What is the current recommendation for diabetes mellitus screening?
How is diabetes defined?
What is the oral glucose tolerance test threshold for diabetes?
Diabetes is diagnosed when glucose levels reach or exceed 200 mg/dL within 2 hours of a 75-g oral glucose dose.
What are the classic differences between type 1 and type 2 diabetes?
What is the most important risk factor for developing type 2 diabetes?
Genetic predisposition is the most important risk factor, along with age, obesity, and physical activity.
What are the goals of treatment for glucose levels in diabetes?
What is a good measure of long-term diabetes control?
HbA1c measures average blood glucose over 2 to 3 months; recommended level is <7%.
How to distinguish between factitious disorder and an insulinoma in hypoglycemia?
Measure C-peptide level; high in insulinoma, low in factitious disorder.
What should you remember before giving IV iodinated contrast to diabetic patients?
Diabetic patients and those with renal insufficiency are prone to acute renal failure.
What is the risk of using IV iodinated contrast agents?
Carefully weigh the risk-to-benefit ratio. Hydrate the patient with IV fluids to avoid renal shutdown.
What can decrease the risk of contrast nephropathy?
Acetylcysteine and bicarbonate may decrease the risk in high-risk patients.
What should be done for patients on metformin before using IV contrast?
Hold metformin before the procedure and for 48 hours after.
What is diabetic ketoacidosis (DKA)?
A life-threatening condition in type I diabetics characterized by hyperglycemia, acidosis, and ketones.
What are the clinical signs of DKA?
Kussmaul breathing, dehydration, hyperglycemia, acidosis, fruity breath odor.
How is DKA treated?
IV fluids, insulin, electrolyte replacement (especially potassium and phosphate).
What should NOT be used to correct acidosis in DKA?
Do not use bicarbonate to correct acidosis.
What is nonketotic hyperglycemic hyperosmolar state?
A condition in type II diabetics with hyperglycemia and increased serum osmolarity without ketones.
What is the initial treatment for nonketotic hyperglycemic hyperosmolar state?
IV hydration with normal saline, followed by insulin and electrolyte replacement.
What are the classic symptoms of new-onset diabetes?
Polyuria, polydipsia, polyphagia, candidal infections, weight loss, blurry vision.
What is a common long-term complication of diabetes mellitus?
Atherosclerosis, retinopathy, nephropathy, peripheral vascular disease, peripheral neuropathy, increased infection risk.
What does diabetes lead to in terms of retinopathy?
Leading cause of blindness in the U.S. for persons age <50 years.
What is the leading cause of end-stage renal disease?
Diabetes is the number one cause, accounting for roughly 30% of cases.
What does peripheral vascular disease in diabetics lead to?
Limb amputation, claudication, strokes, impotence.
What does peripheral neuropathy cause in diabetics?
Silent heart attacks, numbness in the feet, and other findings.
How does hyperglycemia affect infection risk?
White blood cells do not function well in a hyperglycemic environment.
What is the risk of infection in a hyperglycemic environment?
White blood cells do not function well, leading to increased risk of infection.
How can complications from diabetes be managed?
Good glucose control can delay or prevent complications.
What is gastroparesis?
Stomach does not empty well, causing early satiety and vomiting; treat with motility enhancers like metoclopramide.
What are Charcot joints?
Deformed joints in the foot and ankle due to lack of sensation; patients may break bones without feeling it.
What causes impotence in diabetic patients?
Neuropathy and atherosclerosis are the causes.
What are cranial nerve palsies?
Diplopia and extraocular muscle paralysis, usually resolving within 8 weeks without treatment.
What is orthostatic hypotension?
Occurs when arteries do not constrict upon standing; heart rate fails to increase appropriately.
What causes pressure ulcers in diabetic patients?
Lack of sensation leads to overuse or failure to rest injured feet.
What is the treatment for proliferative diabetic retinopathy?
Panretinal laser photocoagulation to prevent progression to blindness.
What is the purpose of focal laser photocoagulation?
Used for nonproliferative retinopathy if symptoms are present from macular edema.
What is the onset of action for insulin aspart?
Onset is less than 0.25 hours.
What is the peak action time for insulin lispro?
Peak is 0.5 to 2.5 hours.
What is the duration of action for insulin glulisine?
Duration is 3 to 4 hours.
What is the duration of regular insulin?
Duration is 5 to 8 hours.
What is the peak time for NPH insulin?
Peak is 4 to 12 hours.
What is the onset of action for insulin glargine?
Onset is 1.5 to 4 hours.
How should NPH insulin be adjusted for high glucose at 7 am?
Increase NPH insulin at dinner the night before.
What is the Somogyi effect?
Body's reaction to hypoglycemia caused by excess NPH insulin at dinnertime.
What is the dawn phenomenon?
Natural increase in blood glucose in the early morning due to hormonal changes.
What happens if too much NPH insulin is given at dinnertime?
How do you treat hypoglycemia caused by too much NPH insulin?
Decrease evening (NPH) insulin
What is the dawn phenomenon?
How do you treat the dawn phenomenon?
Increase evening (NPH) insulin
What insulin dose is given to diabetic patients scheduled for surgery?
One-third to one-half of the normal insulin dose
How is glucose managed during surgery for diabetic patients?
What effect do beta-blockers have on diabetics?
Mask classic symptoms of hypoglycemia (tachycardia, diaphoresis)
When are beta-blockers beneficial for diabetics?
If the patient had a previous myocardial infarction
What is the best oral agent for type 1 diabetes?
None; insulin is required
What is the first treatment for type 2 diabetes?
Weight loss to reduce insulin resistance
What are the first medications tried for type 2 diabetes?
Oral agents, typically starting with metformin
What are some oral agents for type 2 diabetes?
What are the risks of thiazolidinediones?
When might type 2 diabetics require insulin?
If blood glucose or HbA1c levels are significantly elevated
What do current guidelines suggest for insulin use in type 2 diabetes?
Use basal insulin early in therapy after starting one or two oral agents
What is the current recommendation for diabetes mellitus screening?
How is diabetes defined?
What is the oral glucose tolerance test threshold for diabetes?
Diabetes is diagnosed when glucose levels reach or exceed 200 mg/dL within 2 hours of a 75-g oral glucose dose.
What are the classic differences between type 1 and type 2 diabetes?
What is the most important risk factor for developing type 2 diabetes?
Genetic predisposition is the most important risk factor, along with age, obesity, and physical activity.
What are the goals of treatment for glucose levels in diabetes?
What is a good measure of long-term diabetes control?
HbA1c measures average blood glucose over 2 to 3 months; recommended level is <7%.
How to distinguish between factitious disorder and an insulinoma in hypoglycemia?
Measure C-peptide level; high in insulinoma, low in factitious disorder.
What should you remember before giving IV iodinated contrast to diabetic patients?
Diabetic patients and those with renal insufficiency are prone to acute renal failure.
What is the risk of using IV iodinated contrast agents?
Carefully weigh the risk-to-benefit ratio. Hydrate the patient with IV fluids to avoid renal shutdown.
What can decrease the risk of contrast nephropathy?
Acetylcysteine and bicarbonate may decrease the risk in high-risk patients.
What should be done for patients on metformin before using IV contrast?
Hold metformin before the procedure and for 48 hours after.
What is diabetic ketoacidosis (DKA)?
A life-threatening condition in type I diabetics characterized by hyperglycemia, acidosis, and ketones.
What are the clinical signs of DKA?
Kussmaul breathing, dehydration, hyperglycemia, acidosis, fruity breath odor.
How is DKA treated?
IV fluids, insulin, electrolyte replacement (especially potassium and phosphate).
What is nonketotic hyperglycemic hyperosmolar state?
A condition in type II diabetics with hyperglycemia and increased serum osmolarity without ketones.
What is the initial treatment for nonketotic hyperglycemic hyperosmolar state?
IV hydration with normal saline, followed by insulin and electrolyte replacement.
What are the classic symptoms of new-onset diabetes?
Polyuria, polydipsia, polyphagia, candidal infections, weight loss, blurry vision.
What is a common long-term complication of diabetes mellitus?
Atherosclerosis, retinopathy, nephropathy, peripheral vascular disease, peripheral neuropathy, increased infection risk.
What does diabetes lead to in terms of retinopathy?
Leading cause of blindness in the U.S. for persons age <50 years.
What is the leading cause of end-stage renal disease?
Diabetes is the number one cause, accounting for roughly 30% of cases.
What does peripheral vascular disease in diabetics lead to?
Limb amputation, claudication, strokes, impotence.
What does peripheral neuropathy cause in diabetics?
Silent heart attacks, numbness in the feet, and other findings.
How does hyperglycemia affect infection risk?
White blood cells do not function well in a hyperglycemic environment.
What is the risk of infection in a hyperglycemic environment?
White blood cells do not function well, leading to increased risk of infection.
How can complications from diabetes be managed?
Good glucose control can delay or prevent complications.
What is gastroparesis?
Stomach does not empty well, causing early satiety and vomiting; treat with motility enhancers like metoclopramide.
What are Charcot joints?
Deformed joints in the foot and ankle due to lack of sensation; patients may break bones without feeling it.
What are cranial nerve palsies?
Diplopia and extraocular muscle paralysis, usually resolving within 8 weeks without treatment.
What is orthostatic hypotension?
Occurs when arteries do not constrict upon standing; heart rate fails to increase appropriately.
What causes pressure ulcers in diabetic patients?
Lack of sensation leads to overuse or failure to rest injured feet.
What is the treatment for proliferative diabetic retinopathy?
Panretinal laser photocoagulation to prevent progression to blindness.
What is the purpose of focal laser photocoagulation?
Used for nonproliferative retinopathy if symptoms are present from macular edema.
How should NPH insulin be adjusted for high glucose at 7 am?
Increase NPH insulin at dinner the night before.
What is the Somogyi effect?
Body's reaction to hypoglycemia caused by excess NPH insulin at dinnertime.
What is the dawn phenomenon?
Natural increase in blood glucose in the early morning due to hormonal changes.
What happens if too much NPH insulin is given at dinnertime?
What is the dawn phenomenon?
What insulin dose is given to diabetic patients scheduled for surgery?
One-third to one-half of the normal insulin dose
How is glucose managed during surgery for diabetic patients?
What effect do beta-blockers have on diabetics?
Mask classic symptoms of hypoglycemia (tachycardia, diaphoresis)
When are beta-blockers beneficial for diabetics?
If the patient had a previous myocardial infarction
What are the first medications tried for type 2 diabetes?
Oral agents, typically starting with metformin
What are some oral agents for type 2 diabetes?
What are the risks of thiazolidinediones?
When might type 2 diabetics require insulin?
If blood glucose or HbA1c levels are significantly elevated
What do current guidelines suggest for insulin use in type 2 diabetes?
Use basal insulin early in therapy after starting one or two oral agents
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