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PSBIM: Endocrinology > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Diagnosis of DM

A

FBS >/= 126mg/dl
RBS >/= 200mg/dl + symptoms
HbA1c >/= 6.5%
2hppg >/= 200mg/dl

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2
Q

Diagnosis of IFG or IGT

A

FBS 100-125mg/dl
RBS 140-199mg/dl
HbA1c 5.6-6.4%
2hppg 140-199mg/dl

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3
Q

Most reliable screening test for diagnosing DM

A

FBS and HbA1c

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4
Q

Marker of endogenous insulin secretion

A

C peptide

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5
Q

Key regulator of insulin secretion

A

Glucose > 70mg/dl

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6
Q

Rate limiting step in glycosis

A

Glucose phosphorylation by glucokinase

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7
Q

Most potent incretin

A

Glucagon-like peptide 1 (GLP-1)

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8
Q

Glucose transporter for glucose uptake in the muscle and fat

A

GLUT 4

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9
Q

Glucose transporter for glucose uptake into the beta cell of the pancreas

A

GLUT 2

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10
Q

Marker of autoimmune process of T1DM

A

Islet cell autoantibodies (ICAs)

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11
Q

Predominant mechanism in T2DM

A

Postreceptor defects in insulin-regulated phosphorylation/dephosphorylation

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12
Q

Two distinct syndromes of insulin resistance in T2DM

A

Type A: young, obesity, hyperandrogenism

Type B: middle-aged, hyperandrogenism, autoimmune disorders

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13
Q

Lab values of DKA

A 
Glucose 250-600 mg/dl
Hyponatremia
Normal to increased potassium
Normal chloride, phosphate, magnesium
Slightly increased creatinine
Osmolality 300-320 mOsm/ml
High plasma ketones
HAG metabolic acidosis pH 6.8-7.3, < 15 meq/l
Respiratory alkalosis
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14
Q

Lab values of HHS

A 
Glucose 600-1200 mg/dl
Normal sodium, potassium, chloride, phosphate, magnesium
Moderately increased creatinine
Osmolality 330-380 mOsm/ml
\+/- plasma ketones
\+/- HAG metabolic acidosis
Normal arterial pCO2
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15
Q

Pathophysiology of DKA

A

Insulin deficiency + Increased counterregulatory hormone excess (i.e. Glucagon)

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16
Q

Pathophysiology of HHS

A

Insulin deficiency + Inadequate fluid intake

17
Q

More accurately reflect the true ketone body level

A

Beta hydroxybutyrate

18
Q

Indication to start alkaline supplementation in DKA

A

pH = 7

19
Q

Goal glucose in managing DKA to be able to stop insulin infusion

A

150-250 mg/dl

20
Q

Major nonmetabolic complication of DKA therapy

A

Cerebral edema

21
Q

Goal glucose in managing HHS to be able to stop insulin infusion

A

250-300 mg/dl

22
Q

4 major theories explaining how hyperglycemia can lead to complications

A
  1. Advanced glycosylation end-products: protein and endothelial function
  2. Sorbitol pathway: REDOX and cell function
  3. Protein kinase C: enzyme function, gene expression, growth factors
  4. Increased fructose-6-phosphate in hexosamine pathway: growth factors, proteoglycan production
23
Q

Primary causes of blindness in DM

A

Proliferative retinopathy and macular edema

24
Q

Features of nonproliferative retinopathy

A

Cotton wool spots, microaneurysms, blot hemorrhages

25
Q

Features/hallmark of proliferative retinopathy

A

Neovascularization, retinal detachment

26
Q

Most common form of DM nephropathy

A

Distal symmetric polyneuropathy

27
Q

Most frequent presentation of DM polyneuropathy

A

Distal sensory loss

28
Q

Most commonly affected cranial nerve in DM mononeuropathy

A

Cranial nerve III - heralded by diplopia

29
Q

Most common pattern of dyslipidemia in DM

A

Increased triglycerides, low HDL, normal LDL (but smaller, denser and more atherogenic particles)

30
Q

Choice between ACEi and ARB based on ADA

A

T1DM + HTN + micro- or macroalbuminuria: ACEi (slows progression of nephropathy)
T2DM + HTN + microalbuminuria: ACEi or ARB
T2DM + HTN + macroalbuminuria + renal insufficiency: ARB (can slow decline in GFR)

31
Q

Goal BP in DM

A

DM without proteinuria: <130/80

DM with proteinuria: 125/75

32
Q

Goal levels of TG, HDL and LDL

A

> 40y/o, no CVD: LDL < 100, HDL >40 in male and >50 in female, TG < 150
With CVD: LDL < 70, same goal for HDL and TG

33
Q

Most commonly affected with foot ulcer in DM

A

Great toe and MTP

34
Q

Rare infections exclusively seen in DM

A

Rhinocerebral mucormycosis, malignant or invasive otitis media, and emphysematous infections of the gallbladder

35
Q

Most common dermatologic manifestation in DM

A

Protracted wound healing and skin ulceration

PSBIM: Endocrinology (1 decks)

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