Endocrinology

Question 1

What is metabolic memory in regards to diabetes?

Answer 1

The effect of prior glucose control on risk of diabetes complications

Question 2

How is LADA clinically differentiated from T2DM?

Answer 2

LADA usually rapidly progresses (<3 years) to be insulin requiring. Check Anti-GAD65 to confirm.

Question 3

What is the pathogenesis of T1DM?

Answer 3

Autoreactive T cells to Beta cells in Pancreas due to failure of thymus negative selection.

Question 4

What does a higher residual beta cell function in T1DM reduce the risk of?

Answer 4

Retinopathy and hypoglycemia

Question 5

What does the Meal Ratio mean?

Answer 5

This is the ratio of how many grams of CHO one unit of rapidly acting insulin covers to keep blood glucose in the optimal range.

Question 6

What is the Meal Ratio equation?

Answer 6

500/TDD - CHO ratio

TDD = Total Daily Dose of Insulin
CHO is carbs in grams

Question 7

What does the Insulin Sensitivity Factor used for?

Answer 7

To tell how many mmol/L the BGL will drop with 1 unit of insulin

Question 8

What is the Insulin Sensitivity Factor equation?

Answer 8

ISF = 100/TDD

TDD - Total Daily Dose of insulin

Question 9

What is the effect of Continuous Glucose Monitoring on glycemic control in adults with T1DM?

Answer 9

Reduction in HbA1c

Question 10

What is the benefit of continuous subcut insulin infusion over multiple dose injections in T1DM?

Answer 10

CSII therapy results in lower HbA1c levels, decreased insulin requirements without increased risk of hypoglycemia

Question 11

What is the Dawn Phenomenon?

Answer 11

Increased BSLs in the AM due to growth hormone and cortisol

Question 12

What factors would make a patient a good CSII candidate in T1DM?

Answer 12

Those who don’t reach glycemic goals despite adherence and maximum multiple dose injections especially if:

• Very labile diabetes
• Frequent Hypos/Insulin sensitivity
• Significant Dawn Phenomenon

Question 13

What complications does tight glycemic control reduce in the short term?

Answer 13

Reduced microvascular complications; specifically - Retinopathy and nephropathy (DCCT Study 1990)

Question 14

What complications does tight glycemic control reduce in the long term?

Answer 14

42% reduction in macrovascular events (EDIC Study)

Question 15

List the 4 counterregulatory responses to hypoglycemia in order.

Answer 15

1. Reduced Insulin secretion
2. Increased Glucagon secretion (Transient glycogenolysis)
3. Increased Adrenaline secretion (Hepatic glycogenolysis and gluconeogenesis)
4. Increased Cortisol and GH secretion

Question 16

What is the pathophysiology of of hypoglycemic unawareness?

Answer 16

Reduced sympathoadrenal response resulting in absent or reduced neurogenic symptoms. Occurs via decreased SNS output from CNS.