DM/hypoglycemia

Question 1

which deficiency can cause falsely elevated a1c

Answer 1

iron deficiency

Question 2

effect of proteinuria on fructosamine levels

Answer 2

falsely decreased fructosamine (high albumin turnover)

Question 3

fructosamine to a1c ratio

Answer 3

fructosamine should be ~40x higher than a1c

Question 4

target glucose levels during pregnancy

Answer 4

fasting < 95
1hr postprandial < 140
2hr postprandial < 120

Question 5

3 most common MODYs

Answer 5

MODY 3
MODY 2
MODY 1

Question 6

treatment of MODY 3/1

Answer 6

sulfonylurea

Question 7

fructosamine provides an estimate of glucose levels over what time frame

Answer 7

1-2 weeks

Question 8

which SGLT2i has increased rate of fractures

Answer 8

canagliflozin

Question 9

which SGLT2i have warnings regarding limb amputations

Answer 9

canagliflozin

sertugliflozin

Question 10

which SGLT2i has warning regarding bladder cancer

Answer 10

dapagliflozin

Question 11

how many type 2 DM patients have LADA?

Answer 11

~30%

Question 12

criteria for LADA

Answer 12

age > 30
+ antibodies
not requiring insulin for > 6 months

Question 13

u500 candidates

Answer 13

> 200 units per day of insulin

Question 14

DM autoantibodies

Answer 14

GAD 65
Islet cell ab
Insulinoma associated autoantibody
Insulin ab
ZnT8 transporter

Question 15

what % of ab negative DMt1 has ZnT8 ab?

Answer 15

26%

Question 16

ACC/AHA criteria for which age range of diabetics should be on statin

Answer 16

40-75, or

DMt1 x 20 years

Question 17

secondary causes of DM

Answer 17

glucocorticoids
acromegaly
cushings
pancreatic disease
CMV
genetic conditions
hemochromotosis

Question 18

DM, hypogonadism, pituitary dysfunction

Answer 18

hemochromotosis

Question 19

mechanism of DM in hemochromotosis

Answer 19

probably insulin resistance with secondary beta cell dysfunction

Question 20

DM2 medication useful in treating NASH

Answer 20

thiazolidinediones

Question 21

most sensitive test for diagnosis of DM

Answer 21

2 hour OGTT

Question 22

DM1 pt with axial muscle pain, stiffness

Answer 22

Stiff man syndrome
30% of patients have DM1
tx: diazepam

Question 23

ddx for hyperinsulinemic hypoglycemia

Answer 23

insulinoma
NIPHS
insulin ab syndrome (Hirata disease)
sulfonylureas/insulin
post-gastric bypass
nondiabetic drugs

Question 24

imaging studies to localize insulinoma, in order:

Answer 24

1. CT/MRI
2. EUS
3. Octreoscan/Ga-DOTATATE (insulinomas have poor expression of somatostatin type 2 receptors compared to other NE tumors, so sensitivity of these are low)
4. Intra-arterial calcium stimulation

Question 25

ddx for non-insulin-mediated hypoglycemia

Answer 25

``` critical illness (organ failure, sepsis) starvation alcohol glycogen storage diseases adrenal insufficiency non-islet cell tumors (IGF-mediated, typically IGF-2) unripe ackee fruit nondiabetic drugs ```

Question 26

hypoglycemia counter-regulatory hormones

Answer 26

glucagon epinephrine cortisol GH

Question 27

anticipate rise in glucose after glucagon stimulation test for hypoglycemia

Answer 27

25mg/dL

Question 28

typical pattern of hypoglycemia in NIPHS

Answer 28

post-prandial

Question 29

typical pattern of hypoglycemia in post-gastric bypass hypoglycemia

Answer 29

postprandial

Question 30

pathologic findings of NIPHS

Answer 30

neisidioblastosis (beta cell hypertrophy)

Question 31

nondiabetic drugs that cause hypoglycemia

Answer 31

``` indomethacine quinine pentamidine quinolones tramadol cibenzoline ```

Question 32

how does alcohol cause hypoglycemia

Answer 32

acutely inhibits gluconeogenesis poor glycogen stores related to malnutrition typically a combination of both of these

Question 33

DMt1 on basal/bolus insulin, nocturnal PD with high blood sugars at night, normal during the day. Best treatment?

Answer 33

add HS NPH

Question 34

treatment of prediabetes in hispanic women with hx of GDM, intolerant of metformin

Answer 34

pioglitizone