Pales diabetes CIS

Question 1

how do steroids cause leukocytosis?

Answer 1

extravasation of the white blood cells into the vessels

Question 2

pseudohyponatremia

Answer 2

when you correct for the extra glucose you don’t actually have hyponatremia

Question 3

no DKA but acidotic in crazy diabetic state. Why?

Answer 3

hypoperfusion of the organs

Question 4

pathogenesis of DKA

Answer 4

insulin deficiency–> enhanced lipolysis–> increased fatty acid delivery to the liver–> increased ketogenesis (formation of acetoacetic acid–> BHBA–> acetone)–> acidosis

Question 5

what is the mechanism of potassium loss in DM?

Answer 5

polyuria

Question 6

what can be a cause of high hematocrit in DM?

Answer 6

dehydration

Question 7

shortness of breath can represent

Answer 7

acidosis with respiratory attempts at compensation

Question 8

why weight loss in DM?

Answer 8

insulin is anabolic; in the absence of it catabolism will reign

Question 9

how do type II DM patients develop ketoacidosis?

Answer 9

when beta cells are so done that they’re not making insulin (late in the disease)

also in glucose toxicity (blocks glucose receptors; reversible process)

Question 10

most important part of knowing when DKA is resolved and we can stop the insulin drip

Answer 10

wait until the anion gap normalizes;

the problem isn’t glucose, it’s acid

Question 11

compare and contrast DKA and NKHO coma

Answer 11

DKA- usually type I DM, younger patients, factors: stress, noncompliance. Mental status: usually alert. Kussmaul respirations, * Gap acidosis always present but may be masked by concomitant metabolic alkalosis. acute renal failure less common. Major metabolic problem: acidosis. TREAT: INSULIN

NKHO- usually type II DM, very old patients, factors: nursing home, dehydration, dementia. Usually comatose or confused, normal or diminished breathing, * No or mild ketoacidosis, may have acidosis from other causes. Acute renal failure more common. Major metabolic problem: dehydration, Treat: FLUIDS

Question 12

guy shows up with uncontrolled diabetes. What meds should we put him on?

Answer 12

metformin
ACEI (lisinopril)
statin (fibrates don’t decrease mortality, but statins do)

baby aspirin

Question 13

how long to wait before checking A1C again?

Answer 13

3 months

Question 14

people who are professional drivers can’t be on what med?

Answer 14

insulin (risk of hypoglycemia)

try metformin, GLP-1 agonist, DPP-4 inhibitors, TZDs, SGLT-2s or alpha 1 glucorinidase inhibitors instead

Question 15

recommended statins for diabetics with LDL at what levels?

Answer 15

over 70

Question 16

contraindication for metformin?

Answer 16

renal failure

Question 17

morning hyperglycemia is mostly caused by

Answer 17

gluconeogenesis by the liver

Question 18

for signs or history of conditions other than diabetes that may cause hypoglycemia

Answer 18

Liver failure
Sepsis
Adrenal insufficiency
Pan-hypopituitarism
Previous gastric surgeries

Question 19

If BS is low, insulin is high and C-Peptide is low, what would be the likely diagnosis?

Answer 19

factitious insulin

Question 20

BS is low, insulin and C-Peptide is high, what would be the possible causes?

Answer 20

Insulinoma –> images to r/o
Autoimmune – check for antibodies
Factitious – check sulfanyluria level

Question 21

Mixed meal test. If Whipple’s triade develops after mixed meal, what are the possible causes?

Answer 21

reactive hypoglycemia