Diabetes

Question 1

How is obesity defined?

Answer 1

BMI > 30

Question 2

What is the most common endocrinopathy among women of reproductive age?

Answer 2

PCOS

Question 3

What are some signs/symptoms of PCOS?

Answer 3

Obesity
Acanthosis nigricans
Facial hair or male pattern balding
Multiple follicular cysts
Abnormal menstrual bleeding (no bleeding or spotting in between periods)
Inability to conceive

Question 4

Is there a definitive test for diagnosing PCOS?

Answer 4

No, it is a diagnosis of exclusion

Question 5

What are some treatment options for PCOS?

Answer 5

Suppress insulin-facilitated, luteinizing hormone androgen production
Oral contraceptives
Provera (restore menstrual cycle)
Spironolactone (suppress hyperandrogenism)
Clomiphene citrate (Serophene, Clomid) (restore cycle, prevent endometrial hyperplasia, induce ovulation)

Question 6

What is 1st line treatment for weight loss with PCOS?

Answer 6

Metformin

Question 7

What is commonly seen in children with a vitamin D deficiency?

Answer 7

Rickets (bowing of the legs)

Question 8

What is the treatment for patients with a vitamin D deficiency?

Answer 8

2000 IU vitamin D2 or D3 per day x 6 weeks
50,000 IU vitamin D2 per week x 6 weeks
Maintenance dose = 600-100 IU/daily
10-15 mins mid day sun exposure 1-3 times per week

Question 9

A patient presents with some or all of the following complaints, what is your suspected diagnosis? And how do you treat it?

Bone pain, kidney stones , abdominal pain and N/V, frequent urination, and confusion

Answer 9

Vitamin D toxicity (bones, stones, groans, thrones, and psychiatric overtones)
Treat w/IV fluids, loop diuretics, bisphosphonates

Question 11

What is the treatment for a vitamin K deficiency?

Answer 11

Fresh frozen plasma

Question 12

What vitamin deficiency is more commonly seen in alcohol use disorder?

Answer 12

B1 (thiamine)

Question 13

What is the difference between “wet” and “dry” beriberi?

Answer 13

Wet: affects cardiovascular system (high output heart failure 2/2 vasodilation & AV fistulas)
Dry: affects CNS (think Wernicke or Korsakoff) (peripheral neuropathy, ataxia, AMS, memory loss, confabulation)

Question 14

What treatment helps prevent peripheral neuropathy in a patient with a vitamin B6 (pyridoxine) deficiency?

Answer 14

Isoniazid

Question 15

What is the treatment for a vitamin B12 deficiency?

Answer 15

1000-2000 mcg B12 x 1 week
Maintenance dose: 1000 mcg/day

Question 16

What can present with sore lips & tongue, nausea, diarrhea, anorexia, weight loss, cognitive dysfunction, dementia, and/or depression?

Answer 16

Folate deficiency

Question 17

What labs are indicative of DM I?

Answer 17

A1c >6.5, fasting glucose >126 or any glucose >200

Question 18

The primary treatment option for DM I is what?

Answer 18

Insulin

Question 19

What are different types/dosing of insulin?

Answer 19

Long acting injection (detemir/glargine): 10 units/day starting dose, increase 2-4 units until glucose goal met, decrease 4 units in hypoglycemia
Short acting injection (Humulin R/Novolin R): when glucose goal met but A1c high, 4 units single dose, non-fasting glucose above goal increase dose 1-2 units, hypoglycemic decrease 2-4 units
Pre-mixed insulin (Humulin [70/30], Novolin [70/30]): 2x/day when glucose at goal, but A1c above goal
Rapid acting (aspart/lispro): 4 units single dose before largest meal of day

Question 20

What are important assessments/screenings to perform in patients with DM I?

Answer 20

Check A1c every 3 months until controlled, then every 6 months (goal is <7% if life expectancy >10yrs)
Screenings for: retinopathy (annual), HTN (each visit), hyperlipidemia (annual), CKD (annual) microalbumin/creatinine ratio in addition to BMP or CMP (every 3-6 months), neuropathy (annual), PVD (each visit)

Question 21

What are signs/symptoms of DKA?

Answer 21

Blood glucose >250mg/dL
Symptoms of hyperglycemia
Decreased pH <7.3
Decreased bicarb <10mEq/L
Anion gap >12
Ketonuria
Fruity breath
Kussmaul resp.
AMS
Shock

Question 22

How do you treat DKA?

Answer 22

ICU admission
TX goals to correct:
dehydration, hyperglycemia, electrolyte imbalance (K+), acid-base imbalance, underlying trigger (infection, missed dose)
Do NOT typically aim for normalization of blood sugar
Fluids and insulin (w/i 1 hr at IV infusion rate of 0.1 units/kg/hr)

Question 23

What are 1st and 2nd line pharm treatments for DM II?

Answer 23

Metformin (1st line)
Insulin secretagogues (2nd line) (Sulfonylureas - Glipizide, glimepiride) (Meglitinides - Prandin, Starlix)