Small Group: Type I and II Diabetes

Question 1

What are diagnostic tests for diabetes?

Answer 1

• Random glucose above 200 with symptoms
• HbA1c above 6.5%
• Fasting blood glucose over 126 mg/dL
• Two hours post 75 grams of glucose intake with a blood glucose over 200

Question 2

What tests might you order in a newly diagnosed diabetic?

Answer 2

BMP (to assess creatinine) 
Urine albumin to creatinine ratio
A1c
Lipids 
Fasting glucose

Question 3

Many people argue that type-2 diabetics with A1cs above _____ should be started on insulin.

Answer 3

9.0%

Question 4

Guidelines now state that those with GFRs down to ______ can still be started on metformin.

Answer 4

30 ml/min

Question 5

How many excess calories need to be eaten to gain one pound?

Answer 5

3,500

Question 6

For every 100 mg/dL increase in glucose, sodium needs to be correct by ________.

Answer 6

an increase in 1.6 mEq/L

Question 7

Anion gap uses ___________ sodium.

Answer 7

uncorrected

Question 8

HLA _______ are associated with type 1 diabetes.

Answer 8

DR3 and DR4 (DR2 is protective)

Question 9

What test is used to monitor diabetic nephropathy?

Answer 9

Urine albumin:creatinine ratio

Question 10

What is a good rule of thumb for total amount of insulin needed per day?

Answer 10

0.5 units per kg

Question 11

Of the total insulin given per day, how much should be basal and how much prandial?

Answer 11

Half and half. So if a person weighs 88 kg, then they need 44 units per day, of which 22 U should be basal and 22 U should be prandial.

Question 12

How do you calculate correction factor?

Answer 12

1650/(total daily dose of insulin) = amount of mg/dL that one unit will change

Question 13

True or false: patients with type 2 diabetes that need to be NPO should cease all insulin.

Answer 13

False. They should cease prandial insulin but not basal, because the liver is always producing glucose.

Question 14

What causes the pseudo-hyponatremia found in extreme hyperglycemia?

Answer 14

The sugar can pull water into the serum, thus diluting the sodium.

Question 15

Why does serum phosphate fall after administering insulin?

Answer 15

Because many molecules will be phosphorylated (glucose and ADP), so phosphate will fall

Question 16

Which should be given first to a patient with DKA, fluid or insulin?

Answer 16

Fluid, because insulin moves water into cells (pulled by glucose osmosis), and if they’re already hypovolemic then that could precipitate shock.

Question 17

Those with type 1 diabetes are at risk for two main categories of complications: ______________.

Answer 17

microvascular and macrovascular disorders