Kirila CIS

Question 1

What is the dosing of a bolus of insulin is based on?

Answer 1

Sliding scale finger stick glucose (FSG)

Question 2

When someone says “regular” insulin, what do they mean

Answer 2

Like the insulin that THEY take, it’s not necessarily the regular kind of insulin

Question 3

Where should people prick their finger when checking glucose?

Answer 3

On the side of their finger… Not as painful and they get to keep their sense of touch

Question 4

What are we measuring when we measure blood glucose?

Answer 4

The glycosylated hemoglobin! HbA1C

Question 5

What are the possible presentations where we include DM in diff dx?

Answer 5

• mental status changes
• abdominal pain
• dehydration

Question 6

What was bonded in the abdominal pain slide?

Answer 6

Diabetic Ketoacidosis

Question 7

What are the acute complication of diabetes mellitus?

Answer 7

• DKA

- non Ketoacidosis hyperosmolar state (NKHS)

Question 8

Which type of DM has the DKA?

Answer 8

Type 1 usually

Question 9

Which type has NKHS?

Answer 9

Type 2 DM

Question 10

What is rapid and deep respirations?

Answer 10

Kussmal respirations

Question 11

What breath will people with DKA have?

Answer 11

“Fruity”

-she said it’s actually like nail polish

Question 12

What is something obvious that we need to consider when someone has DKA?

Answer 12

Drugs! Cocaine

Question 13

Initial sx of DKA

Answer 13

• anorexia

- nausea….

Question 14

Labs for DKA?

Answer 14

• hyperglycemia
• ketones
• metabolic acidosis

Question 15

How is the anion gap in DKA?

Answer 15

It is high!!!

Question 16

What does acidosis cause K to do in respect to cells?

Answer 16

-shifts potassium out of cells

Question 17

What was the mneumonic for High anion gap acidosis?

Answer 17

-MUDPILES

Question 18

What does MUDPILES mean?

Answer 18

• Methanol
• uremia
• diabetic Ketoacidosis
• Paraldehyde
• Isolpropyl alcohol, Iron, INH (isoniazid)
• Lactic acidosis
• ethylene glycol
• Salicylates

Question 19

Tx of DKA?

Answer 19

• ICU
• frequent monitoring of general status, vital signs, glucose, and other labs: acid base status, renal function, potassium and other electrolytes

Question 20

What is the first choice of fluid replacement in DKA?

Answer 20

Normal saline for both DKA and NHGS

Question 21

What do we have to keep in mind when replacing K+?

Answer 21

-renal function!

Question 22

When do you start intermediate or long-acting insulin?

Answer 22

• when pt is Able to eat as shown by improved mental status, no nausea or vomiting, no abdominal
• anion gap normalized
• allow overlap timing of IV with SQ insulin…. Usually by 30-60 minutes

Question 23

NKHS

Answer 23

Non Ketotic hyperosmolar state

-our example was the 85 year old guy with decreased mental status

Question 24

What is a big difference between NKHS and DKA?

Answer 24

• the fluid deficit is a lot bigger! 8-10L
• so give them 2-3 liters NS or first 1-3 hrs
• when Glc reaches 250 mg/dl, switch to D51/2NS (5% dextrose and 0.45% saline)

Question 25

What is the first treatment of choice for NKHS?

Answer 25

Normal saline!

Question 26

Similarities of NKHS and DKA

Answer 26

``` Insulin deficiency- absolute or relative Glucagon excess- absolute or relative Volume depletion Mental status changes -both are critical conditions needing intensive monitoring ```

Question 27

Differences?

Answer 27

-fluid deficit is much greater in NKHS... Finish this!

Question 28

What is the major cause of mortality in type 2 DM?

Answer 28

-cardiovascular disease

Question 29

What level should the HbA1c be at?

Answer 29

-somewhere below 7.0

Question 30

What will we see in the retina exam In an intense type 2 diabetic?

Answer 30

- extensive retinal vascular leak and lipid deposits | - there will be retinal infractions and the patients lose sight

Question 31

Diabetic gastropathy

Answer 31

When the stomach doesn't work as it should | -the timing of the effect of insulin is all screwed up

Question 32

If there's a guy with t2DM and his sugars seemed much more easily controlled, what's going on?

Answer 32

- worsening renal function | - they aren't clearing the medications as fast

Question 33

In diabetic nephropathy, where is the initial insult?

Answer 33

At the glomerulus | -remember that the clearance of insulin will decrease

Question 34

How to screen for proteinuria

Answer 34

- spot urine sample - protein... * standard urine dipstick not sensitive if proteinuria <300 mg/24 hr*

Question 35

What is a 24 hr urine collection used for?

Answer 35

- protein and creatinine clearance | - need to obtain serum creatinine at the same time to determine creatinine clearance

Question 36

What do we need to encourage diabetic people to do?

Answer 36

-fucking move!

Question 37

What is the first drug of choice for a type 2 diabetic that has no renal problems?

Answer 37

- metformin!! | - you can't do this for type 1