Diabetes Mellitus

Question 1

Describe how Type 2 arises?

Answer 1

• Chronically elevated glucose
• Chronically elevated insulin
• Downregulation of peripheral insulin receptors
  = Insulin Resistance!

Question 2

What is a normal result of a HgbA1c? Normal fasting glucose and random glucose?

Answer 2

< 5.7%
Fasting glucose < 100
Random glucose < 140

Question 3

What levels of HgbA1c, Fasting glucose and Random glucose diagnose DM?

Answer 3

> 6.5%
Fasting glucose > 126
Random glucose > 200

Question 4

What are the first line agents to treat Type 2?

Answer 4

1. Metformin
   +/- GLP-1 Agonist OR SGLT2 Inhibitor

Question 5

What are 3 possible side effects of Metformin?

Answer 5

Self-limiting Diarrhea
Lactic Acidosis
B12 deficiency

Question 6

What is the suffix for GLP-1 Agonists?

Answer 6

–TIDE

Question 7

What is the suffix for SGLT2 Inhibitors?

Answer 7

–GLIFLOZIN

Question 8

What is a target HgbA1c when being treated for DM?

Answer 8

< 7%

Question 9

What 3 things should be tested every year for Diabetics?

Answer 9

1. Eye exam
2. Monofilament test
3. Urine Albumin:Creatinine ratio

Question 10

What is a feared complication of Type 2?

Answer 10

HHS
(Hyperglycemic Hyperosmolar Syndrome)

Question 11

How will Hyperglycemic Hyperosmolar Syndrome present?

Answer 11

Not compliant Type 2, with AMS or Coma!

Question 12

Due to Type 2’s having some insulin, what causes HHS?

Answer 12

Severely and chronically elevated glucose causes severe volume depletion

Question 13

Treatment for Hyperglycemic Hyperosmolar Syndrome?

Answer 13

Insulin to correct glucose
IVF to correct fluids

Question 14

How does Type 1 arise?

Answer 14

Autoimmune attack/lymphocytic infiltration of beta cells in the pancreatic islets

Question 15

Is Insulin present in Type 1?

Answer 15

NO - destruction of beta cells

Question 16

What are often presenting signs of Type 1 DM?

Answer 16

Polydipsia
Polyuria
Weight loss

Question 17

What are 3 long-acting Insulins?

Answer 17

Detemir
Glargine
Degludec

Question 18

What are 3 rapid-acting Insulins?

Answer 18

Aspart
Lispro
Glulisine

Question 19

What type of Insulin can be given IV?

Answer 19

Regular Insulin

Question 20

What should be done once someone is diagnosed with Type 1?

Answer 20

Screen for other autoimmune diseases

Question 21

What is a feared complication of Type 1?

Answer 21

DKA
(Diabetic Ketoacidosis)

Question 22

With no insulin present, what processes will be increased in Type 1?

Answer 22

Gluconeogenesis/Glycogenolysis
FA oxidation
Ketogenesis

Question 23

If you are losing glucose in the urine, what will the body volume water do?

Answer 23

Follow it – dehydrated

Question 24

To compensate for losing glucose and fluid in the urine, what will happen to the Na+ and K+?

Answer 24

Na+ elevated
K+ lost

Question 25

What often triggers DKA?

Answer 25

Some stressor

Question 26

What are presenting signs of DKA?

Answer 26

• Abdominal pain with polyuria/polydipsia
• Kussmaul respirations
• AMS
• Fruity breath

Question 27

What are presenting signs of DKA?

Answer 27

• Abdominal pain with polyuria/polydipsia
• Kussmaul respirations
• AMS
• Fruity breath

Question 28

What tests should be done for DKA?

Answer 28

• Serum Beta-hydroxybutyrate or Urine Ketones
• ABG

Question 29

In order to correct the acidosis mostly, what is given with DKA?

Answer 29

Insulin

Question 30

What fluids should be given to those in DKA?

Answer 30

2 L LR and then D5 1/2 normal saline