PBL 2 DKA

Question 1

If your anion gap is high, is your bicarbonate level high or low?

Answer 1

low

Question 2

Equation for anion gap.

Answer 2

(Na+) - (Cl- + HCO3-)

Question 3

What is a normal anion gap?

Answer 3

8-12

Question 4

What does a high anion gap tell you?

Answer 4

Acidosis

Question 5

What is osmotic diuresis?

Answer 5

An increase in urine production due to high solute in the tubules causing excess water to stay in the tubule (ex. glucose pulls water into the tubule in our case)

Question 6

Describe the physiology of orthostatic hypotension.

Answer 6

Loss of volume –> stand up –> blood leaves central venous compartment –> Decreased Stroke volume –> Decreased BP –> presyncope (in our case)

Question 7

What solute does the Transport maximum refer to?

Answer 7

Glucose

Question 8

What transporters cause reabsorption of glucose?

Answer 8

SGLT (Na+/Glucose)

Question 9

What percent of glucose is normally reabsorbed in proximal tubule?

Answer 9

100 %

Question 10

What is the Transport Maximum (by definition and numerically)?

Answer 10

Saturation of the SGLT’s–>glucose left in tubule
15 mM
240 mg/dL blood glucose

Question 11

What ion does insulin drive into cells?

How?

Answer 11

K+

Activation of the Na+/K+ ATPase

Question 12

Why does the body go into Kussumal respirations in DKA?

Answer 12

To breathe off the CO2 which will reduce H+ because of Le Chateliers principle

Question 13

Name 2 Long acting insulins.
How long does it last?
How long does it take to work?

Answer 13

Glargine Insulin, Determir Insulin
~24 hours
Onset 1-2 hours

Question 14

Name 2 rapid acting insulins.
How long does it take to work?
How long does it last?

Answer 14

Lispro Insulin, Aspart Insulin
Onset 0.25 hours
Duration 3-4 hours

Question 15

How long does regular insulin last?
How long does it take to work?
What category of insulin is this considered?

Answer 15

4-8 hours
Onset 0.5 hours
Short acting

Question 16

Which insulin is intermediate acting?
Whats the onset?
Whats the duration?

Answer 16

NPH insulin
Onset: 2-4 hours
Duration 10-20 hours

Question 17

When do you inject Insulin Lispro and Insulin aspart?

Answer 17

Right before a meal

Question 18

What kind of insulin do insulin pumps deliver?

Answer 18

Rapid acting (Lispro)

Question 19

List typical symptoms of DKA.

Answer 19

Polydipsia
Polyuria
Fatigue
Abdominal pain
Kussumal respirations

Question 20

Which race has the highest prevalence of DM Type 1?

Answer 20

Whites

Question 21

Risk factors for developing Type 1 Diabetes.

Answer 21

High birth weight
Childhood obesity
Increased maternal age at birth

Question 22

Describe the genetics of Type 1 diabetes.

Answer 22

Inheritance pattern unknown.

Mutations in HLA-DR3 and HLA-DR4 are associated with increased risk.

Question 23

What kind of receptor does insulin bind?

Answer 23

Tyrosine Kinase

Question 24

Describe what happens after insulin binds its receptor.

Answer 24

Activation of Phosphatidylinositol leads to activation of a serine/threonine kinase Akt.
Akt activation drives insertion of GLUT4 from its vesicles.

Question 25

What is the effect of insulin on sodium in the kidneys?

Answer 25

Increased sodium retention

Question 26

What is primary gain?

Give an example from the case.

Answer 26

Direct benefits from using a treatment.

Take insulin -> Don’t get sick/acidotic

Question 27

What is secondary gain?

Give an example.

Answer 27

Reasons that a patient would not want to take treatment.

No insulin -> Attention from boyfriend

Question 28

Do long acting or intermediate acting insulins have a quicker onset?

Answer 28

Long acting (glargine, Detemir)