Diabetes DIAL Flashcards

1
Q

What is the most definitive diagnosis of diabetes?

A

HbA1c of 7.2% or greater

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2
Q

What is the fastest way to check a patient’s blood sugar level?

A

Dipstick blood glucose

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3
Q

What is the most accurate way to check a patient’s current blood sugar level?

A

Serum glucose test

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4
Q

If a patient has RBCs with a shortened lifespan what would be considered as a reliable substitute to A1c test to check blood sugar levels?

A

Serum fructosamine test

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5
Q

What constitutes “severe” hypoglycemia?

A

Altered mental state AND blood sugar of 40 mg/dL or less (must be symptomatic for “severe”)

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6
Q

What are the typical signs and symptoms of hypoglycemia?

A

Sweating
Bizarre behavior
Tremor
Coma

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7
Q

What is the best treatment for mild hypoglycemia?

A

Food

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8
Q

What patient would glucagon be most ineffective?

A

Alcoholic with low blood sugar

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9
Q

What is glucagon not effective in an alcoholic?

A

Because glycogen is absent in alcoholics

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10
Q

Why is glycogen absent in alcoholics?

A

Because ethanol is made into acetyl CoA and then FAs and cannot be formed into glycogen

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11
Q

What oral hypoglycemic agent is the most dangerous in an overdose for pediatrics?

A

Glipizide (sulfonylurea)

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12
Q

Why are sulfonylureas dangerous in overdose?

A

The onset can be up to 8 hours and even later, the problems may arise after patient left the ER and is already back home

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13
Q

What is the first line of treatment in the hospital if a patient has low plasma glucose?

A

Give IV glucose

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14
Q

What is the appropriate pediatric dose of glucose?

A

0.5-1 g/kg

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15
Q

What is meant by D10W, D25W and D50W?

A
D10= 10% volume is glucose
D25= 25% volume is glucose
D50= 50% volume is glucose 
W= rest of the volume is water
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16
Q

What is the osmolarity of 5% glucose and the calculation?

A

280 mM

5g/mL x 1 mol/180g x 1000mL/1 L= 280

17
Q

Why does DKA occur?

A

Insulin deficiency

18
Q

What typically is the initial cause of DKA?

A

GI infections

19
Q

What are typical signs of DKA?

A
Tachycardia
Tachypnea
Fever
Hypotension
Depressed mental status
20
Q

Why does hypotension and fever occur in DKA?

A

Hypotension: GI infection leads to diarrhea and dehydration
Fever: GI infection

21
Q

What hormone plays the largest role in ketosis?

A

Glucagon

22
Q

What two metabolic acids are formed in the blood during DKA?

A

Acetoacetate

Beta-hydroxybutyrate

23
Q

What is the dominant ketone body in circulation?

A

Beta-hydroxybutyrate

24
Q

Why is acetoacetate not dominate in blood circulation?

A

Because it is not stable

25
Q

What occurs to acetoacetate?

A

Breaks down losing a CO2 and is breathed out

26
Q

What are typical inciting events for DKA?

A

MI
Sepsis
Inadequate insulin

27
Q

What are the values of K and Na in metabolic acidosis?

A

K: high
Na: low

28
Q

Anion gap in metabolic acidosis?

A

High (Na+K)-(Cl+HCO3)

29
Q

Which ketone is tested for in urine dipstick and why?

A

Acetoacetate since it reacts with the sodium nitroprusside