Diabetic Cases Pales

Question 1

glyburide

Answer 1

100% excreted by kidney

second gen sulfonylurea

Question 2

side effect of sulfonylurea

Answer 2

hypoglycemia

Question 3

meglitinides

Answer 3

short duration of action

close ATP dependent K channels of beta cells

Question 4

incretin

Answer 4

injectable - GLP1
oral - DPP-IV inhibitor

no hypoglycemia

give after meals

Question 5

metformin

Answer 5

biguanide

decreased glucose production by liver**

increased insulin receptor sensitivity

weight loss and no hypoglycemia**

lowers LDL and triglycerides

Question 6

adverse of metformin

Answer 6

lactic acidosis

Question 7

CI biguanides

Answer 7

renal and liver insufficiency

chronic hypoxia

past hx lactic acidosis

alcoholism

withold if pt getting iodinated contrast

Question 8

significant weight gain

Answer 8

TZD

Question 9

CHF

Answer 9

no TZD

Question 10

SGLT-2 inhibitor

Answer 10

block reuptake of glucose in renal tubules

promote loss of glucose in urine

no hypoglycemia

new drug

yeast infection, dehydration, UTIs

Question 11

morning hyperglycemia

Answer 11

either dawn phenomenon or samojyi effect

dawn - anti-insulin hormone in AM - tx increase meds

samojyi - night time low glucose - body tries to increase - tx decrease meds

Question 12

50yo F, allergies and sleepy, N/V anorexia, sleeping and week, given prednisone for allergies

hypotension
HR elevated
T high
resp high
lethargic

feet cold and mottled

BUN/Cr elevated
glucose very high
lactic acid 5.2
ketone negative
pH 7.3

Answer 12

hyperosmolar hyperglycemic non-ketotic coma

renal failure

dehydrated

more likely DM II

tx - fluids

Question 13

hyperosmolar hyperglycemia non-ketotic coma

Answer 13

more in DM II

tx fluids

Question 14

DKA

Answer 14

more in DM I

tx insulin

Question 15

prednisone

Answer 15

increases glucose

Question 16

ACE inhibitor

Answer 16

dilates efferent arterioles

drops pressure in glomeruli - decreases filtration

Question 17

12yo M to ER with SOB and mental status change

increasing fatigue
weight loss
thirsty a lot
urinates at night
breathing deep and fast
thrush in mouth

glucose high
pH 7.05
high anion gap
BUN/Cr elevated

Answer 17

diabetic ketoacidosis

Question 18

path of DKA

Answer 18

insulin deficienct
more lipolysis
more fatty acid to liver
increased ketogenesis
acidosis

Question 19

potassium elevated in DKA**

Answer 19

acidosis - shifts K out of cell

peeing out lots of K
body K low
serum K high

Question 20

tx of DKA

Answer 20

IV insulin

look at the anion gap
-this tells when you can switch to subQ insulin

Question 21

DKA age

Answer 21

younger

Question 22

NKHO age

Answer 22

older

Question 23

DKA mental status

Answer 23

alert

Question 24

NKHO coma

Answer 24

comatose confused

Question 25

renal failure

Answer 25

more common in NKHO

Question 26

metabolic problem

Answer 26

DKA acidosis | NKHO dehydration

Question 27

59yo M diabetic mild burning of feet at times has not taken glipizide smokes 1/2ppd glucose 185 LDL high left vent hypertrophy HbA1c 8.3% done wrong by previous physician?

Answer 27

no metformin (does not cause hypoglycemia) no follow up

Question 28

first thing to do with new diabetic patient

Answer 28

``` HbA1c physical exam get PMH lipid panel assess knowledge of disease give glucometer ask to check blood sugar 4x/daily ```

Question 29

HbA1c

Answer 29

marker for control of diabetes

Question 30

test for peripheral neuropathy

Answer 30

monofilament test

Question 31

diabetes and HTN

Answer 31

atherosclerosis and renal failure secondary HTN

Question 32

initial diabetes tx

Answer 32

metformin and diet/exercise mod also statin if high lipids also ACE inhibitor - DOC for diabetes and HTN

Question 33

ACE inhibitor side effect

Answer 33

cough

Question 34

when to check HbA1c

Answer 34

3 month later

Question 35

52yo F with DM II worried about sugar too low - school bus driver loses insurance - doesn't come back for few years very high glucose - 510 blurry vision, calf pain, urinary frequency, dizzy when stand up

Answer 35

blurry vision - reversible lens swelling meds to start - insulin** bc very high glucose

Question 36

meds to avoid hypoglycemia

Answer 36

``` metformin TZD DDP-IV DLP-1 analog alpha-1 glycosidase ```

Question 37

LDL goal for diabetic

Answer 37

70 if not - give statin

Question 38

what to check with peripheral vascular disease

Answer 38

look for atherosclerosis do stress test

Question 39

complications improve with glycemic control

Answer 39

microvascular problems