THE BEETIES

Question 1

Hyperglycemia microvascular injury

Answer 1

Sugars cause basement membrane thickening leading to nephropathy, retinopathy and other neuropathies

Question 2

Reason for serious infection complications in Wilferd Brimley

Answer 2

Glucose rich environment great for them bugs
Suppression of immune function
Lack of sensation

Question 3

Glucose test

Answer 3

Over 11 after eating is diabetes
Over 7 after 8 hours fasting
Oral glucose tolerance test is 75gm glucose measure 2 hours later, should be below 7.7

Question 4

Hemoglobin A1c

Answer 4

For testing for the beeties. It is a reflection of the 2-3 month average. 6.5% is the cut off
Preggos, kidney/liver disease, recent blood transufusion or blood loss, thalassemia, iron deficiency all make the test inaccurate

Question 5

Short duration rapid acting

3-5 hour duration (3-6 humalog)

Answer 5

Lispro - humalog
Aspart - Novolog
Glulisine - Apidra

Question 6

Short duration slower acting - for with meals 30-60 onset 10 hour activity

Answer 6

Regular insulin - humulin r and novolin R

Question 7

Intermediate insulin 12-24 hours

Answer 7

NPH - humulin N and novolin N

Levemir is here on the slides

Question 8

Long acting insulin

Answer 8

Glargine - Lantus

Detemir - Levemir

Question 9

C-peptide

Answer 9

A link in proinsulin which is cleaved. Measuring C-peptide can help assess if a patient is producing their own insulin (exogenous insulin won’t have c-peptide)

Question 10

Insulin stimulation

Answer 10

Blood glucose but also lesser amino acids, fatty acids, ketones and some gut hormones

Question 11

Labs for insulin administration

Answer 11

Bicarb glucose sodium and K+
Loading dose 10 units regular insulin IV with 0.1units/kg/hr after
BGL of 14 = D5W drip started

Question 12

Insulin in DKA

Answer 12

Continued until bicarb hits 15mEq/L - ketones persist longer than hyperglycemia
May need KCl to prevent hypokalemia

Question 13

Na+ DKA

Answer 13

Dehydration related to DKA may cause hyponatremia. Na+ efflux once insulin is started.
Fluid shift + glucose entering cells may cause cerebral edema - careful with fluid

Question 14

Hyperkalemia

Answer 14

10 units of regular insulin and 50g D50W over 15-30 minutes typically

Question 15

Biguanides

Answer 15

Metformin (glucophage) inhibits glucose production in the liver, reduces intestinal glucose absorption, sensitizes insulin recepotrs

Question 16

Sulfonylureas

Answer 16

Stimulate insulin release from pancrease by blocking K+ channels on beta cells
Prolonged use sensitizes receptors to insulin

Question 17

Glinides

Answer 17

Same mechanism as sulfonylureas

Question 18

Thizaolidinediones

Answer 18

Decrease insulin resistance by activation of a specific receptor in the nucleus of cells

Question 19

Alpha-glucosidase inhibtors

Answer 19

Decrease carb absorption in intestine

Inhibit alpha glucosidase (enzyme) from converting carbs to monosaccharides for absorption)

Question 20

Gliptins

Answer 20

Enhance action of incretin, hormone that stimulates glucose dependent insulin relase (suppress postprandial glucagon release)

Question 21

Glucagon

Answer 21

Polypeptide from pancreatic alpha cells

Glycogenolysis, gluconeogenesis, decreased glyconeogenesis, increased cAMP, relaxes GI smooth muscles

Question 22

Pharmacokinetics of glucagon

Answer 22

Peak within 15 minutes, onset should be seen with approx 10, duration 60-90,

Question 23

Glucagon doses

Answer 23

1mg q 15 max 2mg beeties
OD 2mg IV q 5 max 4 (6)
Anaphylaxis BBs 1mg q 5 ma 5

Question 24

Thiamine

Answer 24

Coenzyme for glucose metabolism, give for malnourhised/ETOH pts with hypoglycemia or if unresponsive to glucose admin
Deficiency leads to wernicke-korsakoff also beriberi (ataxia, paresthesia, nystagmus) no contras 100mg IV/IM
Sugar worsens deficiency

Question 25

Wernickes vs Korsakoffs

Answer 25

Wernicke is acute, opthalmoplegia, confusion, atxia
Korsakoff is chronic and non reversible. Memory problems, decreased cognition, disorientation, hallucinations, painful extremities sometimes