DM type I

Question 1

Chemicals associated with type 1 DM

Answer 1

Alloxan, streptozotocin, pyriminil (Vacor)

Question 2

Pharmaceuticals associated with type 1 DM

Answer 2

Pentamidine, L-asparaginase

Question 3

Viruses associated with type 1 DM

Answer 3

Coxsackie, mumps, rubella

Question 4

True about type 1 DM EXCEPT

a. genetic predisposition is involved
b. immunologic abnormalities precede impairment in insulin release
c. Honemoon period may occur even if overt diabetes could develop
d. NOTA

Answer 4

D

Question 5

Enumerate 4 counter regulatory hormones of insulin

Answer 5

Glucagon, epinephrine, cortisol, GH

Question 6

Most common cause of DKA in type 1 DM

a. poor compliance with insulin
b. infection
c. incompetent caregiver
d. newly diagnosed DM/unkown DM

Answer 6

B

Question 7

Lab findings in DKA EXCEPT

a. Hyponatremia
b. low total body K
c. pH <7.30
d. HCO3 <16meq/L

Answer 7

D

Question 8

Laboratory levels to diagnose DKA

Answer 8

Hyperglycemia (>300mg/dL)
Ketonemia (ketones strongly + at 1: 2 dilution of serum)
Acidosis (pH<7.30, HC)3 < 15 meq/L)
Glucosiuria
Ketonuria

Question 9

True of fluid therapy in DKA

a. Assume 8.5% dehydration
b. 10-20ml/kg 0.45% NaCl in first 1 to 2 hours
c. Both A and B
d. Neither A nor B

Answer 9

A

Question 10

How to correct K+ in DKA

Answer 10

if K+ <6mmol/L before rehydration therapy, incorporate KPO4/K acetate 20-40meq/L to IVF at initiation therapy

Question 11

True of correction of acidosis in DKA

a. Bicarbonate is always indicated
b. Give bicarbonate via IV push
c. may give 1-2 meq/kg in 2hours
d. may give 80mmol/m2 body surface in 2 hours
e. A and B only
f. C and D only

Answer 11

f.

Intervene only if ph is <7.0 and never give via IV push for risk of hypokalemia

Question 12

True of insulin treatment in DKA

a. 0.1 unit /kg/hr (regular insulin) as continuous infusion
b. start immediately after the time of initial fluid expansion
c. SQ injection of fast acting insulin at 0.1-0.25 u/kg/q6-8 hour before meals after postacidotic phase
d. AOTA

Answer 12

D

Question 13

Tx of hypoglycemia in DKA

Answer 13

5-10% dextrose to IVF when CBS=<250mg/dL

Question 14

Persistent acidosis occurs when there’s persistence of HCO3 < ___mmol/L after _____hours

Answer 14

10mmol/L; 8-10hrs

Question 15

Usual cause of persistent acidosis

Answer 15

inadequate insulin effect

Question 16

Complications of DKA (5)

Answer 16

Hypoglycemia
Persistent acidosis
Hypokalemia
Mucor infection
Cerebral edema

Question 17

Most serious complication of DKA

Answer 17

Cerebral edema

Question 18

Patient with DKA, on treatment (fluids, insulin, etc.) develops persistent headache, altered mental status.

What’s the cause?

a. Hypoglycemia
b. Hypokalemia
c. Acidosis
d. Cerebral edema

Answer 18

D

Question 19

Treatment of Cerebral edema EXCEPT

a. Fluid restriction (2/3 of maintenance)
b. Dexamethasone
c. Mannitol infusion
d. Intubate and hyperventlate

Answer 19

B

Question 20

Cerebral edema occurs ____ hrs after inititation of therapy, rarely after ___hrs

Answer 20

6-12

22

Question 21

Trans out to ward EXCEPT:

a. Acidosis resolved
b. Tolerating PO
c. Glucose taken out of IVF
d. On Insulin infusion

Answer 21

D

Converted to SQ insulin (0.5-1.0 u/kg/day)

Question 22

Total insulin dose ____ after acute episode, and how to divide AM PM dose

Answer 22

15-30 units;
AM: 2/3: 1/4 R; 3/4 N
PM: 1/3: 1/2 R; 1/2 N