DM

Question 1

DM labs

Answer 1

HbA1c =/> 6.5

2 random glucose > 200

1 random glucose > 200 + symptoms

Fasting glucose > 126

2hr post glucose tolerance test > 200

Question 2

Type 1 DM

Answer 2

Islet cell destruction from autoAb against pancreatic Beta cells
–> no insulin

Aka insulin dependent DM

Polyuria
Polydipsia
Weight loss
Increased appetite

May have other autoimmune diseases

Question 3

Honeymoon phase

Answer 3

In type 1 DM

The initial gradual reduction in amt of insulin needed because the islet cells are squeezing out the last bit of insulin

Does not mean the diagnosis is incorrect!!!

Honeymoon phase is brief

Question 4

Type 1 DM treatment

Answer 4

Eye exam at age 10 yo
Lipid panel at age 12 yo
Family education

Question 5

Best way to check compliance in diabetes

Answer 5

Glycosylated hemoglobin test a.k.a. hemoglobin A1c

-reflects glucose levels over past 3 months

Question 6

DKA

Answer 6

pH < 7.3

Glucose > 200

Bicarbonate < 15

Can be in type 2 as well

Mostly due to poor compliance, illness

Kussmaul respirations to compensate for the metabolic acidosis

Question 7

DKA treatment

Answer 7

Assume 5-10% dehydration
-10-20 cc/kg NS/LR bolus over 1-2 hrs

Then add insulin drip
Add glucose when glucose level <300
Add K after they pee
-all DKA have K deficit because of the acidosis and then they are peeing out the K

IV–> SQ insulin when pH > 7.3, bicarb >15, glucose <300, and can tolerate PO

NEVER use bicarbonate tx because –> cerebral edema

Watch the Na
+dilutional hyponatremia initially because of osmotic effect of glucose pulling water into ECF.
–if hypernatremic then they have severe dehydration!
–if hyponatremia does not self resolve as glucose falls, then you gave too much fluid and now you’re at risk for cerebral edema (AMS)

Question 8

Type 2 DM

Answer 8

Due to insulin resistance
Usually +Family history

Screen at age 10 or earlier if puberty happened
Screen if BMI >85th percentile (overweight) and 2/3:
1. +FH in 1st or 2nd degree relative
2. Ethnicity not white
3. Signs of insulin resistance 
-acanthosis nigricans 
-HTN
-PCOS
-dyslipidemia 

Screen with a fasting plasma glucose

Tx: first with lifestyle changes, 2nd with methformin

Question 9

Hyperosmotic nonketotic coma

Answer 9

Type 2 DM

Elevated glucose and serum Osm

Tx: fluid replace over 36-48 hrs (like hypernatremic dehydration) to prevent cerebral edema
Also treat the high glucose

Question 10

Metabolic syndrome

Answer 10

Due to insulin resistance

1. hyperinsulinemia/insulin resistance
2. Dyslipidemia
3. HTN
4. Central obesity

Metformin NOT recommended
Tx: lifestyle changes