Kirila CIS Endocrine Pancreas

Question 1

basal vs bolus insulin

Answer 1

basal is long acing insulin to achieve more steady state of glucose control

bolus insulin can be adjusted at mealtime and based on FSG

Question 2

different terms for hemoglobin A1c

Answer 2

HbA1c
GHbA1c
glycosylated hemoglobin

Question 3

how to measure HbA1c

Answer 3

typically on venipuncture sample, also fingerstick machines available

Question 4

possible presentations to include DM in DD

Answer 4

mental status changes

abdominal pain

dehyrdation

Question 5

mental status changes

Answer 5

AEIOU TIPS

alcohol
epilepsy with seizure activity
infection
overdose 
uremia

trauma
insulin (high or low blood sugar)
poisoning/psychosis
stroke

Question 6

abdominal pain DD

Answer 6

BAD GUT PAINS

bowel obstruction
appendicitis, adenitis
diverticulitis/DKA/dysentary/ diarrhea drug withdrawal

Gatroenteritis/GB disease/stones/obstruction/infection
Urinary tract obstruction or infection
Testicular Torsion
Toxin- lead, black widow spider bite

Pneumonia/pleurisy/pancreatitis/perforated bowel/ulcer/porphyuria
Abdominal aneurysm
IN- infarcted bowel
S splenic rupture/infarction/ sickle cell pain crisis

Question 7

non-ketotoic hyperosmolar state seen more in

Answer 7

DM 2

Question 8

etiology of DKA

Answer 8

inadequate insulin administration
infection: pneumonia, UTI, gastroenteritis, sepsis
infarction- any location
surgery 
drugs (cocaine)

iii suk D

Question 9

initial symptoms of DKA

Answer 9

VAN TP

vomiting
Anorexia
nausea

thirst
polyuria

Question 10

DKA hyper or hypotension

tachy or brady cardia

Answer 10

hypotension and tachy

Question 11

high anion GAP acidosis

Answer 11

MUD PILES

Methanol
Uremia
DKA

Paraldehyde
Isopropyl alcohol, iron, INH
Lactic Acidosis
Ethylene Glycol
Salicylates

Question 12

sodium in DKA

Answer 12

measured sodium is low secondary to hyperglycemia (water pulled into ECF bc hyperosmolar)

for every 100 mg/dL that glucose is over 100mg/dL there will be a 1.6 reduction in sodium

Question 13

labs DKA
potassium 
TGs 
lipids and proteins
amylase
WBC

Answer 13

serum may be normal or somewhat high
-actually total body deficit

hyperTGs
hyperlipoproteinemia

hyperamylasemia
-can suggest acute pancreatitis

leukocytosis

Question 14

treatment of DKA

Answer 14

frequent monitoing of gen status, vital signs, glucose and
A-B status
renal function
K+ and electrolytes

Question 15

fluid replacement in DKA

Answer 15

2-3 L NS over first 1-3 hours (5-10 ml/kg/hr)
then 1/2 strength saline at 150 ml/hr

when glucose reaches 250 switch to D51/2 NS at 100-200 ml/hr

fluid deficit is often 3-5 L

Question 16

initial insulin admin DKA

Answer 16

regular insulin

10-20 units UV or IM (0.15/kg)
then: 5-10 units/hr continous IV or (0.05=.1/kg/hr)

increase if no response in 1-2 hours

Question 17

DKA eval for underlying causes

Answer 17

cultures
EKG
CXR
drug scren
seek additional family history

Question 18

initial montioring in DKA

Answer 18

BSG hourly
clinical status hourly
-vitals, mental status, fluid I & O

Question 19

potassium replacement in DKA

consider potassium replacement when serum K is under

Answer 19

5.5 meq/L

Question 20

when supplemnting potassium keep what in mind

Answer 20

renal function
EKG and cardiac monitoring
verify urinary output and measure hourly
-likely will need indwelling foley catheter initially

Question 21

glucose goal of DKA (level)

Answer 21

150-250

Question 22

when do you start intermediate of long acting insulin

Answer 22

when pt is able to eat when
-mental status improved, no nausea/vomiting, no ab pain

anion gap normalized

allow overlap timing of IV with SQ insulin usually by 30-60 mintues

Question 23

etiology of NKHS

Answer 23

insulin deficiency
inadequate fluid intake
osmotic diuresis induced by hyperglycemia

sepsis
MI
glucocorticoids
phenytoin
thiazide diuretics
no water access

Question 24

symptoms of NKHS

Answer 24

polyuria
alterd mental state
thirst
(PAT)

no nausea, vomiting, ab pain, and kussmaul resp

Question 25

labs in NKHS

Answer 25

lactic acidosis may produce mild increase in anion gap
moderate ketonuria from starvation
Corrected sedrum sodium usually increased

Question 26

treatment of NKHS

Answer 26

ICU

freq monitoring of gen status, vitals, glucose, acid base , renal fnct, potassium

Question 27

fluid replacement in NKHS

Answer 27

fluid deficit is often 8-10 L

Question 28

insulin admin in NKHS

Answer 28

regular insulin
-5-10 units IV or IM bolus
3-7 units continuous infucsion

Question 29

what may alter the results of Hb A1c

Answer 29

hemoglobinopathies or recent blood transfusions

Question 30

what level is considered satisfactory control for Hb A1c

Answer 30

under 7

Question 31

screening for proteinuria

sensitivity

Answer 31

spot urine sample

-protein: standard urine dipstick not senstivie if proteinuria is less than 300 mg/24 hr

Question 32

screening for proteinuria with microalbumen

Answer 32

use microalbumen/creatinine ratio

random urine sample

this ratio more acurate than measuring microalbumen alone

use 24 hr urine collection
-need to obtain serum creatinine at same time for clearance

Question 33

what classifies micro vs macroalbumenuria

Answer 33

30-300 mg = micro

over 300 = macro

Question 34

glucose greater than ____ interferes with neutrophil function

Answer 34

150

Question 35

long term diabetes monitoring quarterly

Answer 35

Hgb A1C
review self glucose monitoring log
foot inspection for ulcerations

Question 36

long term diabetes monitoring annual

Answer 36

dilated eye exam
urine protein screening (microalbum/creatinine ratio)
monofilament testing