Endocrine: Insulin Flashcards
Your patient has the following Labs:
FPG= 120
GTT= 178
Ha1c= 6
A. Do they have Diabetes?
B. Do they have pre-Diabetes?
C. What is the management of this patient?
A) No
B) Yes
C. - Health diet and weight control
- Exercise
- Stop smoking
- Get blood pressure and cholesterol under control.
- Medication (primarily metformin) to lower blood sugar if at high
risk of diabetes.
Which of the following labs makes for a diagnosis of diabetes, according to the ADA?
A. HgA1C>6.5
B. FPG ≥126 mg/dl
C. 2 hr PG ≥200 mg/dl OGTT
D. Random glucose ≥200 mg/dl with Sx
All of the above
How often should you test A1C in a diabetic patient?
A. It is not necessary
B. Every two years
C. Yearly
D. At least twice per year
D) at least twice a year
What is the glycemic A1c goal for most patients?
A. <6.5
B. <7
C. <8
D. <10
B) <7
When should you start insulin in patient with DM?
-T1DM?
-T2DM?
T1: always
T2: - Patients with newly diagnosed T2DM who are symptomatic and/or have A1C >10% and/or blood glucose levels ≥300 mg/dL. (with or without additional agents)
- Patients treated with >2 noninsulin glucose-lowering agents and are above their glycemic goal
- Patient preference &/or cost
When should BP medications be recommended?
When BP ≥130/80 mm Hg
A 55 year old female with DM 2 and CAD has microalbuminuria and CKD stage III with a serum creatinine of 2. What medication will help nephropathy most?
A. Statin
B. ACEI
C. BB
D. ASA
B. ACE I
When should statin be recommended in DM patients who have developed cardiovascular complications
such as ASCVD (atherosclerosis cardiovascular disease)?
- All diabetic patients 40 or older
- High intensity or Moderate intensity
When should Aspirin be recommended in DM patients who have developed cardiovascular complications such as ASCVD (atherosclerosis cardiovascular disease)?
- Use aspirin therapy (75-162 mg/day) as a secondary prevention strategy in those with diabetes and a history of ASCVD, but no documented aspirin allergy
- Use aspirin therapy as aual antiplatelet therapy (with low-dose aspirin and a ADP/P2Y12 inhibitor) is reasonable for a year after an acute coronary syndrome and may have benefits beyond this period
Despite a program of diet and exercise, a 50 y. o. obese diabetic man has a fasting plasma glucose of 150 mg/dL. A1c is elevated at 8.5%. Kidney and liver tests are normal. Vital signs and exam wnl except for weight 210 lb with height 5 ft 4 in.
What should we do now?
- Weight reduction & Exercise
- Medications
1) Primary Metformin
2) Depends on AIC (>10%) and/or blood glucose levels (≥300
g/dL) condisdering to start Insulin.
A 27 y.o. male diabetic uses 32 units of NPH insulin each morning. His FBS is 280%. The blood glucose before supper is running around 130 mg%.
What should be done now?
Give the patient long acting Insulin, such as Glargine or Determir.
A 65 y.o. hypertensive type 2 diabetic on lisinopril, glimepiride, and Actos (pioglitazone) shows up in your office with mild dyspnea. Home sugar tests before meals 2 days per week generally range from 100 to 140. Exam reveals a weight gain of 10 lb since his last exam 2 months ago, 3+ leg edema bilaterally, hepatomegaly, mild jvd, and rales (crackles) at each lung base. FBS is 118 mg%. Kidney and liver tests are wnl.
How are we going to handle this situation?
- Antihypertensive drug to control BP <130/80 mm Hg
- Intermediate acting Insulin control glucose
- Diuretics for edema
A 16 yo female presents to the ER with altered mental status. Odor of acetone on breath. Markedly dehydrated. Kussmaul respirations. Fingerstick glucose higher than the monitor can record. You tell her parents with some confidence:
A. she has type 2 diabetes.
B. she has type 1 diabetes.
C. We must send urine for toxicology because maybe drug abuse accounts for mental state.
D. We will give IV dextrose because we always do that when mental status altered.
E. We will get a stat CT of brain.
B. she has type 1 diabetes
Which of the following is NOT a typical finding in HHS?
A. Blood PH <7.30
B. Dehydration
C. Mental Status Changes
D. Osmotic diuresis
A. blood pH <7.3
Which of the following statements is INCORRECT about Hyperosmolar Hyperglycemic State?
A. HHS occurs mainly in type 2 diabetics.
B. This condition presents without ketones in the urine.
C. Metabolic alkalosis presents in severe HHS.
D. Intravenous Regular insulin is used to treat hyperglycemia.
C. metabolic alkalosis presents in severe HHS
