Endocrine Topics 1

Question 1

DM Type 2

Answer 1

• insulin resistance bc ineffective glucose transport out of bv
• hyperglycemia

Question 2

Risk Factor of DM Type 2

Answer 2

• Age>45
• BMI>25
• 1st degree relative
• high risk ethnicity (African american, hispanic)
• hypertension
• impaired fasting glucose

Question 3

Clinical Presentation of Type 2 DM

Answer 3

• Polyuria
• Polydypsia (excessive thirst)
• polyphagia (excessive eating)
• Acanthosis nigricans
• foot ulcers
• retinopathy

Question 4

ADA criteria for diagnosis of Type 2 DM

Answer 4

• HbAlc>6.5%
• fasting glucose >126
• 2 hr glucose >200

Question 5

Diabetic Foot Exam

Answer 5

-check for callus/corn formation, breaks in skin
-check sensation, vibratory and monofilament
DOCUMENT for diabetic footwear

Question 6

Management Type 2 DM

Answer 6

• lifestyle changes
• insulin
• check HbAlc every 3 months when adjusting treatment, every 6 months when stable

Question 7

Ominous Octet Hyperglycemia Type 2 Diabetes

Answer 7

1. NT dysfunction
2. Increase lipolysis and reduced glucose intake
3. Increased glucose reabsorb
4. decreased glucose uptake
5. decreased incretin effect
6. increased hepatic glucose production
7. increased glucose secretion
8. impaired insulin secretion

Question 8

Complications of Type 2 DM

Answer 8

1. Microvascular Disease-blurred vision, CKD (chronic kidney disease), numbness and tingling extremities
2. Macrovascular Disease- MI, Stroke, Peripheral vascular disease
3. Increase in infections- necrotizing

Question 9

DKA

Answer 9

• Usually associated with Type 1
• Mental changes, vomit, abdominal pain
• signs of dehydration
• Kussmaul resp: using accessory muscles
• fruity smelling breath (acetone)
• gluecose >200 bc of inadequate insulin treatment or noncompliance

Question 10

DKA Versus HHS (Hyperosmolar hyperglycemic state)

Answer 10

DKA
-hyperglycemia: blood glucose >200
-Metabolic acidosis: venous pH<7.4 plasma HCO3<15
-Ketosis: ketones in urine
HHS
-marked hyperglycemia: glucose>600
-minimal acidosis: venous pH >7.25, arterial pH >7.3m serum HCO3 >15
-Absent or mild ketosis, marked elevation in serum osmolality >320
ADMIT TO HOSPITAL FOR BOTH

Question 11

DM Type 1 Risk Factors

Answer 11

• genetic

- environmental trigger

Question 12

DM Type 1 Presentation

Answer 12

• polydipsia
• polyuria
• weight loss with hyperglycemia and ketonemia or ketonuria
• DKA

Question 13

DM Type 1 versus Type 2

Answer 13

Type 1
-normal insulin sensitivity when controlled
-permanent insulin dependence
-20-25% overweight
-Pancreatic Ab present 
-present at childhood 
-association with HLA-DR3/4
Type 2
-decreased insulin sensitivity
-variable insulin dependence
-80% overweight
-NO pancreatic Ab
-no association with HLA-DR3/4

Question 14

Associated Conditions/Management with Type 1 DM

Answer 14

-Autoimmune Thyroiditis
-Celiac Disease
-Addison’s Disease
MANAGE WITH EDUCATION and INSULIN

Question 15

Metabolic Syndrome

Answer 15

-increased risk of CVD and DM

Question 16

Risk Factors of Metabolic Syndrome

Answer 16

• Overweight/obese
• Sedentary life
• Genetics
• DM type 2
• CVD

Question 17

Diagnosis of Metabolic Syndrome

Answer 17

Any of the following 3
-Abdominal obesity
-Triglycerides >150
-HDL <40 in men and <50 in women 
-BP > 130/85
-Fasting glucose >100
CAN HAVE BOTH Metabolic Syndrome and Diabetes

Question 18

Associated Conditions with Metabolic Syndrome

Answer 18

• Polycystic Ovary Syndrome
• Obstructive Sleep Apnea
• Nonalcoholic Fatty Liver Disease
• Hyperuricemia

Question 19

Management of Metabolic Syndrome

Answer 19

• LIFESTYLE CHANGES: diet, exercise
• Weight loss surgery, meds
• Statin meds
• Fibrate Meds
• BP meds
• metformin