MKSAP Endocrinology and Metabolism Flashcards
Diagnosis of type II DM
Must have 1 of these:
- fasting blood glucose >126 mg/dL
- random blood glucose >200 mg/dL with symptoms of hyperglycemia (polyuria, polydipsia, or blurred vision)
- 2-hr oral glucose tolerance test of at least 200
- HGB A1c of >6.5%
Impaired fasting glucose
Fasting plasma glucose level of 100 to 125
Impaired glucose tolerance
Plasma glucose at the 2 hr mark is 140-199
Metabolic syndrome
- BP >/= 130/85
- triglyceride level >/=150
- HDL cholesterol /=110
- waist circumference >40 in for men
Treatment for pre-diabetes
- Diet and exercise
Secondary diabetes
Hyperglycemia due to Cushing’s syndrome, acromegaly, pancreatitis, pancreatic cancer, drugs, or genetic syndromes
Management of hyperglycemia in hospitalized pts
Basal and preprandial insulin
- Sliding scale regular insulin associated with increased hyperglycemia and hypoglycemia.
Management of diabetic retinopathy and macular edema
Treatment: pan-retinal photocoagulation
Types of diabetic retinopathy
- Nonproliferative - hard exudates, microaneurysms, minor hemmorhages, no associated visual decline
- Proliferative - cotton wool spots and neovascularization associated with visual loss —->retinal ischemia —–> scarring and fibrosis ——> retinal detachment or leaking of vasculature —–> macular edema
Diagnosing and treating diabetic ketoacidosis
Tests to order: serum glucose (> 250), electrolytes (serum CO2
Treatment for hyperglycemic hyperosmolar syndrome
- Begin IV fluids w/ normal saline
- When normal BP and urine output is restored, start hypotonic solution.
- Replace half of TBWD during first 24 hrs and the next half over the next 2-3 days.
- Only give insulin later.
Diagnostic criteria:
- plasma glucose >600
- arterial pH >7.3
- serum bicarbonate >15
- serum osmolality >320
- absent urine or serum ketones
