Endocrinology Flashcards
What are the criteria for making a diagnosis of DM?
(i) Fasting BG > 126
(ii) Random BG > 200 with symptoms
(iii) A1C > 6.5%
(iv) Abnormal 2hr glucose tolerance test
If diet, exercise, and metformin fail for treating T2DM what is your next treatment option?
Sulfonylurea
What are two scenarios in which metformin is contraindicated?
Patient has renal insuffiency (risk of lactic acidosis)
Patient inpatient and receiving contrast agents
What are the adverse effects of sulfonylureas (e.g. glipizide, glyburide)?
Weight gain (due to insulin release)
SIADH
Hypooglycemia
Gliptins are what class of agents? How do they work?
DPP-IV inhibitors
Promote insulin release and block glucagon release
How do thiazolidinediones work (e.g. rosglitazone and pioglitazone)? In what situations do you want to avoid their use?
Increase peripheral insulin sensitivity
Avoid in CHF
Acarbose and miglitol are what type of agents? What side effects do they have and why?
Alpha-glucosidase inhibitors which block the absorption of glucose in the GI tract which can lead flatulence and diarrhea
Nateglinide and reapaglinide are what type of medicaiton?
Insulin secretagogues. Similar to sulfonylureas by promoting insulin secretion
SGLT inhibitors such as canagliflozin and dapagagliflozin have what side effects?
May cause UTIs
What is the best initial test for DKA?
Serum bicarbonate
What are lab findings of DKA?
AG metabolic acidosis
Hyperkalemia (but systemically deplete of K)
Hyperglycemia
Acetone, acetoacetate, and beta hydroxybutyrate
Acidosis generally leads to what potassium disturbance? Why?
Te reverse is true for alkalosis.
Hyperkalemia. Cells begin taking in H+ in exchange for K+
What is the best way to initially manage the patient with DKA (i.e. labs and treatment)?
Order labs and ABG quickly and start bolus of normal saline. Once confirmed hyperglycemia then start insulin drip. Monitor the K+ and watch to see if it is going down and once so then begin repleting K+
What is goal BP in DM?
What is the LDL goal in DM patient? What if they have CAD too?
LDL
How do you treat DM proliferative retinopathy?
Laser photocoagulation
If fails then VEGF inhibitors like bevacizumab
If patients with microscopic proteinuria and DM what should they be started on?
ACEi
In patients with DM neuropathy how should they be treated?
Gabapentin or pregabalin
Why does DM lead to gastroparesis?
What agents can be used to help?
Basically neuropathy of GI tract and impaired stretch receptors which causes impaired motility
Erythromycin promotes release of motilin
Metoclopramide (D2 R antagonist; mixed effect at 5HT R)
What are the radioactive iodine uptake levels in: Graves disease Silent thyroiditis Subacute thyroiditis Pituitary adenoma
Graves: elevated
Silent thyroiditis: low
Subacute thyroiditis: low
Pituitary adenoma: elevated
Tx for subacute thyroiditis
Aspirin for pain
Tx for Graves disease
PTU/Methimazole
Radioactive iodine ablation
Propranolol
Separation from the nail from the nail bed may be a sign of what disease?
Graves disease, called onycolysis
What is silent thyrioditis? What Abs may be present?
Nontender gland with hyerthyroidism (auotimmune process) caused by leaking of thyroid hormone. Radioactive iodine uptake is normal/low. Thyroid peroxidase and antithyroglobulin antibodies may be present
