Endocrin

Question 1

Insulin Drugs - timing / rando facts
Lantus / Levimir

Lin vs Log

NPH

Regular insulin

Answer 1

Lantus / Levimir - long acting

Lin vs Log - lin are older, used in sliding scale? Log are more complex

NPH - rapid acting - medium

Regular insulin - normal - medium

Question 2

Insulin calc for basal-bolus

Answer 2

.5 units / kg = total per day
1/2 as night time long acting (lantus / levimir)
1/2 as qAC (before each meal) (short term) (Novolog/humalog)

Question 3

Sliding scale insulin

Answer 3

No basal, just short acting depending on current surgar

Question 4

Somogyi Effect
vs
Dawn Phenomena

Answer 4

Too much insulin at night, high AM BG

Too little insulin at night, high AM BG

Check early am BG to tell the difference?

Question 5

Conditions of DX of diabetes for each testing method:

Random glucose measurement

Fasting glucose

Oral glucose tolerance test

HgA1C

Answer 5

Random glucose measurement : Over 200 w/ sxs (polyurea, polydipsea)

Fasting glucose: <100 normal. 100-125 pre diabetes/ insulin insensitivity. >125 is DM, but needs confirmatory test

Oral glucose tolerance test: Fasting check then 75g sugar consumed. Wait 2 hrs, <140 is normal, 140-199 is pre DM, >200 is DM

<5.7, 5.7-6.4 pre DM, >6.5 is DM

Question 6

Type 1 DM ab

Answer 6

GAD65 and IA-2

Question 7

Pre Diabetes TX

Answer 7

Metformin and lifestyle

Question 8

Effectiveness of certian DM txs

Answer 8

lifestyle A1c by about 1%.
Oral agents reduce the A1c by 3%
If the patient has an A1c >9%, insulin should be started.

Question 9

Ongoing assesment of DM

Answer 9

Always pre prandial
If pre prandial good BUT A1C not at goal, check post prandial

A1C every three months
Yearly microalb/creatinine , eye exam, foot exam (monofillament)

Question 10

Biguanides (metformin)

Answer 10

↑Insulin sensitivity

SE - Weight loss? diarhea
cant give with liver dz

Question 11

Sulfonylureas

Answer 11

Glyburide (ride!)
Glipizide (zig zag!)

↑Insulin secretion

SE - hypoglycemia

Question 12

DDP-4-i (liptins)

Answer 12

Inc DDP-4-i

SE - weight neutral

Question 13

GLP-1 analogs (Tides)

Answer 13

Inc GLP-1! - so more secretin?

SE: Weight loss!

Question 14

Meglitinides (glinide)

Answer 14

Gliding stork!

Increased insulin secretion

SE - hypoglycemia

Question 15

SGLT2-i (flozins)

Answer 15

Flossin!
Increase glucose secretion

SE: Euglycemia, can cause DKA, UTI

Question 16

Alpha- Acarbose Glucosidase Miglitol inhibitors

Answer 16

Stop digestion, Diarhea. Not the best.

Question 17

TZDs (pioglitazone)

Answer 17

Chubby dude
↑Insulin sensitivity

SE - ortho hypoten, weight gain, osteopenia

Question 18

Symptoms of adrenal insufficiency

Clinical features of AI

Answer 18

Weakness
Fatigue
Nausea
Vomiting
Anorexia
Abdominal pain
Weight loss 
Salt craving

Primary:
Hyperpigmentation if skin hair nails

Labs
Hyponatrimia, hyperkalemia, acidosis, hypoglycemia

Question 19

Dx of adrenal insuf

Answer 19

Low then High

Low dosedexa with

Question 20

Treatment of AI

Primary

Secondary

Answer 20

Primary:
cortisol (hydrocortisone) Aldosterone(fludrocortisone; Florinef)

Secondary: cortisol1