Diabetic Complications & Hypoglycemia

Question 1

what diabetic complication leads to end stage renal disease?

Answer 1

nephropathy

Question 2

kidney functioning at 10-15% of normal capacity

Answer 2

end stage renal disease (ESRD)

Question 3

which type of DM is nephropathy more common in?

Answer 3

type 1 DM

Question 4

how does nephropathy initially present?

Answer 4

proteinuria (increased albuminuria)

Question 5

what should the ratio of albumin to creatinine be in the first morning void urine to be considered normal?

Answer 5

< 30 albumin mcg : 1 mg creatinine

Question 6

what is a good predictor of future chronic renal disease?

Answer 6

ratio of albumin to creatinine in first morning void urine

Question 7

how many abnormal readings of ratio of albumin to creatinine, and how often, to diagnose a patient with neuropathy d/t DM?

Answer 7

two abnormal readings
over 3-6 months

Question 8

what 5 other conditions can cause albuminuria?

Answer 8

short term hypoglycemia
exercise
UTI
heart failure
fever

Question 9

why is it important to identify diabetic nephropathy early?

Answer 9

to prevent progression to end stage renal disease

Question 10

how can we prevent progression of nephropathy to end stage renal disease? (3)

Answer 10

glycemic control
low protein diet
ACE inhibitor or ARB

Question 11

why is an ACE inhibitor or ARB used for nephropathy?

Answer 11

lowers intraglomerular pressure

Question 12

what do the combination of atherosclerosis and dyslipidemia caused by DM, lead to?

Answer 12

3-5x increased risk of MI

Question 13

what can peripheral vascular disease lead to, due to DM? (2)

Answer 13

ischemia of lower extremities
gangrene of feet

Question 14

diseased blood vessels cannot supply blood to nerves - nerves shrivel up and lead to decreased sensation in extremities

Answer 14

peripheral neuropathy

Question 15

what is the prevalence of peripheral neuropathy?

Answer 15

50% of older patients with type 2 DM

Question 16

what kind of pattern is seen in peripheral neuropathy?

Answer 16

stocking and glove pattern

(distal symmetric polyneuropathy)

Question 17

what is gone first in peripheral neuropathy? how does the patient present? (3)

Answer 17

sensory

decreased pain
decreased vibratory
decreased temp

Question 18

what exam can we use to determine if a patient has peripheral neuropathy?

Answer 18

Semmes Weinstein filament

Question 19

dot hemorrhages, exudates, and retinal edema present in 60% of diabetes after 16 years

Answer 19

non-proliferative retinopathy

Question 20

what occurs in non-proliferative retinopathy? what does it lead to?

Answer 20

retinal capillary leaks proteins and lipids into retina/macula

visual impairment

Question 21

what is the most common cause of visual impairment?

Answer 21

non-proliferative retinopathy

Question 22

neovascularization in the retina and vitreous chamber due to capillary being totally closed off and not providing any nutrients to retina

Answer 22

proliferative retinopathy

Question 23

what does proliferative retinopathy lead to? (leading cause in the US)

Answer 23

blindness

Question 24

what can severe hypertriglyceridemia lead to?

Answer 24

cutaneous xanthomas

Question 25

brown, painless spots that don't require treatment

Answer 25

shin spots

Question 26

what kind of infection can DM cause below the breasts, axillas, between the fingers, and vulvovaginitis?

Answer 26

candidal infection

Question 27

if a patient presents with shin spots, when do they say the onset was?

Answer 27

1-2 weeks ago

Question 28

hyperpigmented, velvety plaques located in the axillae, groin, and posterior neck

Answer 28

acanthosis nigricans

Question 29

how is acanthosis nigricans described?

Answer 29

hyperkeratosis (increased production of skin)

Question 30

in which DM type is hyperpigmentation/ acanthosis nigricans common in?

Answer 30

type 2 DM

Question 31

in patients with DM, what should be done at every annual appointment? (6)

Answer 31

foot exam optometry with dilation U/A serum creatinine lipid panel LFT

Question 32

what are we looking for in a U/A for DM patients? (2)

Answer 32

albumin glucose

Question 33

what vaccines should we encourage at appointments for DM patients?

Answer 33

flu vaccine annually pneumococcal q 5 yrs

Question 34

how often should Hgb be checked?

Answer 34

at least q 6 months

Question 35

what is our goal for BP and LDL in patients with DM? (2)

Answer 35

BP 120-130/90 lower LDL by 30-50%

Question 36

at what glucose level is endogenous insulin inhibited?

Answer 36

glucose < 80

Question 37

at what glucose level does glucagon get released into the blood?

Answer 37

glucose < 70

Question 38

what is released into the blood when glucose is below 65? (3)

Answer 38

epinephrine GH cortisol

Question 39

what occurs when glucose is below 50?

Answer 39

decreased alertness

Question 40

a patient presents with diaphoresis, palpitations, hunger and anxiety. what is their approximate glucose level?

Answer 40

less than 65

Question 41

what causes the sweating, palpitations, nausea, hunger, anxiety and tremor in hypoglycemia?

Answer 41

adrenergic surge (cortisol and epi)

Question 42

what causes the blurred vision, decreased fine motor skills, poor concentration, and dizziness in hypoglycemia?

Answer 42

decreased cognitive function

Question 43

what 3 components are required to diagnose hypoglycemia? what is the name for it?

Answer 43

hx of hypoglycemic symptoms fasting BG < 45 immediate recovery after getting glucose Whipple's Triad

Question 44

what are 4 causes of hypoglycemia?

Answer 44

fasting excess insulin postprandial (reactive) alcohol

Question 45

in which patients is postprandial (reactive) hypoglycemia seen?

Answer 45

after gastric bypass

Question 46

what is the treatment for a patient that is asymptomatic/mildly symptomatic with glucose equal to or less than 70?

Answer 46

give 15-20 grams of oral glucose