Medicine Marrow Pg No 925-934 (Endocrinology)
53 Questions
0 Views

Medicine Marrow Pg No 925-934 (Endocrinology)

Created by
@PremierMetaphor

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the typical glucose level in a patient with HHS?

  • 125-135 mg/dL
  • >800 mg/dL (correct)
  • 350-400 mg/dL
  • 300-320 mg/dL

    • In DKA, plasma ketones are indicated by a result of +++++.

    True

    What type of saline is recommended for fluid correction in DKA management?

    1/2 NS

    The sodium level in a patient with HHS typically ranges from ____ meq/L.

    <p>135-145</p> Signup and view all the answers

    Match the following parameters with their values in DKA:

    <p>Glucose = 350-400 mg/dL Osmolality = 300-320 mOsm/mL pH = ↓ Creatinine = Slight ↑</p> Signup and view all the answers

    Which of the following conditions is NOT associated with Diabetes Mellitus?

    <p>Asthma</p> Signup and view all the answers

    Acromegaly is a genetic disease associated with Diabetes Mellitus.

    <p>False</p> Signup and view all the answers

    Name one genetic disease associated with Diabetes Mellitus.

    <p>Down's syndrome</p> Signup and view all the answers

    ___ is a condition characterized by an excessive production of growth hormone, leading to enlarged features.

    <p>Acromegaly</p> Signup and view all the answers

    Match the following endocrine disorders with their brief descriptions:

    <p>Cushings = Hypersecretion of cortisol Pheochromocytoma = Tumor of the adrenal gland producing excess catecholamines Glucagonoma = Tumor that secretes glucagon Hyperthyroidism = Overactivity of the thyroid gland</p> Signup and view all the answers

    Which of the following is NOT a cause of Type 3 Diabetes Mellitus?

    <p>Obesity</p> Signup and view all the answers

    Macrovascular complications are common in Type 3a Diabetes Mellitus.

    <p>False</p> Signup and view all the answers

    What is the gold standard investigation for diagnosing pancreatic causes of diabetes?

    <p>ERCP</p> Signup and view all the answers

    Type 3c diabetes is associated with __________ due to large ductal calculi.

    <p>Tropical chronic calcific pancreatitis</p> Signup and view all the answers

    Match the following drugs with their associated categories causing Diabetes Mellitus:

    <p>Tacrolimus = Immunosuppressants L-asparaginase = Anticancer Olanzapine = Psychiatric Thiazide = Diuretics</p> Signup and view all the answers

    Which of the following is a feature of Hyperosmolar Hyperglycemic State (HHS)?

    <p>Occurs primarily in elderly patients</p> Signup and view all the answers

    In HHS, blood glucose levels must be monitored every four hours.

    <p>False</p> Signup and view all the answers

    What is the initial stat dose of regular insulin administered intravenously in HHS treatment?

    <p>0.1 u/kg</p> Signup and view all the answers

    In HHS, fluid replacement is typically around ______ liters.

    <p>6-9</p> Signup and view all the answers

    Match the following components of HHS treatment to their correct description:

    <p>IV Fluids = Replace fluid loss of 6-9 L Regular Insulin = Initial bolus of 0.1 u/kg Blood Glucose Monitoring = Every hour during treatment Switching Fluids = When glucose is 200 mg/dL</p> Signup and view all the answers

    What is a common symptom of ketoacidosis?

    <p>Polyuria</p> Signup and view all the answers

    High anion gap metabolic acidosis is a characteristic finding in ketoacidosis.

    <p>True</p> Signup and view all the answers

    What causes the fruity odor of the breath in patients with ketoacidosis?

    <p>Acetone</p> Signup and view all the answers

    In ketoacidosis, excessive ________ hormones lead to lipolysis and ketone body formation.

    <p>counter-regulatory</p> Signup and view all the answers

    Match the following signs/symptoms with their description:

    <p>Tachycardia = Increased heart rate often linked to dehydration Dehydration = Loss of body fluids, leading to dry skin and mucous membranes Respiratory distress = Difficulty breathing not proportionate to visible lung issues Abdominal pain = Discomfort often associated with digestive system complications</p> Signup and view all the answers

    Which of the following tissues primarily uses GLUT-4 for insulin-dependent glucose uptake?

    <p>Skeletal muscle</p> Signup and view all the answers

    Insulin is a polypeptide consisting of 51 amino acids.

    <p>True</p> Signup and view all the answers

    What is one consequence of decreased amino acid uptake due to insulin deficiency?

    <p>Weakness</p> Signup and view all the answers

    Insulin acts via a __________ receptor.

    <p>Tyrosine kinase</p> Signup and view all the answers

    Match the following complications of diabetes mellitus with their descriptions:

    <p>Mucormycosis = A serious fungal infection Emphysematous cholecystitis = Gas-forming infection of the gallbladder Emphysematous pyelonephritis = Gas-forming infection of the kidney Malignant otitis externa = Severe ear infection often in diabetics</p> Signup and view all the answers

    Which of the following statements about GLP-1 is true?

    <p>GLP-1 has a half-life of 1-2 minutes.</p> Signup and view all the answers

    GLP-1 is associated with reducing body weight.

    <p>True</p> Signup and view all the answers

    Name one acute complication of insulin deficiency in diabetes mellitus.

    <p>Diabetic ketoacidosis (DKA)</p> Signup and view all the answers

    GLP-1 enhances _____ cell glucose responsiveness.

    <p>beta</p> Signup and view all the answers

    Match the following GLP-1 characteristics with their descriptions:

    <p>Enhances satiety = Increases feelings of fullness Cardio-protective = Reduces cardiovascular risk Half-life = Duration of action before degradation Nephroprotective = Protects kidney function</p> Signup and view all the answers

    Which of the following medications is NOT associated with a risk of hypoglycemia?

    <p>Metformin</p> Signup and view all the answers

    Gliclazide has a neutral effect on weight.

    <p>False</p> Signup and view all the answers

    Name one type of ultra-short acting insulin.

    <p>Lispro</p> Signup and view all the answers

    SGLT-2 antagonists, such as ______ and ______, primarily function by blocking the NLRP3 inflammasome pathway.

    <p>Dapagliflozin, Empagliflozin</p> Signup and view all the answers

    Match the following oral hypoglycemic drugs with their characteristics:

    <p>Metformin = Weight loss (mild) and no hypoglycemia risk Gliclazide = Weight gain and risk of hypoglycemia Semaglutide = HbA1c reduction (2-2.5%) and cardioprotective Dapagliflozin = HbA1c reduction (1.5-2%) and reduces comorbidities</p> Signup and view all the answers

    What characterizes the dawn phenomenon?

    <p>Early-morning hyperglycemia</p> Signup and view all the answers

    The Somogyi effect is caused by insufficient nighttime insulin doses.

    <p>False</p> Signup and view all the answers

    What is the recommended nighttime insulin dose of Glargine?

    <p>16 units</p> Signup and view all the answers

    The components of Continuous Glucose Monitoring System (CGMS) include a Continuous Glucose Monitor, a cable, a glucose sensor, and a ______.

    <p>Com-station/Charger</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Dawn Phenomenon = Early-morning hyperglycemia Somogyi Effect = Nighttime hypoglycemia leading to morning hyperglycemia Regular Insulin = Short-acting insulin administration Long-Acting Insulin = Insulin with extended duration of action</p> Signup and view all the answers

    What is the primary function of GLUT4?

    <p>Insulin-stimulated uptake of glucose</p> Signup and view all the answers

    GLUT2 is primarily found in the brain and is responsible for glucose uptake.

    <p>False</p> Signup and view all the answers

    Which incretin hormone is known to augment insulin production in response to a glucose meal?

    <p>GLP-1</p> Signup and view all the answers

    SGLT2 is responsible for the __________ of glucose in the proximal convoluted tubule of the kidney.

    <p>reabsorption</p> Signup and view all the answers

    Which condition is associated with undetectable glucose levels and high C-peptide levels?

    <p>Type 1 Diabetes Mellitus</p> Signup and view all the answers

    Match the following GLUT transporters with their tissue locations:

    <p>GLUT1 = Brain, kidney, colon, placenta, erythrocyte GLUT2 = Liver, pancreatic β cell, small intestine, kidney GLUT3 = Brain, kidney, placenta GLUT5 = Small intestine</p> Signup and view all the answers

    Liraglutide is an example of a recombinant GLP-1 used in diabetes treatment.

    <p>True</p> Signup and view all the answers

    What is the role of incretin hormones in glucose metabolism?

    <p>They augment insulin production in response to glucose.</p> Signup and view all the answers

    Study Notes

    Endocrinopathies Associated with DM

    • Cushing's syndrome, Acromegaly, Hyperthyroidism, Hyperparathyroidism, Pheochromocytoma, Glucoganoma, Somatostatinoma are conditions associated with Diabetes Mellitus

    Genetic Diseases Associated with DM

    • Down's syndrome, Klinefelter syndrome, Friedreich's ataxia, Huntington's, Prader Willi, Porphyria, Myotonic dystrophy, Wolfram syndrome, Laurence-Moon-Biedl syndrome are conditions associated with Diabetes Mellitus

    DKA vs HHS Lab Values

    • DKA: Glucose 350-400 mg/dL, Plasma Ketones ++, pH ↓
    • HHS: Glucose >800 mg/dL, Plasma Ketones ++++++, pH (N)
    • Both DKA & HHS: NaHCO3 (mEq/L) ↓
    • Both DKA & HHS: Anion Gap (N)/↓

    Type 3 DM (Pancreatic DM)

    • Tropical chronic calcific pancreatitis (TCCP)
    • Cystic fibrosis

    Type 3a DM

    • Alzheimer's disease

    Type 3c: TCCP DM

    • Large ductal calculi + duct dilatation + marked fibrosis
    • Increased risk of pancreatic cancer
    • Lean, young ketosis -ve DM
    • 2nd-3rd decade, Younger males
    • Diabetes Mellitus (DM)
    • Steatorrhea
    • Abdominal pain
    • Nephropathy
    • Macrovascular complications are rare
    • ERCP (Gold standard)

    Type 3d: Drugs Causing DM

    • Immunosuppressants: Tacrolimus
    • Anticancer: L-asparginase
    • Endocrine: Growth Hormone (GH)
    • ANS: Beta-agonist
    • Psychiatric: Olanzapine
    • Diuretics: Thiazide
    • Act independent of insulin: Nicotinic acid, statins, aspirin

    Other Conditions Associating with DM

    • Hemochromatosis
    • IgG4 related disease

    Hyperosmolar Hyperglycemic State (HHS) Pathophysiology & Features

    • Relative insulin deficiency + mild increase in counter-regulatory hormones
    • T2DM > TIDM
    • Elderly patient
    • Precipitating factor(+) e.g., LRTI
    • Develops over a week's time

    HHS Treatment

    • 2 IV lines inserted
    • Fluids: Replace 6-9 L of fluid
    • Regular insulin: Stat dose 0.1 u/kg/kg IV
    • Infusion 0.1 u/kg/hr
    • Monitor blood glucose every hour
    • When values are 200 mg/dL, switch fluids from NS to 5% dextrose

    HHS Prognosis

    • Good

    Insulin Physiology

    • Islets of Langerhans (2% of pancreatic volume)
    • Polypeptide (51 amino acids) made of a chain, connected by disulfide bonds
    • Acts via Tyrosine kinase (TK) receptor

    Carbohydrate Metabolism

    • Insulin-dependent glucose uptake via GLUT-4: Skeletal muscle, Adipose tissue, Heart
    • Regulates glucose production: (-) gluconeogenesis, (-) glycogenolysis

    Protein Metabolism

    • ↓ amino acid uptake → Weakness
    • ↓ amino acid synthesis
    • ↑ proteolysis → Wasting

    Fat Metabolism

    • Lipolysis

    Specific complications of diabetes mellitus (DM)

    • Mucormycosis
    • Emphysematous cholecystitis
    • Emphysematous pyelonephritis
    • Malignant otitis externa

    Absolute insulin deficiency (TIDM >> T2DM)

    • Excessive counter-regulatory hormones (Glucagon/Epinephrine/Cortisol)
    • ↑ CPT I (Carnitine Palmitoyl Transferase)
    • Free fatty acids undergo β-oxidation in mitochondria
    • Lipolysis
    • ↑ Acetyl-CoA formation
    • Ketone body formation
    • Ketosis/Ketoacidosis

    Clinical Features of DKA

    • Nausea/vomiting
    • Thirst/Polyuria
    • Respiratory distress out of proportion to lung signs
    • Dehydration
    • Tachycardia

    Investigations for DKA

    • ABG: High anion gap metabolic acidosis (HAGMA)
    • β-Hydroxybutyrate level
    • Urine Ketones
    • CBC
    • RFT
    • S.Electrolytes

    Other Findings

    • Abdominal Pain
    • Shortness of breath
    • Acidotic breath (fruity odor)
    • Abdominal tenderness (D/D: Acute pancreatitis)

    GLP-1 vs GIP

    • GLP-1: Source- L cells/ileum & colon, Glucose dependent insulin release +++, Enhances Beta cell glucose responsiveness +++, Suppresses glucagon release +++, Stimulates beta cell expansion +++, Inhibition of gastric emptying +++, Enhances satiety +++, Reduces body weight +++, Half life 1-2 min (Rapidly degraded by DPP-4)
    • GIP: Source- K cells/jejunum, Glucose dependent insulin release +++, Enhances Beta cell glucose responsiveness +++, Enhances satiety +++, Reduces body weight +++, Half life 5-7 min

    Advantages of recombinant GLP-1 over other hypoglycemic agents

    • Promotes weight loss (used in Rx of NASH/NAFLD)
    • No risk of hypoglycemia
    • Cardio-protective
    • ↑ HbA1c reduction potential
    • Nephroprotective

    Complications of Insulin deficiency (DM)

    • Acute: Diabetic ketoacidosis (DKA), Hyperglycemic hyperosmolar state (HHS)
    • Chronic: Retinopathy, Nephropathy, Peripheral neuropathy
    • Macrovascular: Atherosclerotic CVD, CKD

    Precipitating factors of Diabetic KetoAcidosis (DKA)

    • Infection
    • Infarction
    • Pregnancy
    • Cocaine
    • Non-compliance to Rx

    Oral Hypoglycemic Drugs

    • Biguanide: Metformin: Weight loss (mild), HbA1c reduction good (1-2%), No hypoglycemia risk, No cardiac risk, Renal: C/1: GFR < 30 ml/min, Combats resistance, Acts by ↑ AMP Kinase, No effect on comorbidity, macrovascular disease
    • Sulfonylurea: Gliclazide: Only drug in use, Vasodilator (NO), Antioxidant, Other drugs are not in use due to cardiotoxicity, Weight gain, HbA1c reduction good (1-2%), Risk: Hypoglycemia
    • Oral GLP-1 Analogue: Semaglutide: New, Liraglutide, Tirzepatide, Used in NASH, HbA1c reduction (2-2.5%), Protective glycemic, Cardioprotective, Renoprotective, Tirzepatide: Newer drug, Dual GLP-1, GIP action, Weight loss (max)
    • SGLT-2 Antagonist: Dapagliflozin: Empagliflozin, HbA1c reduction: 1.5-2%, Blocks: NLRP3 inflammasome pathway, Blocks atherosclerosis, Reduces other comorbidities,
    • Gliptins: Linagliptin: Weight neutral

    Indications of Insulin therapy

    • Hybrid diabetes form
    • T1DM
    • GDM
    • HbA1c ≥ 9.5%
    • macro/micro vascular involvement
    • Ketosis
    • Significant Polyurea, polydipsia and weight loss

    Types of Insulin

    • Ultra Short: Lispro, Aspart
    • Short: Regular
    • Intermediate: NPH
    • Long: Glargine, Detemir
    • Ultralong: Degludec

    CBGM (Continuous blood glucose monitoring)

    • CBGM should be done before starting insulin therapy

    Dawn Phenomenon vs Somogyi Effect

    • Dawn Phenomenon: Characterized by early-morning hyperglycemia.
    • Somogyi Effect: Characterized by excess in nighttime insulin doses, leading to early-morning hyperglycemia and midnight hypoglycemia.

    Continous Glucose Monitoring System (CGMS) Components

    • Continuous Glucose Monitor (CGM)
    • Cable
    • Glucose Sensor
    • Com-station/Charger

    Insulin Regime

    • Regular Insulin: 8 units - 8 units - 8 units
    • Long-Acting Insulin: Glargine: 16 units (Nightly) or Degludec: 16 units (Alternate Nights) or Regular Insulin: 16 units (Twice daily)

    Insulin Administration Instructions

    • Frequency: Perform blood glucose checks before and after breakfast, lunch, and dinner 6 times
    • Dose Adjustment: Insulin doses can be adjusted by increasing or decreasing by 4 unit(s) based on measured blood sugar level(s)

    Glucose Transporter (GLUTs)

    • GLUT1: Brain, kidney, colon, placenta, erythrocyte - Uptake of glucose
    • GLUT2: Liver, pancreatic β cell, small intestine, kidney - Rapid uptake and release of glucose
    • GLUT3: Brain, kidney, placenta - Uptake of glucose
    • GLUT4: Heart and skeletal muscle, adipose tissue - Insulin-stimulated uptake of glucose
    • GLUT5: Small intestine - Uptake of fructose

    SGLT1 & SGLT2

    • SGLT1: Small intestine - Active uptake of glucose from lumen of intestine
    • SGLT2: Kidney - Reabsorption of glucose in proximal convoluted tubule of kidney

    Conditions associated with Glucose & C-peptide level:

    • Undetectable Glucose | ↑ C-peptide: TIDM
    • ↑ Glucose | ↑ C-peptide: T2DM
    • ↓ Glucose | ↓ C-peptide: Insulinoma
    • ↓ Glucose | ↓ C-peptide: Exogenous insulin

    Incretin Hormones

    • Incretins: GLP-1, GIP
    • Mechanism: Augment insulin production in response to a glucose meal (intrajejunal glucose).

    Applied Aspects of Incretins

    • Recombinant GLP-1 used in the Rx of DM.Not easily degraded by dipeptidyl peptidase-4 (DPP-4)
    • Exenatide (Pancreatitis risk)
    • Liraglutide s/c
    • Semaglutide oral (↑ weight loss)
    • Dual GLP-1/GIP analogues (new): Tirzepatide

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Explore the intricate relationship between diabetes mellitus (DM) and various endocrinopathies and genetic diseases. This quiz covers conditions like Cushing's syndrome and Down's syndrome, as well as compares lab values between DKA and HHS. Test your knowledge on the types of diabetes related to both endocrine and genetic factors.

    More Like This

    Diabetes Mellitus Overview and Symptoms
    23 questions

    Diabetes Mellitus Overview and Symptoms

    TenaciousFeynman9892 avatar
    TenaciousFeynman9892
    Diabetes Mellitus NCLEX Flashcards
    5 questions

    Diabetes Mellitus NCLEX Flashcards

    TenaciousFeynman9892 avatar
    TenaciousFeynman9892
    Diabetes Mellitus Management Flashcards
    8 questions

    Diabetes Mellitus Management Flashcards

    RadiantLaplace9461 avatar
    RadiantLaplace9461
    Diabetes Mellitus Flashcards Chapter 26
    20 questions

    Diabetes Mellitus Flashcards Chapter 26

    SkilledAzalea avatar
    SkilledAzalea
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser