Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > DM- Diagnosis and Management Part 1 - Exam 4 > Flashcards

DM- Diagnosis and Management Part 1 - Exam 4 Flashcards

1
Q

______ due to near-complete or total absence of circulating insulin

______ due to insulin resistance, decreased insulin secretion, increased hepatic glucose production

A

T1DM

T2DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The presentation of DM have many s/s related to ______, its result is ______ and _____ associated with diabetes

A

hyperglycemia

hyperosmolality

glycosuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 Polys? Which one is more associated with T1DM?

A

Polyuria
Polydipsia
Polyphagia** associated with T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Besides the 3 polys, name some additional s/s of T1DM

A

Weight loss
postural hypotension
weakness
blurred vision
peripheral neuropathy
chronic infections, dry skin, itching ,poorly healing wounds
vulvovaginitis
balanoposthitis
marked dehydration
ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why do you see peripheral neuropathy with DM?

A

neurotoxicity from sustained hyperglycemia
Includes erectile dysfunction, GI dysmotility

aka sugar is toxic at high levels especially nerve endings and blood vessels, decreased blood vessel s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Geographically, what is the correlation to DM1? What are the age peaks?

A

Geography - further from the equator = higher T1DM risk

dual peak incidence in childhood (4-7 y/o, 10-14 y/o)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Will you see acanthosis nigricans in T1DM? Why or why not?

A

will NOT see it

acanthosis nigricans is due to insulin resistance not increased glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some environmental risk factors for T1DM?

A

low vit D, cow’s milk, viral exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some s/s of T2DM?

A

overweight, blurred vision, peripheral neuropathy, chronic skin infections, vulvovaginitis, balanoposthitis, acanthosis nigricans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

diabetic ketoacidosis on a test should think ____. What is it called in T2DM?

A

T1DM

hyperglycemic hyperosmolar state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the association between birth weight and T2DM?

A

women who delivered a baby >9 lb

aka high sugar in mom= larger babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name some additional conditions that are risk factors for T2DM?

A

Metabolic Syndrome (including low HDL or high TG)
acanthosis nigricans
polycystic ovarian syndrome (PCOS)
cardiovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nocturnal enuresis is more associated with _____

A

T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the s/s of hypoglycemia due to?

A

due to a combination of epinephrine and decreased CNS levels of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

confusion, irritability, drowsiness, dizziness, headache, blurred vision, feeling faint/actual loss of consciousness
anxiety, palpitations, tachycardia, trembling, hunger, diaphoresis, pallor

What am I?
At what level?

A

hypoglycemia

serum glucose level of <60-70 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who needs to be screened for DM?

A

adults at age 35

anyone who has a hx of gestational DM, pancreatitis, or prediabetes

Are overweight or obese and have 1+ DM risk factors

Have symptoms suggestive of T1DM or T2DM

HIV pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When should a pt be screened for gestational DM?

A

1st prenatal visit if risk factors, otherwise at 24-28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why do HIV pts need to be be screened for DM?

A

ART therapy can cause DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If the DM screen is negative, when do they need to be retested? What about if positive? What tests are acceptable to use as a screening tool?

A

negative: repeat at least every 3 years!

positive for prediabets: retest at least every year!

A1C, Fasting plasma glucose or 2-hr plasma glucose after 75-g OGTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which of the dx tests for DM is NOT preferred for T1DM?

A

A1C is not preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

** What are the reference ranges for fasting plasma glucose for normal, preDM and DM?

A

Normal: 70-99
PreDM: 100-125
DM: 126 or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

** What are the reference ranges for 2 hour- PG for normal, preDM and DM?

A

normal: less than 140
preDM: 140-199
DM: 200 or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

** What are the A1C ranges for normal, preDM and DM?

A

normal: 4-5.6%
preDM: 5.7-6.4%
DM: 6.5% or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If presentation for DM is unclear, what must you do?

A

repeat lab results, must have 2 abnormal values

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a normal random glucose value?

A

normal should be less than 200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are some factors that could influence the blood glucose sample?

A

fasting/nonfasting
plasma or whole blood
site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

plasma blood glucose samples tend to be _____ than whole blood. For glucometry, some locations _____ have a delay of 5-20 minutes

A

10-12% higher

(arm, thigh)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When treating a pt in an emergency setting, would you trust a DM pt’s arm sensor reading? Why or why not?

A

permanent arm sensors have a lag to them so always best to still get a finger stick to tell accurate BS in the moment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are interfering factors that could cause an increase in blood glucose levels? Decrease?

A

increase:
Major physical stressors (trauma, infection, MI, burns)
Steroids
Caffeine
Hct < 40%
Pregnancy
IV fluids containing sugars

Decrease:
Acetaminophen
Alcohol
High uric acid levels
Hct > 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does a high BG reading indicate?

A

PreDM: 100-125 fasting or 140-199 2hr OGTT

DM: greater than 126 fasting or greater than 200 2-hr OGTT or random

other causes: acute stress response, Cushing syndrome, pheochromocytoma, pancreatitis, chronic renal failure

31
Q

What does a low BG reading indicate? What are the values?

A

Excess insulin, hypopituitarism, liver disease, Addison’s

hypoglycemia is 60-70

32
Q

98% of Hb is _____ ; 7% is ____, which can combine with ____ through a process called _______. ____ represents the amount of glycosylated Hb. Measures glycemic state over the last ____ weeks. With more heavily weighted for the last ____

A

HbA

HbA1

glucose

(glycosylation)

HbA1c

8-12 weeks

4 weeks

33
Q

What factors can make an A1C appear falsely low?

A

-Hemoglobinopathies, in particular high levels of HbF
-“Young” RBCs (hemolytic anemia, recent blood loss, IV iron or other erythropoietic drugs
- low protein levels

34
Q

What factors can make A1C appear falsely high?

A

“Old” RBCs (e.g., splenectomy) aka older RBC are more likely to have glucose stuck to them

Prolonged or recurrent acute stress response

35
Q

What does a high A1C indicate? low?

A

high:
DM
preDM
stress response
cushings
acromegaly
pregnancy
splenectomy
___________

Low:
hemolytic anemia
chronic blood loss
chronic renal failure

36
Q

What is a normal AIC? PreDM? DM?

A

normal: 4-5.6

preDM: 5.7-6.4

DM: 6.5 and above

37
Q

Describe the glucose tolerance test? What is the pt education?

A

Check BS

Glucose load (75 g in 300 mL of water) is administered to patients

Plasma glucose measured at start of test and at 30 min, 1 hr, 2 hr, 3 hr, 4 hr
_________
low carb diets can interfere with the results: need to consume at least 150 carbs for 3 days before the test

avoid physical activity and smoking

37
Q

What about a pediatric glucose tolerance test?

A

Pediatric patients - 1.75 g of glucose per kg of weight

38
Q

What are interfering factors of the glucose tolerance test?

A

Acute stress response
Endocrine disorders (especially those affecting endogenous steroids)
Exercise
Fasting or reduced dietary intake prior to test
Smoking
Vomiting

39
Q

What are the normal results of a glucose tolerance test?

A
40
Q

When is a C-peptide test / C-peptide insulin ration indicated?

A

Evaluation of beta-cell function; identify causes of hypoglycemia; evaluation of insulinomas

41
Q

Why is a C-peptide considered more helpful than measuring insulin alone? Why is measuring C-peptide helpful?

A

C-peptide is more stable and has a longer half-life

Pt has anti-insulin antibodies
Pt has factitious hypoglycemia
Pt is on exogenous insulin (suppresses endogenous insulin production)
It is unknown if pt is a type 1 or type 2 diabetic

42
Q

What are interfering factors of the C-peptide and ratio to be increased? Decreased?

A

Increased - renal failure; sulfonylureas; pancreas transplant

Decreased - destruction of part or all of the pancreas

43
Q

What is a normal C-peptide/insulin ratio? What does a High C-peptide, high insulin indicate?

A

normal: 5-10
High C-peptide, high insulin: hypoglycemic meds, insulinoma, chronic renal failure

44
Q

What does a Low C-peptide, low insulin indicate? Low C-peptide, high insulin?

A

Low C-peptide, low insulin-> DM

Low C-peptide, high insulin -> exogenous insulin administration

45
Q

What are the 2 MC DM autoantibodies? ____ is the autoantibodies associated with childhood T1DM. ____ is also found in neural tissues

A

anti-GAD65

Isle Cell Antibodies

Insulin Autoantibodies (IAA)

GAD

46
Q

When will you see ketones? Where are they present?

A

when the body is using ketones for energy instead of glucose such as in alcoholism, fasting, starvation, malnutrition, eating disorders, high-fat/low-carb diets, strenuous exercise, cold, pregnancy

present in serum or urine

47
Q

What medications can interfere with measuring ketones? What are the 3 ketone bodies?

A

Vitamin C, levodopa, valproic acid, and phenazopyridine can interfere

acetone, acetoacetate, beta-hydroxybutyrate

48
Q

_____ is the predominant ketone body in severe diabetic ketoacidosis.

A

Beta-hydroxybutyrate

49
Q

At what level are you concerned about serum ketones? What level is ketoacidosis?

A

greater than 3 is concerning

15-25 is ketoacidosis

50
Q

What are the general goals for treating DM?

A

achieve glycemic control

Reduce or eliminate the long-term complications (microvascular and macrovascular) of DM

maintain quality of life

51
Q

What are the blood glucose targets for a non-pregnant adult pt with DM?

A
52
Q

Under what conditions do you want to aim for a target A1c under 6.5%?

A

Short diabetes duration
Long life expectancy
T2DM tx with lifestyle or metformin only
No significant CVD/vascular complications

53
Q

Under what conditions do you want to aim for a target A1c under 8.0%?

A

Severe hypoglycemia history
Severe disease:
Limited life expectancy
Advanced DM complications
Extensive comorbidities
Long-term DM pts

54
Q

What are the blood glucose targets for ped pts with DM?

A
55
Q

What are the hypoglycemic management guidelines?

A

if conscious: 15-20mg of glucose orally, recheck sugar levels in 15-20 minutes then eat a snack when glucose returns to normal

unconscious pt: IV glucose or injectable glucagon

56
Q

How often should T1DM check BS? T2DM? When should they check it?

A

T1DM often needs 3+ times/day

T2DM may need less often (1-2/day or less)

At directed times - fasting, prior to meals, postprandial

57
Q

What is the general diet recommendations for DM pts?

A

Low-carb, hypocaloric - 45-60% carbs, 25-35% fat, and 10-35% protein

overweight/obese pts: goal of 500-700 calorie deficit

58
Q

It is important for DM pts to remain up to date on ____. Especially _____ and ______

A

vaccines

Tdap (pertussis is the main concern in that combo)

pneumococcal

59
Q

____ are recommended for DM pts with hyperlipidemia. Need to asses _____.

A

Moderate-to-high intensity statin therapy

factors for atherosclerotic CVD (or presence of atherosclerotic CVD)

60
Q

All DM adults need to be screened for ______. Need to screen for _____ if DM patient 50+ yrs old, or any DM patient diagnosed 10+ yrs ago.
Signs of end-organ damage from DM or foot complications.

A

heart failure

peripheral vascular disease

61
Q

Consider _____ for DM pts who have ASCVD or who are at increased ASCVD risk (10-yr risk >10%) and no increased bleeding risk

A

75-162 mg/day of aspirin

62
Q

Yearly check of _____ and _____ in T1DM pts with ≥ 5-year duration of dx, T2DM pts from time of dx on, and all DM pts with HTN. ____ are preferred medications for pts who display signs of proteinuria

A

urinary albumin and eGFR

ACE/ARB

63
Q

If proteinuria persists in a pt with DM, may add _____ and/or ______

A

SGLT-2 inhibitor

mineralocorticoid agonist

64
Q

How often should DM pts be screened for retinopathy?

A

T1DM pts (initial) - dilated and comprehensive eye exam within 5 yrs of DM onset

T2DM pts (initial) - dilated and comprehensive eye exam at the time of DM dx

No signs of retinopathy - Perform repeat eye exam every 1-2 years

Evidence of retinopathy - Perform repeated dilated retinal exam at least yearly

65
Q

Approximately ___ of T2DM pts also have non-alcoholic fatty liver dz. What is the screening tool used? When do you screen?

A

70%

FIB-4 score

Presence of central obesity, CVD, insulin resistance
Patients >50 years of age
Patients with persistently high (>6 months) AST and ALT levels

66
Q

If DM pt has an intermediate to high risk for NAFLD/NASH, what do you do? What medication?

A

refer to further testing and tx

advise weight loss and diet changes

GLP-1 receptor agonists

67
Q

How often do you need to screen for signs of neuropathy? What does the screening include?

A

Yearly in T1DM pts with ≥ 5-years of dx
T2DM pts from time of dx on

Screening: good hx, monofilament testing and 1+ additional test (pinprick, vibration, reflexes)

68
Q

What are the 4 categories of ulcer risks and what are the characteristics? How often does the pt need to get examined?

A
69
Q

When is metformin considered appropriate in preDM?

A

BMI > 35
Age < 60 years
Women with hx of gestational DM

70
Q

What increases the risk of noncompliance, failure to follow up and poor patient care outcomes?

A

failure to involve the patient!!

71
Q

Give the recap of guidelines a DM pt should be receiving at least once a year!

A
72
Q
A

Endocrine (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions