Diabetes

Question 1

What is the diagnostic criteria for diabetes

Answer 1

1. ) Two fasting blood glucose greater than 125
2. ) Single glucose level above 200
3. ) Increased glucose level on oral glucose tolerance testing
4. ) Hemoglobin A1C > 6.5

Question 2

What is the first thing you do for a patient with diabetes

Answer 2

Recommend weight loss and exercise with diet

Question 3

What is the first line therapy for diabetes type 2

Answer 3

Metformin - sensitizes skeletal muscle to insulin, decreases gluconeogenesis

Side effect: Lactic acidosis

Question 4

What is second line therapy for diabetes type 2

Answer 4

Sulfonylureas - glybiride, glipizide, glimeperide, tolbutamine - increases insulin, chance of hypoglycemia, and drives obesity

Question 5

When are thiazoladinediones (glitazones) contraindicated

Answer 5

In CHF - promotes fluid overload, can cause hepatotoxicity, weight gain, edema, pathologic bone fractures in women

Question 6

If someone is allergic to sulfa but need something that stimulates insulin release similar to sulfonylureas, what do you give them

Answer 6

Nateglinide and repaglinide

Question 7

What do alpha-glucosidase inhibitors do for diabetes and what are their side effects

Answer 7

Acarbose and miglitol - block glucose absorption in bowels, causing flatus, diarrhea, and abdominal pain

Question 8

What are incretins, what is their mechanism, and side effects

Answer 8

Exenatide (IV) and sitagliptin - increase insulin stimulation and promotes weight loss by decreasing gastric motility.- Never use as monotherapy

Side effect - Exenatide causes pancreatitis

Question 9

What are the short acting, intermediate acting, and long acting insulin

Answer 9

Short acting - lispro, aspart, glulisine - works 3 to 4 hours
Regular insulin - works 6 to 8 hours
NPH - works 10 to 20 hours but must be dosed twice
Glargine - works for 24 hours and faster onset than NPH and more steady blood glucose levels

Question 10

What is the strategy for insulin therapy for type 2 diabetics

Answer 10

Combine short acting insulins with glargine

Question 11

What is the strategy for treating diabetes ketoacidosis

Answer 11

First give large volume saline and insulin therapy, then only replace potassium when levels are approaching normal. Treat underlying cause

Question 12

What is the best way to test if someone is in DKA

Answer 12

Check serum bicarbonate level - if low it automatically indicates there is anion gap acidosis

Question 13

What should all diabetics receive for health amintainence

Answer 13

• Pneumococcal vaccine
• Statins if LDL > 100
• ACE/ARBs if blood pressure greater than 140/90 or urine tested positive for microalbuminuri
• Aspirin if above age 30

Question 14

One of the main complications of diabetes is gastroparesis. What is it, and what is its treatment

Answer 14

Body begins to lose ability to push bowel through because of nerve damage and cannot sense stretch which stimulates gastric motility - you get bloating, constipation, early satiety, etc.

Treatment: Metoclopromide and erythromycin

Question 15

What is a complication of diabetes neuropathy

Answer 15

Decreased sensation to feet - causing skin ulcers - can lead to osteomyelitis

Treatment: Pregabalin, gabapentin, or tricyclic antidepressants

Question 16

What are four causes of nonketotic hyperosmolar shit and what is it

Answer 16

1. ) Sepsis
2. ) Dehydration
3. ) Diuretics
4. ) Glucocorticoids

Causes prerenal azotemia (BUN/Creatinine risen) with hyperosmolarity (385) and blood glucose 1000