DKA

Question 1

How does sodium decrease in relation to glucose?

Answer 1

Every 100 glucose increase is 1.6 Na decrease

Question 2

Why do ketone levels elevate with resolution?

Answer 2

Nitroprusside test detects acetoacetate and acetate. More is formed towards resolution.

Question 3

Fluid replacement regimen

Answer 3

2 to 3 L first 3 hours (10 to 20 ml/kg/hr) pNSS
250to 500 mL per hour 0.45NSS
150 to 250 mL per hour D50.45NSS once glucose 250

Question 4

Insulin dose

Answer 4

0. 1 U/kg then 0.1U/kg/hr as drip

0. 02 to 0.1 U/kg/hr once CBG 200 to 250 and add glucose

Question 5

Cut off for bicarbonate

Answer 5

PH < 7.0

50 mmol HCO3 in 100 mL with 10 meq Kl

Question 6

Cut off for phosphate supplementation

Answer 6

Phosphate less than 0.32

Question 7

Hydration in HHS

Answer 7

9 to 10 L replaced in 1 to 2 days.
200 to 300 mL per hour of hypotonic solution
0.45 NSS then D5W

Question 8

Glycemic goals for hospitalized patients

Answer 8

140 to 180 in critically ill

110 to 140 in selected patients

Question 9

What to remember before discontinuing insulin IV

Answer 9

Overlap 2 to 4 hours with long acting insulin

Question 10

Insulin adjustment for individuals

Answer 10

1U per 50 mg/dL for thin

2U per 50 mg/dL for fat

Question 11

TPN and insulin

Answer 11

TPN increases insulin requirements

Question 12

Steroids and diabetes

Answer 12

Steroid-induced diabetes due to decreased glucose utilization.
Oral agents if less than 200.

Question 13

Reproductive capacity in people with DM

Answer 13

Normal

Question 14

Glucose is a (blank) at high doses in pregnancy?

Answer 14

Teratogen

Question 15

Oral hypoglycemics in pregnancy

Answer 15

Glyburide and metformin

Question 16

Risk for fetal malformations in pregnant DM is?

Answer 16

4 to 10x a normal individual

Question 17

Pathophysiology of lipodystrophy DM

Answer 17

Decreased leptin and increased insulin resistance with acanthosis nigricans, hypertriglyceridemia and hepatic steatosis

Question 18

Leading contributor to CHD

Answer 18

Diabetes

Question 19

Microvascular DM complications

Answer 19

Retinopathy, neuropathy, and nephropathy

Question 20

Macrovascular complications of DM

Answer 20

CHD
PAD
CVD

Question 21

CHD rate increased by this much if you have DM

Answer 21

2 to 4 times

Question 22

Trial comparing standard and intensive glycemic control in diabetes

Answer 22

Diabetes Control and Complications Trial

Question 23

Results of DCCT

Answer 23

HbA1c 7.3% intensive
9.1% conventional

Intensive higher risk of hypoglycemia and weight gain

Question 24

Follow up of 30 years after DCCT

Answer 24

Epidemiology of Diabetes Intervention and Complications or EDIC

Question 25

More than 5000 individuals with more than 10 years of DM

Answer 25

UK Prospective Diabetes Study

Question 26

Comparison groups in UKPDS

Answer 26

Insulin, SU and metformin vs. conventional

Question 27

UKPDS HbA1c microvascular complication reduction

Answer 27

1 unit HbA1c to 35% risk reduction

Question 28

UKPDS BP guidelines

Answer 28

Reduce moderately to lower micro and macrovascular rates

Question 29

Japanese study showing reduced microvascular complications

Answer 29

Kumamoto study

Question 30

Phenomenon where early glycemic control affects later life

Answer 30

Metabolic memory or legacy effect

Question 31

Hypothesis for DM complications

Answer 31

1. Epigenetic 2. Advance glycosylation end products (pentosidine, glucosapene and carboxymethyllysine) 3. Aldose reductase sorbitol pathway 4. Diacylglycerol-fibronectin 5. Altered glycosylation of proteins

Question 32

Features of nonproliferative DR

Answer 32

Retinal microaneurysms Blot hemorrhages Cotton wool spots

Question 33

Hallmark of PDR

Answer 33

Neovascularization

Question 34

Predictors of retinopathy in DM

Answer 34

Duration of DM | Degree of glycemic control

Question 35

Most effective treatment for DRet?

Answer 35

Prevention

Question 36

DRet may transiently worsen in first (blank) of glycemic control

Answer 36

6 to 12 months

Question 37

Drug that reduces progression of retinopathy

Answer 37

Fenofibrate

Question 38

Recommendation for eye exam in diabetics

Answer 38

Routine undilated eye exam not recommended. Refer to Ophtha.

Question 39

Aspirin and DRet

Answer 39

No effect

Question 40

Leading cause of CKD, ESRD

Answer 40

DNeph

Question 41

Associated with increased risk of CVD in DM patients

Answer 41

Albuminuria

Question 42

Risk factors for DNeph

Answer 42

Family history and race

Question 43

First years of DNeph

Answer 43

Glomerular hyperperfusion and renal hypertrophy with increased GFR

Question 44

Define albuminuria

Answer 44

Spot albumin to creatinine ratio > 30 mg/g

Question 45

GFR cut-off for DNeph

Answer 45

60

Question 46

Type 2 DM neohropathy differences with type 1

Answer 46

1. Albuminuria on diagnosis 2. Hypertension 3. Less association with albuminuria 4. Albuminuria from HTN, CHF, prostate disease or infection

Question 47

Screening for albuminuria

Answer 47

Five years after DM1 | Immediately after DM2

Question 48

Optimal therapy for diabetic nephropathy

Answer 48

Prevention

Question 49

Slowing progression of albuminuria by

Answer 49

1. Glycemic control 2. BP control 3. ACEI or ARB

Question 50

Glucose medications contraindicated in ESRD

Answer 50

Metformin | Sulfonylureas

Question 51

BP targets for DNeph

Answer 51

<140/90 diabetics | <130/80 risk for CVD or CKD progression

Question 52

When to refer DNeph to renal

Answer 52

GFR less than 30 and albuminuria

Question 53

Referral for transplant in DNeph patient

Answer 53

GFR < 20

Question 54

Leading cause of death in diabetics with nephropathy and hyperlipidemia

Answer 54

Complications of atherosclerosis

Question 55

Hypotension in DNeph patients

Answer 55

Autonomic nephropathy loss of reflex tachycardia Difficult vascular access retinopathy

Question 56

Type of neuropathy in DM

Answer 56

Distal symmetric polyneuropathy

Question 57

Risk factors for DNeuro

Answer 57

``` BMI Smoking Duration Glycemic control CVD Elevated TG HTN ```

Question 58

Most common DNeuro

Answer 58

Distal symmetric polyneuropathy

Question 59

Character of distal symmetric polyneuropathy

Answer 59

``` Lower extremities At rest At night Pain Loss of ankle tendon reflezes Abnormal position sense Foot drop ```

Question 60

Aim of DNeuro screening

Answer 60

Identify loss of protective sensation

Question 61

Features of cardiovascular autonomic neuropathy

Answer 61

Decreased heart rate variability resting tachycardia Orthostatic hypotension Sudden death

Question 62

Other autonomic problems of DM

Answer 62

``` Gastroparesis Bladder emptying Hyperhidrosis of UE Anhidrosis of LE Hypoglycemia unawareness due to counterregulatory hormone release ```

Question 63

Most common mononeuropathy of DM

Answer 63

Third CN diplopia with ptosis and ophthalmoplegia