SECRETS Endo - Pancreas

Question 1

DM 1 sx

Answer 1

polyuria
polydipsia
weight loss
polyphagia

hyperglycemia

may present as DKA

Question 2

DM 1 cause

Answer 2

autoimmune destruction of beta cella

Question 3

DM 2 cause & hyperglycemia cause

Answer 3

insulin resistance
beta cell dysfunction

lipolysis, reduced glucose uptake –> hyperglycemia

Question 4

c peptide - insulinoma vs exogenous insulin

Answer 4

high in insulinoma
low in exogenous insulin

proinsulin = c peptide + insulin

Question 5

weight loss in DM 1

Answer 5

insulin deficiency = hypercatabolic state

stimulate gluconeogenesis, glycogenolysis, fatty acid catabolism

Question 6

DKA mechanism

Answer 6

w/o insulin, fatty acids delivered to liver instead of taken up by adipocytes

metabolized in liver –> ketoacids

hyperglycemia –> dehydration –> kidneys cannot excrete acid

Question 7

hyperglycemia ADR - short and long term

Answer 7

short = prevent DKA
long = reduce microvascular, macrovascular complications

Question 8

HbA1C

Answer 8

represents glycosylated Hb
associated with levels of plasma glucose

effective measure of long term diabetes b/c RBC lifespan is 120 days

Question 9

diabetes + HTN tx

Answer 9

ACEi

reduce incidence of nephropathy and MI

Question 10

BB in diabetics

Answer 10

contraindicated

mask signs of hypotension
inhibit epinephrine response to hypotension

Question 11

overdose nighttime insulin

Answer 11

elevated morning plasma glucose due to ++ sympa response to hypoglycemia

Question 12

DM 2 sx

Answer 12

overweight
sedentary
strong family history
polydipsia
polyuria

Question 13

which GLUT is insulin dependent

Answer 13

GLUT4
in skeletal muscle and adipose tissue

glucose & K cotransporter

Question 14

primary metabolic fuel in fasting state

Answer 14

fatty acids

glucose, ketones in brain

Question 15

metformin

Answer 15

inhibit hepatic glucose production
stimulate adipose/skeletal muscle uptake of glucose
beneficial to lipid profile

anorexic effect

Question 16

Metformin ADR

Answer 16

lactic acidosis

esp in pts with CHF, liver disease, renal disease

Question 17

DM 2 tx

Answer 17

sulfonylureas
a-glucosidase inhibitors
PPAR-y agonists

Question 18

a-glucosidase inhibitors

Answer 18

acarbose
miglitol

inhibit intestinal enzymes that break down disaccharides
undigested sugars cannot be absorbed
metabolized by colonic bacteria –> flatulence

Question 19

sulfonylureas

Answer 19

tolbutamide
glyburide

stimulate insulin secretion
depolarize cell –> open Ca channels –>influx Ca

Question 20

sulfonylureas ADR

Answer 20

weight gain
hypoglycemia

disulfiram like rxn in 1st gen

Question 21

foot ulcers in diabetics

Answer 21

microvascular disease = poor perfusion

neuropathy (stocking-glove) = can’t feel feet

Question 22

PPAR-y agonists

Answer 22

glitazones

pioglitazone

Question 23

diabetic nephropathy

Answer 23

nodular glomerulosclerosis
Kimmelstein-Wilson lesio

expansion of mesangium by intensely PAS-positive material without thickening of glomerular capillary walls

Question 24

DM 2 poor glycemic control complications

Answer 24

OD on sulfonylureas = hypoglycemic coma

hyperglycemia = hyperosmolar nonketotic coma, DKA

Question 25

gestational diabetes

Answer 25

diabetes dx in pregnancy, resolves 6 weeks after birth

increased risk of DM 2

Question 26

maternal insulin resistance mechanism

Answer 26

placental secretion of hPL = antagonize maternal insulin

facilitate delivery of glucose to fetus via passive diffusion

Question 27

gestational diabetes –> fetus

Answer 27

macrosomia
birth injury
increased fetal insulin
hypoglycemia at birth
respiratory distress syndrome

Question 28

hypoglycemia in neonate

Answer 28

maternal diabetes

elevated fetal glucose –> chronic fetal hyperinsulinemia

tx give baby glucose

Question 29

respiratory syndrome in neonate of maternal diabetes

Answer 29

respiratory distress syndrome

lack of surfactant

surfactant synthesis decreased by insulin
increased by cortisol, T4

Question 30

reactive hypoglycemia causes

Answer 30

functional* = excessive insulin secretion
alimentary = rapid glucose absorption –> surge of insulin secretion (gastric resection)
occult diabetes = exaggerated late phase insulin secretion

Question 31

Whipple’s triad

Answer 31

hypoglycemia
sx of hypoglycemia
resolution with food

insulinoma

Question 32

insulinoma tx

Answer 32

surgery

Question 33

nesidioblastosis

Answer 33

beta islet cell hyperplasia

excess insulin secretion

hypoglycemia