk

A

diabetic neuropathic cachexia

55
Q

Why is motor and sensory nerve conduction delayed in peripheral nerves?

A

longer nerves are more vulnerable

56
Q

In a diabetic patient, excessive doses of insulin or oral hypoglycemic can result in

A

hypoglycemic coma

57
Q

diabetic ketoacidosis in T1DM is most commonly due to

A

increased insulin requirements during an event such as infection, trauma, MI or surgery

58
Q

Cause of proliferative retinopathy

A

small vessel occlusion → retinal hypoxia → stimulate new vessel growth

59
Q

heart disease in diabetics is due to

A

coronary atherosclerosis

60
Q

what occurs first in distal symmetric pilyneuropathy?

A

sensory involvement

61
Q

goal BP of patient with diabetes

A

<140/<90 → target is <130/<80

62
Q

what drug is safe for diabetes in pregnancy?

A

glyburide

63
Q

onset before age 25, nonobese, hyperglycemia is due to impaired glucose-induced secretion of insulin

A

MODY (Maturity onset diabetes of the young)

64
Q

what can falsely lower HbA1c?

A

any condition that shortens the erythrocte survival or decreases mena erythrocyte age

65
Q

Pros of using HgA1c to diagnose DM?

A

no need to fast
less variation
estimates glucose control for previous 2-3 months

66
Q

How do you differentiate HHS from DKA?

A

HHS will not have elevated ketones

67
Q

untreated T1DM is usually associated with ____

A

ketosis

68
Q

Symptoms and signs of T1DM

A

polyuria, polydipsia, blurred vision, weight loss, increased appetite, paresthesia → hyperosmolality and hyperketonemia

69
Q

“normotensive” diabetic patients with microalbuminuria have slightly elevated

A

nocturnal systolic blood pressure

Diabetes Mellitus (4 decks)

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