Diabetes part 2

Question 1

What is the etiology of T1DM

Answer 1

autoimmune pancreatic beta-cell destruction
childhood/adolescence

Question 2

What is the clinical presentation of T1DM

Answer 2

usually presents wtih symptomatic hyperglycemica, may present in DKA
polyuria, polydipsia, catabolism, polyphagia
dehydration, nausea, unexplained weight loss, weakness, irritability, fatigue, blurry vision

Question 3

what is the honeymoon phase

Answer 3

transient phase of near-normal glucose levels after onset (partial recovery of insulin secretion)

Question 4

What is the workup of T1DM

Answer 4

random serum glucose
fasting glucose
glucose tolerance testing (OGTT)
(urinalysis)

Question 5

What is the treatment of a new diagnosis of T1DM

Answer 5

insulin induction (lifetime)
IVF management
electrolyte management
family/patient education (diet/exercise)
consult nutritionist
consult diabetic specialist (endocrinology)

Question 6

what is the treatment of Existing T1DM

Answer 6

educate and manage:
insulin with endocrine specialist
diet and exercise
comorbidities (ASCVD, HTN, HLD, psychosocial issues)
complication (DKA, hypoglycemia)

Question 7

What are exercise recommendations with T1DM

Answer 7

ADA: 150 min of aerobic activity 3-4times per week
Surgeon general: 30 minutes of moderate physical activity most days of the week
should be individualized

Question 8

what is the initiation dose of insulin

Answer 8

0.5 Units/kg/day

Question 9

what is the maintenance dose of insulin

Answer 9

0.4 - 1.0 U/kg/day

Question 10

what type of patients require a higher TDI

Answer 10

Puberty, pregnancy and medical issues

Question 11

what are insulin adverse reactions

Answer 11

Lioatrophy or Hypertrophy and/or Resistance

Question 12

what is Lioatrophy with insulin

Answer 12

loss of fat at injection site; may allow for incidental intra-muscular injection

Question 13

what is hypertrophy with insulin

Answer 13

increase in fat mass at site; leads to erratic insulin absorption

Question 14

what is resistance with insulin

Answer 14

require larger amounts of insulin to get desired effect, due to antibody formation

Question 15

What are the “I’s” of DKA etiology

Answer 15

Infection -i.e. pneumonia, UTI, appendicitis, cholecysitis
Infarction - CVA or MI
Iatrogenic - insulin/diet/exercise change by pt or provider
Incision - surgery
Intoxication - ETOH or illegal drugs
Initial - initial T1DM diagnosis
Insulin - too little or no insulin administered

Question 16

What are the diagnostic criteria for DKA

Answer 16

Diabetic: glucose >200mg/dL
Ketonuria: pts may produce both acetoacetate and beta-hydroxybuterate as ketones; ONLY acetoacetat is detected by urine dipstick - order serum beta-hydroxybuterate if necessary
Acidosis: arterial pH <7.3
venous bicarb <15 mmol/L

Question 17

What is the treatment plan for DKA

Answer 17

step one: fluid replacement: isotonic fluid replacement
step two: electrolyte replacement (correct hypokalemia, potassium, serum sodium)
step three: insulin drip (GO SLOW- 0.05 - 0.1 Units/kg/hour) - once serum glucose < 200mg/dL reduce insulin drip by 50%

Question 18

what determines DKA resolution

Answer 18

Glucose <200mg/dL
pH >7.3
Bicarbonate level is > 18mEq/L

Question 19

what are the risk factors for T2DM

Answer 19

age > 45
overweight or obese
sedentary lifestyle
fhx of DM
hx of glucose intolerance
gestational DM or delivery of baby >9 lbs
hx HTN
dyslipidemia
hx CVD
PCOS
black, hispanic, asian american or american indian

Question 20

what is the clinical presentation of T2DM

Answer 20

may present with symptomatic hyperglycemia but usu asx or “non-complainers”
hyperglycemia: polyuria, polydipsia progress to orthostatic hypotension, dehydration, N/V, weight loss, blurred vision, bacterial/fungal infections

Question 21

what is the ADA criteria for T2DM diagnosis

Answer 21

one of the following:
-FPG > 126 mg/dL
- random glucose >200mg/dL
- 2hr plasma glucose >200mg/dL
- HbA1c >6.5%

Question 22

what is the ADA criteria for pre-diabetes

Answer 22

one of the following:
FPG >100-125mg/dL
2hr OGTT plasma glucose of 140-199 mg/dL
HbA1c 5.7-6.4%

Question 23

What is the preferred medication for T2DM

Answer 23

Metformin
initial: 500mg per day
titrate 500mg per week
maintenance dose 500 or 800mg BID/TID

Question 24

if a patient has an A1c less than 8 with T2DM what do you think

Answer 24

resistance

Question 25

if a patient has an A1c greater than 8 with T2DM what do you think

Answer 25

post-prandial

Question 26

What is MODY

Answer 26

Maturity onset DM of youth
usually seen in adolescents with obesity; peripheral insulin sensitivity 50%

Question 27

What is HHNK

Answer 27

hyperosmotic hyperglycemia non-ketotic syndrome
metabolic complication characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma and altered consciousness
most often occurs in T2DM, usu. in setting of physiologic stress

Question 28

what is the treatment of HHNK

Answer 28

IV saline solution and insulin
(correct hypokalemia)

Question 29

what are complications of HHNK

Answer 29

coma, seizure and death

Question 30

how is HHNK diagnosed

Answer 30

severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis

Question 31

what is the mean plasma glucose for an A1c of 7

Answer 31

154 mg/dL

Question 32

what is the mean plasma glucose for an A1c of 10

Answer 32

240 mg/dL