Lecture 5 - Advanced Diabetes Management

Question 1

Hypoglycemia is defined as blood glucose < ____mg/dL. It is considered severe if the patient requires treatment. Pseudohypoglycemia is defined as blood glucose > ____mg/dL WITH symptoms.

Answer 1

70mg/dL

70mg/dL

Question 2

Screening for diabetes complications in patients with DM1 should occur within ___ years of diagnosis. It should occur at the time of diagnosis of patients with DM2. Why?

Answer 2

5 years

This is bc patients with DM2 have likely had it for a while, so complications are more likely given the potential for chronicity.

Question 3

At every visit, a patient with DM should have their ____ measured and their ____ visually checked.

Annually, they should have ______ foot exam, dilated ____ exam, fasting ____ measurement, and urine _____-_____ratio measurement.

Answer 3

BP

Feet

Monofilament foot

Dilate Eye exam

Fasting Lipids

Albumin-Creatinine

Question 4

Diabetic patients with evident nephropathy determined by elevated albumin-creatinine ratio should be started on _____ inhibitors or ____.

Answer 4

Ace inhibitors

ARBs

Question 5

Pregabalin, Duloxetine, and Tapentadol are used to treat diabetic ______ pain.

Answer 5

Nueropathy pain

Question 6

_______ photocoagulation therapy can reduce the risk of vision loss in diabetics with retinopathy.

Answer 6

Laser photocoagulation

Question 7

Of the two hyperglycemic emergencies in Diabetics, which is more common in DM1 and which is more common in DM2?

Answer 7

Diabetic Ketoacidosis is more common in DM1.

Hyperosmolar Hyperglycemic State (HHS) is more common in DM2.

NOTE: HHS is a more severe hyperglycemia WITHOUT ketoacidosis.

Question 8

There are no Ketones present in HHS bc there is enough insulin to prevent ______. It’s worse than DKA bc DKA symptoms present ______ (earlier or later?) –> hyperosmolarity has time to develop. Also, DKA is typically present in DM1 patients, so typically _____ (older or younger?) than DM2 patients –> better _____ function for increased excretion of excess glucose.

Answer 8

Lipolysis

Earlier

Younger

Kidney

Question 9

Are abdominal symptoms more common in DKA or HHS?

Answer 9

DKA

Question 10

Neurological symptoms are more common in HHS, but what are they attributed to?

Answer 10

Dehydration

Question 11

With HHS, patients will NOT exhibit Kussmaul’s respirations. Why?

Answer 11

There’s no acidosis with HHS! So there’s no need for respiratory compensation.

Question 12

With hyperglycemic emergencies, the first step in treatment is providing isotonic _____ to treat _______ –> this improves insulin responsiveness by reducing _______.

Next step is to correct _______. Remember that insulin ______ (raises or lowers?) it. Initial goal is greater than or equal to _____ mM before insulin is given.

After this, Insulin and Bicarb (if blood pH < _____) should be administered. If glucose comes down to < _____ in DKA or < _____-_____ in HHS –> add D5 to IVF.

Answer 12

Isotonic Saline

Dehydration

Osmolarity

Potassium

Lowers

3. 3mM
4. 9

200

250-300

Question 13

Acute phase of DKA is considered resolved when anion gap < ____ and there are no _____ in blood or urine. Acute phase of HHS is considered resolved when the patient is alert, osmolarity < _____, and the patient can tolerate PO intake.

Answer 13

12

Ketones

315