Diabetes mellitus

Question 1

What do you do for management of diabetes if lifestyle and metformin don’t work?

Answer 1

Add a 2nd agent (GLP-1 agonist or SGLT-2 inhibitor)

Question 2

What is the HbA1C goal in diabetes?

Answer 2

< 7%

Question 3

High A1c and normal fasting glucose =

Answer 3

postprandial hyperglycemia

Question 4

Management of acute severe hypoglycemia in
- Unconscious patient who is actively seizing:
- Conscious patient who is tolerating oral intake:
- Unconscious patient without available IV or oral routes:

Answer 4

• Intravenous administration of 50% dextrose + continuous serum glucose monitoring .
• Oral glucose or fast-acting carbohydrates (fruit juice or candy).
• Glucagon (intramuscular, subcutaneous, or intranasal).

Question 5

How do total body K+ levels typically change in patients with diabetic ketoacidosis or hyperosmolar hyperglycemic state?

Answer 5

Decreased

Question 6

What is the effect of hyperglycemia (e.g., DKA/HHS) on serum sodium levels?

Answer 6

Hyponatremia (low Na+)

Question 7

What is the treatment regimen for diabetic ketoacidosis?

Answer 7

• Prophylactic potassium, IV insulin, and IV fluids
• Once anion gap closes: subQ insulin
• Once blood glucose reaches 200-250 mg/dL: D5W

Question 8

What is the most likely diagnosis for an elderly patient with nausea, lethargy, polyuria, dry mucous membranes, blurred vision and cough?

Answer 8

Hyperosmolar hyperglycemic state

Question 9

What is the treatment for hyperosmolar hyperglycemic state (HHS)?

Answer 9

Intense IV fluids(normal saline) and insulin therapy

Question 10

Rapid lowering of glucose in DKA can lead to:

Answer 10

Cerebral edema and seizures

Question 11

ACE-inhibitors/ARBs are the first-line treatment for hypertension in patients with any of which four conditions?

Answer 11

• CHF
• MI
• Chronic kidney disease
• Diabetes

Question 12

What do you do for management of diabetes if lifestyle and metformin don’t work?

Answer 12

Add a 2nd agent (GLP-1 agonist or SGLT-2 inhibitor)

Question 13

Criteria to initiate Insulin in DM newly diagnosed patients:

Answer 13

• Initial glucose ≥ 300 mg/dL or
• HbA1c > 10% or
• Symptoms of hyperglycemia or - Signs of a continued catabolic state (e.g., weight loss).

Question 14

Hyperosmolar hyperglycemic non-ketotic state often presents with glucose levels ____ and serum osmolarity____

Answer 14

• > 600 mg/dL
• > 320 mOsm/kg