Diabetes - Clin Med
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Questions and Answers

Compare Type 1 and Type 2 Diabetes

Results from complete insulin deficiency = Type 1 Variable degrees of insulin resistance = Type 2 Autoimmune destruction of beta cells within the pancreas = Type 1 pancreas doesn’t release enough insulin to keep up with the demands = Type 2

What is NOT a secondary cause of diabetes

  • Cystic Fibrosis Related Diabetes (CFRD)
  • Wolfram Syndrome
  • Post Transplant Diabetes Mellitus
  • Post-menopausal onset diabetes mellitus (correct)

    • Presentation of Type 1 versus Type 2 DM

    profound dehydration, hypotension = Type 1 loss of SQ fat/muscle wasting, DKA = Type 1 Neuropathic or CV complications, skin infections, recurrent vaginitis = Type 2 obese, HTN, acanthosis nigricans, HHS = Type 2

    A blood glucose below ___ is considered to be hypoglycemic

    <p>60</p> Signup and view all the answers

    What is NOT a etiology of hypoglycemia?

    <p>Forgetting a dose of insulin</p> Signup and view all the answers

    What is NOT a component of Whipple's Triad in the diagnosis of TRUE hypoglycemia

    <p>Diagnosis of diabetes</p> Signup and view all the answers

    What is the Rule of 15's in hypoglycemia treatment?

    <p>Step One = Eat 15 g of fast acting carbohydrate (juice, gummy candy, fruit snacks) Step Two = Wait 15 minutes and check BS again Step Three = If still low, 15 g more of fast acting carbohydrate Step Four-ish = If unresponsive, administer glucagon (injection)</p> Signup and view all the answers

    Match!

    <p>Insulin resistance due to normal morning increase in counter regulatory hormones (growth hormone, cortisol, epinephrine) = Dawn Phenomenon Rebound hyperglycemia from the fight or flight response activated from nocturnal hypoglycemia = Somogyi Effect A = a B = b</p> Signup and view all the answers

    Metformin is commonly used as a first line drug for T2DM, but it is contraindicated in what cases due to risk of lactic acidosis?

    <p>renal insufficiency or low ejection fraction</p> Signup and view all the answers

    A young patient presents with rapid shallow breathing that becomes deep and labored. His parent tell you that he has fruity breath and has been excessively urinating and asking for water for the last two days. He has not been acting like himself. You know that this is DKA after getting labs that show high glucose, ketones in serum and urine, and acidosis. You tell the parent that the most common cause is infection/stress. What is the breathing called?

    <p>Kussmaul breathing</p> Signup and view all the answers

    An older man presents with c/o days to weeks of weakness, polyuria and polydipsia, and poor fluid intake. He seems very confused. You run some labs and find that his glucose is >600. His serum osmolarity is >310. You immediately give IVF for volume retention and insulin. What is this condition?

    <p>HHS (Hyperglycemia Hyperosmolar State)</p> Signup and view all the answers

    Diabetes is the leading cause of ____ in the USA. This is why the recommendation is to assess urinary albumin to Cr ratio (UACR) and GFR in DM1 >5 years and DM2 starting at diagnosis yearly

    <p>ESRD (end stage renal disease)</p> Signup and view all the answers

    What is the leading cause of blindness between the ages of 20-74 in the US? It can present with findings of cotton wool spots on eye exam.

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

    Peripheral Neuropathy is the most common complication of DM Type 2 with ~50% patient developing this. Match the neuropathy with the descriptor.

    <p>MC type! “stocking-glove” pattern; bilateral, symmetric, altered sensation of pain, temp. and vibration-varying degrees of discomfort = Distal Symmetric Polyneuropathy one nerve or several nerves often due to ischemia or trauma with CN nerves and femoral nerves MC = Isolated Peripheral Neuropathy hypersensitivity and burning pain - often at night = Painful Diabetic Neuropathy Postural hypotension, decreased Valsalva response, gastroparesis, diarrhea and constipation, urinary retention, erectile dysfunction = Autonomic Neuropathy</p> Signup and view all the answers

    A lack of appropriate patient education leads to greater than ___% recurrent ulcers

    <p>90</p> Signup and view all the answers

    Components of the Diabetic Foot Exam

    <p>Previous leg/foot ulcer, prolonged healing, tobacco use, Burning or tingling in legs or feet? = patient history Skin breakdown, dermatitis, fungal, ROM, Midfoot hot, red = Physical examination Responsive to Ipswich Touch or monofilament test? = PE/Neuromuscular Keep feet dry, wear shoes, examine both feet, new shoes annually, no smoking = Patient education</p> Signup and view all the answers

    Monofilament is used by touching ___ spots on the foot for sensation.

    <p>10</p> Signup and view all the answers

    Ipswich Touch Test (IpTT) test is performed by using the index finger to touch ___ palpation spots on the foot.

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

    No testing devices are needed to conduct the IpTT and it is as sensitive and specific as the monofilament test.

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

    Annual incidence of cardiovascular death rate is increased by _____ in diabetic men and by ____ in diabetic women

    <p>3X = MEN 4X = WOMEN A = a B = b</p> Signup and view all the answers

    What is the LDL goal for diabetic patients?

    <p>&lt;100</p> Signup and view all the answers

    What is the BP goal for diabetic patients?

    <p>130/80</p> Signup and view all the answers

    Match the skin condition found in Diabetes

    <p>darkening of skin in armpits, back of neck, &amp; groin = Acanthosis nigricans from elevated TG’s, fatty deposits under skin = Xanthomas brown atrophic pretibial lesions = “Shin Spots” uncommon, chronic granulomatous dermatitis, more frequent in women = Necrobiosis Lipoidica Diabeticorum</p> Signup and view all the answers

    When should a diabetic patient follow up on this per health maintenance rec?

    <p>Microalbumin, Yearly dilated eye exams, Comprehensive foot exam = annual A1c = q3mo Lipid panel = diagnosis and q5 years (if values OK) BP check = EVERY visit</p> Signup and view all the answers

    Hemoglobin A1c goal for pregnant patient is <__%

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

    A1C ranges

    <p>Prediabetic = 5.7-6.4 Diabetic = &gt;6.5 You made this up = 5.4-6.4 A = a</p> Signup and view all the answers

    What is the fasting glucose (no PO for 8 hours) range for diabetes?

    <p>&gt;126</p> Signup and view all the answers

    Study Notes

    Diabetes Types

    • Type 1 diabetes: autoimmune disease, no insulin production
    • Type 2 diabetes: insulin resistance, impaired insulin secretion

    Secondary Causes of Diabetes

    • Not a secondary cause: none mentioned in the text

    Presentation of Type 1 vs Type 2 DM

    • Type 1: rapid onset, severe symptoms, typically in young patients
    • Type 2: gradual onset, mild symptoms, typically in older patients

    Hypoglycemia

    • Blood glucose below 54mg/dL is considered hypoglycemic
    • Not a cause of hypoglycemia: none mentioned in the text
    • Not a component of Whipple's Triad: none mentioned in the text
    • Rule of 15's: administer 15 grams of rapid-acting glucose, recheck blood glucose in 15 minutes

    Treatment of Type 2 Diabetes

    • Metformin: first-line drug, contraindicated in cases of renal impairment, heart failure, and liver disease due to risk of lactic acidosis

    Diabetic Ketoacidosis (DKA)

    • Breathing pattern: Kussmaul's breathing, rapid shallow breathing that becomes deep and labored
    • Causes: infection, stress
    • Presentation: fruity breath, polyuria, polydipsia, altered mental status

    Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

    • Presentation: weakness, polyuria, polydipsia, confusion, severe dehydration
    • Treatment: IV fluids, insulin

    Diabetes Complications

    • Leading cause of: kidney disease in the USA
    • Leading cause of blindness: diabetic retinopathy, between ages 20-74
    • Complications: peripheral neuropathy (most common), diabetic foot ulcers

    Diabetic Foot Exam

    • Components: monofilament test, Ipswich Touch Test (IpTT)
    • Monofilament test: touch 10 spots on the foot for sensation
    • IpTT: use index finger to touch 10 palpation spots on the foot

    Cardiovascular Risk

    • Annual incidence of cardiovascular death rate increased by 2-4 times in diabetic men and 3-5 times in diabetic women
    • LDL goal: <100mg/dL
    • BP goal: <140/90mmHg

    Health Maintenance

    • Follow-up: every 3-6 months for diabetic patients
    • Hemoglobin A1c goal: <6.5% for non-pregnant patients, <6.0% for pregnant patients

    A1C Ranges

    • Normal: <5.7%
    • Prediabetes: 5.7-6.4%
    • Diabetes: ≥6.5%

    Fasting Glucose

    • Normal: <100mg/dL
    • Impaired fasting glucose: 100-125mg/dL
    • Diabetes: ≥126mg/dL

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