Endo-glucose metabolism Flashcards

Question

Postprandial hypoglycemia

Answer 1

Most often occurs with a former bariatric surgery Occurs within

Answer 2

Most often occurs with a former bariatric surgery Occurs within 5 hours of food consumption

Answer 3

Diagnosis: measure glucose, insulin pro-insulin, and c-peptide levels prior to the meal and repeat 30 minute intervals after or at the time of symptomatic hypoglycemia * if symptomatic hypoglycemia--> measure insulin Abs * oral hypoglycemic screen test obtained

Answer 4

involves small, frequent complex meals composed of protein, fat, and carbohydrate to avoid the sensation of hypoglycemia

Answer 5

urine and serum ketones elevated beta-hydroxybutyrate Elevated anion gap glucose can be normal and up to 700 stress related mild leukocytosis is usually present serum sodium levels low due to osmotic shifts serum potassium elevated due to shifts

Answer 6

normal or small amounts of urine or serum ketones, plasma glucose is >700 serum osmolality is elevated an greater than 320 mOsm/kg

Answer 7

FLUIDS: give normal saline at first (1L/h) then switch to 1/2 normal saline at 250-500 mL/hr if corrected serum sodium level becomes normal or high--> when glucose reaches 200-300, then switch to D5-1/2normal INSULIN:Insulin drip, 0.1 units/kg POTASSIUM: If potassium <3.3 do not start insulin and give potassium IV until it is >3.3, then add 20-30mEq of potassium chloride to each tier of IV druids to keep potassium at 4-5. If potassium >5.2, then just start insulin CORRECTION OF ACIDOSIS: if pH <6.9--give sodium bicarb and potassium over2 hrs. If pH 6.9 or greater, do not give sodium bicarb

Answer 8

- Type 1 DM: start 5 yrs after dx, do annually - Type 2 DM: start at dx, do annually - Pregnant women: every trimester and then closely for 1 year postpartum

Answer 9

- Type 1 DM: 5 years after dx, albumin-cr ratio on random spot urine - Type 2 DM: at diagnosis, albumin-cr ratio on random spot urine

Answer 10

DMI: at 5 years after dx, use 19t monofilament, 128 Hz tuning fork, ankle reflexes DMII: 10-g monofilament, 128 Hz tuning form, ankle reflexes

Answer 11

CV--monitor for hypertension at every visit! | Dyslipidemia-Annually with a fasting lipid profile

Answer 12

For women with a history of gestational diabetes, diabetes screening using standard criteria should occur at 4 to 12 weeks postpartum and every 3 years thereafter.

Answer 13

LIFESTYLE MEASURES FIRST. The ADA 2018 Standards of Medical Care recommends insulin as the preferred agent for management of type 1 and type 2 diabetes in pregnancy.

Answer 14

Lifelong insulin therapy is the first-line treatment for type 1 diabetes; physiologic insulin therapy reduces early microvascular disease by 34% to 76% in patients with type 1 diabetes mellitus compared with nonphysiologic regimens. Continuous subcutaneous insulin infusion is a cost-effective treatment modality and should be considered for select patients with type 1 diabetes mellitus if adequate glycemic control is not achieved with adherence to multiple daily injection therapy.

Answer 15

For patients with type 2 diabetes mellitus, metformin is recommended first-line therapy and should be initiated in conjunction with lifestyle modifications; it has a lower incidence of hypoglycemia and weight gain compared with some of the other oral agents and insulin.

Answer 16

The FDA now considers metformin to be safe for patients with mild chronic kidney disease and some patients with moderate kidney impairment using estimated glomerular filtration rate (eGFR) as a measure of kidney function. Metformin continues to be contraindicated in those with an eGFR less than 30 mL/min/1.73 m2.

Answer 17

In older patients with type 2 diabetes mellitus of longer disease duration, treatment of severe recurrent hypoglycemia should take precedence over controlling hemoglobin A1c values; the increased risks of hypoglycemia outweigh the risks of diabetes complications.

Answer 18

Distal symmetric polyneuropathy (DPN) is the most common form of diabetic neuropathy, and it presents as a sensation of numbness or burning pain in a stocking-glove distribution; management may require one or more classes of drugs, including antidepressants (amitriptyline, venlafaxine, duloxetine, paroxetine), anticonvulsants (pregabalin, gabapentin, valproate), or capsaicin cream