Flashcards in Endocrine Deck (77)
how can you establish a dx. of DM?
1. FPG > 126 mg/dL (7 mmol/L)
2. random PG > 200 mg/dL (11.1 mmol/L)
and symptoms OR
3. OGTT > 200 mg/dL (11.1 mmol/L)
4. HbA1c > 6.5%
impaired fasting glucose
fasting plasma glucose 100-125 mg/dL (5.6-6.9 mmol/L)
impaired glucose tolerance
OGTT at 2 hrs is 140-199 mg/dL (7.8 to 11.0 mmol/L)
diagnosis of metabolic syndrome
1. BP > 130/85
2. TG > 150, HDL < 40
3. FPG > 110
4. waist circumference > 40 in
Tx. for pt with impaired fasting glucose or impaired glucose toleracnce
intensive lifestyle change - 30 minutes of exercise daily and calorie-restricted diet
first line agent for newly diagnosed type II DM
in whom is metformin contraindicated in?
renal insufficiency pts
- Cr > 1.4 mg/dL for women and > 1.5 in men
side-effects/cons of rosiglitazone/pioglitazone
edema, weight gain
increased fracture risk in women
increased CV morbidity
what is exenatide approved for?
combination regimens with oral agents (tx. of DM 2) - inappropriate as monotherapy
hospitalized pt with uncontrolled diabetes - what should you tx with?
basal bolus insulin regiment consisting of long-acting insulin and rapid-acting insulin before meals
diabetic pt presents to eye doctor; on exam, hard exudates, microaneurysms and minor hemorrhages are seen; when questioned, the patient does not report any decline in vision
non-proliferative diabetic retinopathy
diabetic pt presents to eye doctor with loss of vision; on exam, cotton wool spots and neovascularization are visible - dz?
proliferative diabetic retinopathy
- fibrosis causes retinal detachment and vision loss
new vessels in the eye become more permeable and leak serum (diabetic retinopathy)
what two interventions can decrease incidence and progression of diabetic retinopathy?
tight glycemic control
Tx. of proliferative diabetic retinopathy and macular edema
timed laser photocoagulation
what is the ideal insulin regimen to reduce episodes of hypoglycemia?
long acting basal insulin + rapid-acting insulin
long acting basal insulins
NPH - intermediate acting; 2x daily dosing
rapid acting preprandial insulins
tests to establish dx. of DKA?
serum glucose, electrolytes, ketones and arterial blood gases
diagnostic criteria for DKA (4)
1. blood glucose < 250 mg/dL
2. anion gap metabolic acidosis (ph < 7.30)
3. serum HCO3 < 15
4. positive serum or urine ketones
diagnostic criteria for hyperosmolar hyperglycemic syndrome (5)
1. blood glucose > 600 mg/dL
2. arterial pH > 7.30
3. serum HCO3 > 15
4. serum osmolarity > 320
5. absent serum or urine ketones
first step in management of hyperglycemia hyperosmolar syndrome
IVF with normal saline
- once volume status is restored, switch to hypotonic solutions for maintenance therapy
most effective Tx. of DKA (After IVF)
insulin drip (IV)
- measure plasma glucose every 1-2 hours and adjust dose accordingly
can xanthelasma occur w/o hyperlipidemia?
yes, but it is mostly assoc with familial dyslipidemias
clusters of erythematous papules typically on extensor surfaces associated with extremely high TG levels (> 3000)
subcutaneous nodules on extensor tendons; assoc with familial hypercholesterolemia
yellow-red plaques found in skin folds of neck and trunk; assoc with familial dyslipidemias and hematologic malignancies
which endocrine disorder is assoc with elevated lipid levels?
first step in management of patients with isolated low HDL cholesterol
lifestyle interventions - exercise, tobacco cessation, weight reduction