DM Clinical and Lab

Question 1

DM 1 caused by?

Answer 1

destruction of β-cells -> no insulin prdxn

Question 2

DM 2 caused by?

Answer 2

Insulin resistance and inadequate secretion

Question 3

Key sxs?

Answer 3

Polyuria
Polydipsia
Polyphagia

Question 4

Other sxs?

Answer 4

Blurred vision
Infections
Delayed healing

Question 5

Exam findings: mild/moderate?

Answer 5

normal

Question 6

Exam findings: advanced?

Answer 6

Retinal ∆
Dry muc memb
Skin/Feet ∆

Question 7

Exam findings: emergent?

Answer 7

hypoglycemia
DKA
Nonketotic hyperosmolar synd

Question 8

Normal glucose levels?

Answer 8

FPG < 100

Oral Glu Tolerance Test (OGTT) < 140

Question 9

Impaired Glucose Tolerance glucose levels?

Answer 9

FPG 100 - 125

OGTT 140 - 199

Question 10

Diagnositc DM glucose levels?

Answer 10

FPG ≥ 126 or
OGTT ≥ 200 or
Random PG w/ sxs of hypergly ≥ 200

If no sxs, repeat tests to confirm

Question 11

Diagnotic DM HgbA1c level?

Answer 11

≥ 6.5%

Question 12

HgbA1c is?

Tells us?

Answer 12

glycosylated HgbA (glucose attached to Hgb)

average blood glu of preceding 2-3 mo

Question 13

HgbA1c level for controlled DM?

Level for poorly controlled?

Answer 13

≤ 1% above top normal (i.e. 7%)

> 3% above top normal

Question 14

HgbA1c should be rechecked how often?

Answer 14

6 mo if controlled

3 mo if uncontrolled or therapy change

Question 15

Gestational DM (GDM) may result in?

Answer 15

Fetal death during 3rd tri
Large babies
Deformities
Hypogly/Ca2+
Polycythemia
Jaundice

Question 16

GDM diagnostic glucose levels?

Answer 16

(Screen at 24 wks)

FPG ≥ 92
1hrGTT ≥ 180
2hrGTT ≥ 153

Question 17

Glucosuria caused by?

Answer 17

blood glu over tubular threshold

150 - 180, lower for preggos

Question 18

HgbA1c level for prediabetes?

Answer 18

5.7 - 6.4%

Question 19

Glucose goals for DM tx?

Answer 19

FBG: 80 - 120
2hrPPG: 100 - 160
BedtimeG: 100 - 140
HgbA1c < 7%

Question 20

Glucose goals for GDM tx?

Answer 20

FBG ≤ 95
1hrPPG ≤ 140
2hrPPG ≤ 120

Question 21

Microalbuminuria best test?

+ levels?

Early sign of?

Answer 21

24hr urine

Micro: 30 - 300
clinical: > 300

DM nephropathy

Question 22

DM screening protocol?

Answer 22

> 44yo Q 3 yrs
younger if risks/sxs

HgbA1c, FPG, OGTT

Question 23

DM dyslipidemia tx goals?

Answer 23

LDL ≤ 100 or 70 if CAD
HDL > 40
trigly < 400
BMI ≤ 25

Question 24

Triglycerides > 1000 risk of what?

Answer 24

pancreatitis

Question 25

Signs of MICROvascular disease? (3)

Answer 25

retinopathy nephropathy neuropathy

Question 26

Ketones result from?

Answer 26

inability of body to use glu as fuel (inadequate insulin) Body catabolizes fat -> ketones are waste prd

Question 27

Test for ketones? If +, next step?

Answer 27

Urine dip serum CO2: low = acidosis

Question 28

If + ketones and acidosis, next step?

Answer 28

serum ketone: if + admit

Question 29

DKA labs summary? (4)

Answer 29

↑ blood/urine glucose ↓ blood CO2 + urine ketones + serum ketones

Question 30

True Hypoglycemia is? Sxs?

Answer 30

glu < 40 ↑ epi causes: sweat, tachy, weak, hunger, tremor ↓ CNS glu causes: HA, dizzy, vision, confusion, etc

Question 31

Hypoglycemia tx: If can take PO? Severe or can't swallow?

Answer 31

Carb-rich food/drink (juice, candy) Glucagon subQ or IV D50W: bolus + drip

Question 32

Fasting Hypoglycemia caused by?

Answer 32

``` High insulin ETOH Liver/kidney dz Glucocort deficiency Hypopitu ```

Question 33

Postprandial Hypoglycemia signs? results from? caused by?

Answer 33

1-2hrPP sweat, tachy, weak, hunger, tremor NORMAL blood glu rapid glu absorption followed by high insulin response ETOH Rx

Question 34

Insulin levels: Normal? Hypoglycemia?

Answer 34

2 -20 < 6 (N response is to inhib insulin secretion)

Question 35

High insulin levels w/ hyopglycemia caused by?

Answer 35

Insulinoma (secreting tumor) Over-admin of insulin Sulfonylureas Insulin Ab's

Question 36

C-peptide tells us?

Answer 36

if pt is producing insulin if hypoglycemia is from injected insulin (c-peptide will be low)

Question 37

Lab results if hypogly from Insulinoma?

Answer 37

↑ insulin, proinsulin, c-peptide

Question 38

Lab results if hypogly from sulfonylurea?

Answer 38

↑ c-peptide

Question 39

Lab results if hypogly is factitious (insulin abuse)?

Answer 39

↑ insulin | ↓ c-peptides