ENDOCRINE DM

Question 1

CRITERIA CLASSIFICATION FOR DIAGNOSIS DM

Answer 1

FASTING GLUCOSE >126 NPO FOR 8 HOURS

OR 2 HR > 200 DURING ORAL GLUCOSE TORENANCE TEST

OR AIC >6.5%

Question 2

CRITERIA FOR PREDIABETES

Answer 2

100-125 fasting glucose; 2 hour post glucose oral testing 140 -199 or aic 5.7-6.4%

Question 3

CHRONIC COMPLICATIONS OF DM

Answer 3

GASTROPARESIS, RETINOPATHY, PVD, NEUROPATHY, CARDIOAVADCULAR, NEPHROPATHY

Question 4

GOAL OF HBGAIC

Answer 4

<7

Question 5

GOAL OF DRUG THERPAY FOR DM

Answer 5

American Diabetes Association (ADA): HBA1C <7.0%.

American Association of Clinical Endocrinologist (AACE): HBA1C ≤6.5%
Both ADA and AACE
Preprandial plasma glucose level 80–130 mg/dL
Postprandial plasma glucose level <180 mg/dL
Blood pressure: <130/90 mm Hg

Question 6

HOW ARE WE GOING TO ATTAIN GLUCOSE CONTROL FOR A T1 DM

Answer 6

MULTIPLE DAILY INJECTIONS FOR TYPE 1 SHOULD BE TREATED WITH MULTIPLE DAILY INJECTIONS OF PRANDIAL AND BASAL INSULIN OR CONTINUOUS SUBCUTANEOUS INSULIN INFUSION; WE WANT TO AVOID PEAKS CAUSE IT CAN BE DAMAGING, REDUCE HYPOGLYCEMIA RISKS; THEY SHOULD ALSO BE TRAINED TO MATCH PRANDIAL INSULIN DOSES TO CARB INTAKE, PREMEAL BLOOD GLUCOSE AND ANTICIPATED PHYSICAL ACTIVITY

Question 7

SHORT ACTING INSULIN

Answer 7

LISPRO, APART, GLULISINE; DURATION OF ACTION 2-4HOURS; ONSET OF ACTION 3-15MINUTES

Question 8

REGULAR INSULIN

Answer 8

ONSET 30 MINUTES, DURATION 5-8 HOURS

Question 9

GLARGINE IS _____ INSULIN

Answer 9

LONG ACTING DURATION OF ACTION IS 20-24 HOURS

Question 10

INSULIN DEGLUDEC

Answer 10

LONG ACTING THAT THE DURATION IS GREATER THAN 40 HOURS, NO PEAK AND ONSET IN 2 HOURS

Question 11

NPH

Answer 11

1/2 WAY THE DURATION IS 8-12 HOURS AVERGAE 12 AND THE ONSET IS IN 2 HOURS

Question 12

DAWN PHENOMENON

Answer 12

EARLY MORNING HYPERGLYCEMIA

OBSERVED INCREASE IN BLOOD SUGAR LEVELS THAT TAKES PLACE IN THE EALRY MORNING OFTEN BETWEEN 2AM AND 8AM

Question 13

Pts blood glucose becomes progressively elevated during the night resulting in increased glucose at 0700

WHAT IS HAPPENING

Answer 13

DAWN PHENOMENON

Question 14

HOW DO YOU TREAT THE DAWN PHENOMENON

Answer 14

ADD OR INCREASE THE BEDTIME INSULIN; AVOID CARBS BEFORE BEDTIME, COULD ALSO USE AN INSULIN PUMP TO GIVE YOU EXTRA INSULIN DURING EARLY MORNING HOURS

Question 15

PREFERRED INITAL TREATMENT FOR A TYPE 2 DM

Answer 15

METFORMIN

Question 16

MAIN STAY FOR TYPE 2 DM TO DROP THEIR AIC DRUG

Answer 16

METFORMIN; Once initiated, metformin should be continued as long as it is tolerated
and not contraindicated; other agents, including insulin, should be added
to metformin

Question 17

METFORMIN WORKS HOW?

Answer 17

DREASES THE AMOUNT GLUCOSE RELEASED FROM THE LIVER

Question 18

MSYK- SIDE EFFECT OF 2ND GEN SULFONYLUREAS MEDICATIONS

Answer 18

HYPOGLYCEMIA 2 GEN **

Low blood glucose, occasional skin rash, irritability, upset stomach

Question 19

MEDICATIONS LINKED WITH INCREASE RISK OF CARDIAC EVENTS

Answer 19

SUCH AS SWELLING EDEMA OR FLUID RETENTION, TZD THIAZOLIDINEDIONES

Question 20

THIS MEDICATION IS FDA APPROVED FOR IMPROVING CV HEART FAILURE DISEASE IT IS A SGLT2

Answer 20

JARDIANCE (EMPAGLIFLOZIN)

Question 21

ONCE INSULIN IS STARTED WHAT IS THE TARGET GLUCOSE RANGE

Answer 21

140-180

Question 22

Insulin therapy should be initiated for treatment of persistent hyperglycemia starting at a threshold ≥_______ mg/dL

Answer 22

180

Question 23

Consider adding insulin to TPN if > 20 units have been administered in 24 HRs, WHATS THE TREATMENT

Answer 23

2/3 OF INSULIN REUIREMTN ADDED TO THE TPN

Question 24

EXCESSIVE INTRACELLULAR DEHYDRATION, HYPERGLYCEMIA INCREASES SERUM OSMOLALITY CAUSING A SHIFT OF INTRACELLEULAR WATER INTO THE INTRAVASCULAR SPACE

Answer 24

DKA

Question 25

DKA IS WHAT KIND OF PATIENTS

Answer 25

TYPE 1

Question 26

KETOURIA AND ACIDOSIS

Answer 26

DKA

Question 27

DKA LABS

Answer 27

URINE KETONES POSITIVE, SERUM KETONES POSITIVE ANION GAP >10 MILD, >12 MODERATE-SEVERE

Question 28

ACIODIC BUT NORMAL ANION GAP THEN

Answer 28

PATIENT HAS LOSS BICARB

Question 29

NORMAL ANION GAP

Answer 29

3-10 MEQ

Question 30

TYPE ONE DM IS WHAT AND CAN LEAD TO WHAT

Answer 30

ABSOLUTE LACK OF INSULIN AND CAN DEVELOP INTO KETOACIDSOS

Question 31

TYPE 2 DM

Answer 31

IMPAIRED ABILITY OF THE ITSSUES TO USE INSULIN, IMPAIRED RELEASE OF INSULIN IN REPSONSE TO THE BLOOD GLUCOSE LEVELS, EXCESSIVE HEPATIC GLUCOSE PRODUCTION AND MORE COMMON IN OBESE ADOLESCENT AND CHILDREN

Question 32

METABOLIC SYNDROME

Answer 32

IMPORTANT GROUP OF RISK FACTOR FOR CV DISEASE, DM AND STROKE A constellation of abnormalities includes: ▪ Central obesity ▪ Insulin resistance ▪ Hypertension ▪ High triglycerides ▪ Low HDL

Question 33

METABOLIC SYNDROME TX

Answer 33

WT REDUCTION, ANTIHYPERTENSIVES REGIMENT SHOULD INCLUDE AN ACE OR ARBS, MANAGE IMPAIRED FASTING GLUCOSE OR DIABETES AND MANAGE THE LIPID LEVELS

Question 34

CRITERIA FOR DX DM THE FASTING GLUCOSE NUMBER WHEN YOU HAVE BEEN FASTING FOR AT LEAST 8 HOURS

Answer 34

126>

Question 35

CRITERIA FOR DX DM THE GLUCOSE NUMBER 2 HOURS POST

Answer 35

>200

Question 36

CRITERIA FOR DX DM THE AIC

Answer 36

>6.5

Question 37

main symptoms of DM include

Answer 37

blurred vision; polydipsia, polyphagia, polyuria, glycosuria, abd pain, n/v, smell of acetone (t1) kussmaul (t1) wt loss (t1)

Question 38

MSYK COMPLICATIONS OF DM

Answer 38

RETINOPATHY, AUTONOMIC NEUROPATHY WITH DIZZINESS AND SYNCOPE, HTN, MICROANGIOPATHY CEREBRAL INFARCTS, PVD, GANGRENE INFECTIONS, SOMATIC NEUROPATHY, BLADDER INFECTIONS,

Question 39

MAJOR ADVERSE EFFECT OF INSULIN

Answer 39

HYPOGLYCEMIA IF INSULIN IS ADMINISTERED IN THE ADBSENCE OF CARBO; EXCESSIVE INSULIN IS INJECTED & COULD HAVE AN INSULIN ALLERGY- HISTAMINE RELEASE, ANAPHYLAXIS

Question 40

thiazolidinadiones (tzd) side effects

Answer 40

heart failure swelling edema

Question 41

in the hospital we should do this test if not done within the 3 months

Answer 41

aic with dm or hyperglycemia

Question 42

If the enteral feeds (continuous or bolus) are unexpectedly discontinued...give what?

Answer 42

an intravenous 10 percent dextrose solution, providing a similar number of carbohydrate calories as was being administered via the enteral feeds, should be infused in order to prevent hypoglycemia.

Question 43

Consider adding insulin to TPN if > 20 units have been administered in 24 HRs...how much

Answer 43

2/3 of insulin requirement added to TPN

Question 44

dka

Answer 44

excessive intracellular dehydration , hyperglycemia increases serus osmolality cuasing a shift of intracellular water into the intravascular space; ketouria and acidosis

Question 45

in dka and hhns there are counterregulatory hormones that the stress response increase

Answer 45

salt sugar sex, catecholamines, glucagon, cortisol and GH

Question 46

diagnostic criteria labs for DKA

Answer 46

glucose >350, low sodium, 4.5 k, bicarb <10 bun 25-50, and serum ketones present

Question 47

diagnostic criteria labs for HHNS

Answer 47

glucose >700 sodium 140 potassium >5 , bicarb >15, BUN >50 and absent ketones

Question 48

low versus high anion gap

Answer 48

important tool for metabolic acidosis. you can have a metabolic acidosis with a normal or low anion gap. bicarb falls and not related to ketones this is loss of bicarb via diarrhea

Question 49

how to talk to your patients to avoid another episode of hyperglycemic

Answer 49

have enough medications available, talk to the hpc if they have any illness, if they need potassium replacement

Question 50

whipples triad

Answer 50

hypoglycemia tremors palpitations hunger sweating anxiety arousal paresthesias

Question 51

Low plasma glucose concentration with or without symptoms that exposed to individual to to

Answer 51

Hypoglycemia defined as a blood glucose less than 70

Question 52

Hypoglycemia with cognitive impairment is blood glucose less than what

Answer 52

60 and maybe iatrogenic 

Question 53

Signs and symptoms of hypoglycemia

Answer 53

Tremors, palpitation, anxiety or arousal sweating para Tasia’s hungry 

Question 54

Hypoglycemia Whipples’s triad

Answer 54

One a low plasma, glucose concentration at the time of symptoms, two resolution of those signs and symptoms after raising the plasma, glucose concentration, three symptoms signs and are both consistent with hypoglycemia 

Question 55

Treatment for hypoglycemia

Answer 55

Mild – glucose sugar, beverage, milk, candy, or crackers Moderate to severe level two or three we would give 2 to 50 ML‘s of 50% dextrose, infusion of D5W or D 10 W for level 100, could also give glucagon 1 mg sub Q or IM if no IV access available 

Question 56

Clinical manifestations of hypoglycemic episode

Answer 56

You could have cognitive impairment, behavioral changes, psycho motor abnormalities, and the worst case is seizures or coma