DM/hypoglycemia Flashcards

1
Q

which deficiency can cause falsely elevated a1c

A

iron deficiency

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2
Q

effect of proteinuria on fructosamine levels

A

falsely decreased fructosamine (high albumin turnover)

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3
Q

fructosamine to a1c ratio

A

fructosamine should be ~40x higher than a1c

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4
Q

target glucose levels during pregnancy

A

fasting < 95
1hr postprandial < 140
2hr postprandial < 120

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5
Q

3 most common MODYs

A

MODY 3
MODY 2
MODY 1

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6
Q

treatment of MODY 3/1

A

sulfonylurea

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7
Q

fructosamine provides an estimate of glucose levels over what time frame

A

1-2 weeks

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8
Q

which SGLT2i has increased rate of fractures

A

canagliflozin

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9
Q

which SGLT2i have warnings regarding limb amputations

A

canagliflozin

sertugliflozin

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10
Q

which SGLT2i has warning regarding bladder cancer

A

dapagliflozin

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11
Q

how many type 2 DM patients have LADA?

A

~30%

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12
Q

criteria for LADA

A

age > 30
+ antibodies
not requiring insulin for > 6 months

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13
Q

u500 candidates

A

> 200 units per day of insulin

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14
Q

DM autoantibodies

A
GAD 65
Islet cell ab
Insulinoma associated autoantibody
Insulin ab
ZnT8 transporter
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15
Q

what % of ab negative DMt1 has ZnT8 ab?

A

26%

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16
Q

ACC/AHA criteria for which age range of diabetics should be on statin

A

40-75, or

DMt1 x 20 years

17
Q

secondary causes of DM

A
glucocorticoids
acromegaly
cushings
pancreatic disease
CMV
genetic conditions
hemochromotosis
18
Q

DM, hypogonadism, pituitary dysfunction

A

hemochromotosis

19
Q

mechanism of DM in hemochromotosis

A

probably insulin resistance with secondary beta cell dysfunction

20
Q

DM2 medication useful in treating NASH

A

thiazolidinediones

21
Q

most sensitive test for diagnosis of DM

A

2 hour OGTT

22
Q

DM1 pt with axial muscle pain, stiffness

A

Stiff man syndrome
30% of patients have DM1
tx: diazepam

23
Q

ddx for hyperinsulinemic hypoglycemia

A
insulinoma
NIPHS
insulin ab syndrome (Hirata disease)
sulfonylureas/insulin
post-gastric bypass
nondiabetic drugs
24
Q

imaging studies to localize insulinoma, in order:

A
  1. CT/MRI
  2. EUS
  3. Octreoscan/Ga-DOTATATE (insulinomas have poor expression of somatostatin type 2 receptors compared to other NE tumors, so sensitivity of these are low)
  4. Intra-arterial calcium stimulation
25
Q

ddx for non-insulin-mediated hypoglycemia

A
critical illness (organ failure, sepsis)
starvation
alcohol
glycogen storage diseases
adrenal insufficiency
non-islet cell tumors (IGF-mediated, typically IGF-2)
unripe ackee fruit
nondiabetic drugs
26
Q

hypoglycemia counter-regulatory hormones

A

glucagon
epinephrine
cortisol
GH

27
Q

anticipate rise in glucose after glucagon stimulation test for hypoglycemia

A

25mg/dL

28
Q

typical pattern of hypoglycemia in NIPHS

A

post-prandial

29
Q

typical pattern of hypoglycemia in post-gastric bypass hypoglycemia

A

postprandial

30
Q

pathologic findings of NIPHS

A

neisidioblastosis (beta cell hypertrophy)

31
Q

nondiabetic drugs that cause hypoglycemia

A
indomethacine
quinine
pentamidine
quinolones
tramadol
cibenzoline
32
Q

how does alcohol cause hypoglycemia

A

acutely inhibits gluconeogenesis
poor glycogen stores related to malnutrition
typically a combination of both of these

33
Q

DMt1 on basal/bolus insulin, nocturnal PD with high blood sugars at night, normal during the day. Best treatment?

A

add HS NPH

34
Q

treatment of prediabetes in hispanic women with hx of GDM, intolerant of metformin

A

pioglitizone