Spring 2011Mid D.m. Adult Medicine

Front 1

Non obese
non diabetic population that has insulin resistance of a magnitude similar to that seen in type 2 diabetes. These individuals are at a much higher risk for developing type 2 diabetes.

Back 1

Insulin resistance syndrome
(aka: metabolic syndrome)

Front 2

If the fasting glucose level is ???Mg/dl or higher on more than one occasion
further evaluation of the patient with a glucose challenge is necessary.

Back 2

126

Front 3

What are the diagnostic numbers for fasting plasma glucose? Two hours post glucose load?

Back 3

Normal = 100 and 140

impaired glucose tolerance = <125 and <199

DM = >126 and >200

Front 4

Weighted to more recent glucose levels (previous month) and this explains why significant changes are observed with short term (1 month) changes in mean plasma glucose levels.

Back 4

Hba1c

Front 5

The target for blood glucose control is?
?(elevated or lowered labs)?
in elderly patients since they have the greatest risk if subjected to hypoglycemia and the least long-term benefit from more rigid glycemic control.

Back 5

Elevated

Front 6

A specific and convenient method to detect glucosuria is

Back 6

The paper strip which is sensitive to as little as 0.1% glucose in urine.

Front 7

Qualitative detection of ketone bodies can be accomplished by

Back 7

Nitroprusside tests
remember they do not detect β-hydroxybutyric acid

Front 8

Hormonal tumors
drugs
liver disease
muscle disorders
adipose tissue disorders
insulin receptor disorders. What can all these cause?

Back 8

Hyperglycemia due to tissue insensitivity to insulin

Front 9

Pancreatic disorders
drugs
Hormonal tumors
(somatostatoma pheochromocytoma)
can all cause what?

Back 9

Hyperglycemia due to reduced insulin secretion

Front 10

Does intensive insulin therapy to prevent type 1 diabetes mellitus work?

Back 10

No
the trial failed

Front 11

How can type II diabetes be prevented?

Back 11

Exercise
balance size and frequency of meals

Front 12

The best persons to manage a disease that is affected so markedly by daily fluctuations in environmental stress
exercise
diet
and infections are

Back 12

The patients themselves and their families.

Front 13

what are the 3 Ocular Dz:
aka:
Ocular effects of DM:

Back 13

Cataracts
retinopathy
glaucoma

Front 14

Renal complications of DM include microalbuminuria and

Back 14

Progressive diabetic nephropathy

Front 15

Not a problem in and of itself
but a predictor of kidney disease and correlated with cardiovascular events

Back 15

Microalbuminuria

Front 16

What intervention
helped type 1 DM pts
achieve a lower risk of

retinopathy
&
microalbuminuria

significantly reduced risk of
cardiovascular disease events
by
42%

Back 16

Intensive insulin therapy
in type I DM

Tight Control

Front 17

Thus
it seems that the benefits of good glucose control persist even if

Back 17

Control deteriorates at a later date.

Front 18

Attempts have been made to prolong the "honeymoon period" aka partial clinical remission using drugs

Back 18

Immune intervention trials in new onset type I diabetes

Front 19

We should aggressively treat HTN
cholesterol
overweight
smoking and all other risk factors in diabetic patients.

Back 19

UK Prospective Diabetes study
and the
STENO 2 study

Front 20

What personal hygiene should be provided along with diet?

Back 20

Detailed instructions on foot care

Front 21

Sensory involvement
usually occurs first
and is
generally bilateral symmetric
&
associated with dulled perception of
vibration
pain
temperature.

pain can range from
mild discomfort
to
severe incapacitating symptoms

Back 21

Distal symmetric polyneuropathy

Front 22

Neuropathy along only one nerve root

Back 22

Isolated peripheral neuropathy

Front 23

Burning pain
particularly at night

Back 23

Painful diabetic neuropathy

Front 24

Postural hypotension
decreased cardiovascular response
to
Valsalva maneuver
gastroparesis
alternating bouts of diarrhea & constipation
(particularly nocturnal)
inability to empty the bladder
impotence.

Back 24

Autonomic neuropathy

Front 25

Three to five times more common in diabetic patients and is the leading cause of death in patients with type 2 diabetes.

Back 25

Myocardial infarction

Front 26

Atherosclerosis
in the large arteries
as well as
gangrene of the feet

Back 26

PVD

Peripheral vascular disease

Front 27

Chronic pyogenic skin infections

Eruptive xanthomas

Necrobiosis lipoidica diabeticorum
(unusual lesion over the anterior surface of the legs)
"Shin spots"

Candidal infections

Back 27

Skin complications in
DM Pts

Front 28

Lesions over the anterior surface of the legs
look like oval shaped plaques with glistening yellow surface.

Back 28

Necrobiosis lipoidica diabeticorum

Front 29

Keeping blood glucose values close to what value ?Mg/dl should be considered in the surgical and medical icus.

Back 29

100

Front 30

Tight glycemic control with normal hba1c levels is very important during pregnancy. Early in pregnancy
poor control increases the risk of

Back 30

Spontaneous abortion and congenital malformations.

Front 31

Polyhydramnios
preterm labor
stillbirth
&
fetal macrosomia
with its associated problems.

Back 31

Poor DM Control

Front 32

Can first develop during pregnancy

Back 32

Diabetic retinopathy

Front 33

Although there is evidence that glyburide is safe during pregnancy
the current practice is to control diabetes with

Back 33

Insulin therapy

Front 34

Every effort should be made
utilizing multiple injections of insulin or a continuous infusion of insulin by pump
to maintain

Back 34

Near-normalization of fasting and preprandial blood glucose values while avoiding hypoglycemia.

Front 35

Currently the preferred intermediate insulin for basal coverage during pregnancy.

Back 35

NPH