DM/hypoglycemia Flashcards
which deficiency can cause falsely elevated a1c
iron deficiency
effect of proteinuria on fructosamine levels
falsely decreased fructosamine (high albumin turnover)
fructosamine to a1c ratio
fructosamine should be ~40x higher than a1c
target glucose levels during pregnancy
fasting < 95
1hr postprandial < 140
2hr postprandial < 120
3 most common MODYs
MODY 3
MODY 2
MODY 1
treatment of MODY 3/1
sulfonylurea
fructosamine provides an estimate of glucose levels over what time frame
1-2 weeks
which SGLT2i has increased rate of fractures
canagliflozin
which SGLT2i have warnings regarding limb amputations
canagliflozin
sertugliflozin
which SGLT2i has warning regarding bladder cancer
dapagliflozin
how many type 2 DM patients have LADA?
~30%
criteria for LADA
age > 30
+ antibodies
not requiring insulin for > 6 months
u500 candidates
> 200 units per day of insulin
DM autoantibodies
GAD 65 Islet cell ab Insulinoma associated autoantibody Insulin ab ZnT8 transporter
what % of ab negative DMt1 has ZnT8 ab?
26%
ACC/AHA criteria for which age range of diabetics should be on statin
40-75, or
DMt1 x 20 years
secondary causes of DM
glucocorticoids acromegaly cushings pancreatic disease CMV genetic conditions hemochromotosis
DM, hypogonadism, pituitary dysfunction
hemochromotosis
mechanism of DM in hemochromotosis
probably insulin resistance with secondary beta cell dysfunction
DM2 medication useful in treating NASH
thiazolidinediones
most sensitive test for diagnosis of DM
2 hour OGTT
DM1 pt with axial muscle pain, stiffness
Stiff man syndrome
30% of patients have DM1
tx: diazepam
ddx for hyperinsulinemic hypoglycemia
insulinoma NIPHS insulin ab syndrome (Hirata disease) sulfonylureas/insulin post-gastric bypass nondiabetic drugs
imaging studies to localize insulinoma, in order:
- CT/MRI
- EUS
- Octreoscan/Ga-DOTATATE (insulinomas have poor expression of somatostatin type 2 receptors compared to other NE tumors, so sensitivity of these are low)
- Intra-arterial calcium stimulation
ddx for non-insulin-mediated hypoglycemia
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
hypoglycemia counter-regulatory hormones
glucagon
epinephrine
cortisol
GH
anticipate rise in glucose after glucagon stimulation test for hypoglycemia
25mg/dL
typical pattern of hypoglycemia in NIPHS
post-prandial
typical pattern of hypoglycemia in post-gastric bypass hypoglycemia
postprandial
pathologic findings of NIPHS
neisidioblastosis (beta cell hypertrophy)
nondiabetic drugs that cause hypoglycemia
indomethacine quinine pentamidine quinolones tramadol cibenzoline
how does alcohol cause hypoglycemia
acutely inhibits gluconeogenesis
poor glycogen stores related to malnutrition
typically a combination of both of these
DMt1 on basal/bolus insulin, nocturnal PD with high blood sugars at night, normal during the day. Best treatment?
add HS NPH
treatment of prediabetes in hispanic women with hx of GDM, intolerant of metformin
pioglitizone
