Diabetes Fundamentals
The ADA diagnostic threshold for diabetes using fasting plasma glucose.
What is ≥126 mg/dL
Despite severe total body depletion, this electrolyte is often normal or elevated on presentation.
What is potassium?
The biochemical endpoint indicating resolution of DKA, beyond normalization of glucose alone.
What is closure of the anion gap (resolution of ketoacidosis)?
This is the most dangerous complication of insulin therapy during DKA treatment.
What is hypokalemia?
The most common precipitating factor for DKA in hospitalized adults.
What is infection?
The pathophysiologic defect that primarily drives postprandial hyperglycemia in Type 2 diabetes.
What is insulin resistance?
In DKA, this ketone body predominates because the elevated NADH/NAD ratio shifts acetoacetate metabolism toward its production.
What is β-hydroxybutyrate?
Insulin therapy should generally not be started if serum potassium is below this value?
What is 3.3 mEq/L?
A DKA patient has pH 7.05, PCO₂ 18 mmHg, and HCO₃⁻ 5 mEq/L. The low PCO₂ represents this compensatory response.
What is respiratory compensation through hyperventilation (Kussmaul respirations)?
When transitioning from IV insulin to subcutaneous insulin, this should occur at least 1–2 hours before stopping the insulin infusion.
What is administration of long-acting (basal) insulin?
This autoimmune marker is most commonly associated with Type 1 diabetes
What is GAD-65 antibody?
An obese 38-year-old man of Afro-Caribbean ancestry presents with new-onset DKA. Six months later, his insulin requirements have resolved, C-peptide levels are preserved, and pancreatic autoantibodies are negative. He most likely has this form of diabetes.
What is Flatbush diabetes (ketosis-prone Type 2 diabetes)?
The recommended insulin infusion rate for most adults with DKA.
What is 0.1 units/kg/hour?
A patient with DKA has Na 132 mEq/L, Cl 95 mEq/L, and HCO₃⁻ 8 mEq/L. This calculated value best reflects the severity of ketoacid accumulation.
What is the anion gap of 29 mEq/L?
This class of medications is associated with cardiovascular and renal benefits in many patients with Type 2 diabetes.
What are SGLT2 inhibitors?
Like classic Type 1 DM, this type of DM occurs when the immune system attacks pancreatic beta cells, but it develops much more gradually and is typically diagnosed in adulthood?
What is Latent Type 1 Diabetes, commonly known as LADA (Latent Autoimmune Diabetes in Adults) or "Type 1.5"
A patient presents with 3-day history of epigastric pain with associated uncontrolled nausea and vomiting. Initial labs show glucose 420 mg/dL, bicarbonate 12 mEq/L, anion gap 24, and positive ketones. The pH is 7.40. The normal pH is best explained by this concurrent acid-base disorder.
What is metabolic alkalosis (e.g., from vomiting) masking the acidemia of DKA?
A patient with DKA has a glucose of 180 mg/dL but still has an elevated anion gap and positive ketones. This fluid should be added while continuing insulin therapy.
What is dextrose-containing IV fluid (e.g., D5½NS or D5NS)?
According to Winter's formula, expected PCO₂ equals 1.5(HCO₃⁻) + 8 ± this number.
What is 2?
A patient presents with glucose 900 mg/dL, serum osmolality 340 mOsm/kg, minimal ketones, and altered mental status. This diagnosis is more likely than DKA.
What is Hyperosmolar Hyperglycemic State (HHS)?
Diabetes remission is defined as sustaining normal blood glucose levels without ongoing glucose-lowering medications for what duration of time?
What is 3 months?
A patient taking canagliflozin develops severe ketosis with glucose of 180 mg/dL. This diagnosis should be suspected.
What is euglycemic DKA?
A patient with DKA is receiving an insulin infusion. Four hours later, the glucose has fallen from 700 mg/dL to 450 mg/dL. The anion gap remains elevated. According to guideline-recommended management, what is the desired rate of glucose decline?
What is 50–75 mg/dL per hour?
A more rapid decline increases the risk of cerebral edema, while a slower decline may indicate inadequate treatment or ongoing insulin resistance. Monitoring the rate of glucose fall helps guide adjustments to insulin and fluid therapy.
A DKA patient's anion gap closes, but bicarbonate remains 15 mEq/L after several liters of saline. This acid-base disturbance is likely present.
What is hyperchloremic non-anion gap metabolic acidosis?
A patient with DKA has a pH of 7.15, bicarbonate of 8 mEq/L, and a measured PCO₂ of 38 mmHg. Based on Winter's formula the expected PCO₂ 20-22 mmHg. What additional acid-base disorder is present?
What is a concomitant respiratory acidosis?