Diabetes Definitions
Diabetes Medications
Glucose Treatment Targets
Other Treatment Targets
Adrenal Cases
100
A1C ≥6.5% OR Fasting plasma glucose (FPG) ≥126 mg/dL (7.0 mmol/L) OR A random plasma glucose ≥200 mg/dL (11.1 mmol/L), in patients with classic symptoms
What are 3 of the 4 diagnostic criteria for diabetes? What is the 4th? Which one of the 4 does NOT require a confirmatory test?
100
$90 vs. $150/vial
What is the cost of NPH and Regular compared to Analog insulins, Lantus or Levemir? How many units of insulin are in one vial? How many units fit in an insulin syringe?
100
A1C and pre/post prandial targets for excellent diabetes control
What are: A1C < 7% FBG < 70-130 PPP < 180
100
< 140/80
What is the blood pressure treatment target in diabetes? What is/are the first line agents recommended?
100
36 yo F weight gain (18 lbs in 3 months),BMI 36, fatigue, oligomenorrhea, IGT
What is Cushings syndrome? What else is in the differential?
200
Fasting plasma glucose (FPG) of 100–125 mg/dL (5.6–6.9 mmol/L); OR Hemoglobin A1C 5-7-6.4%
What are 2 of the 3 diagnostic criteria for "increased risk for diabetes (pre-diabetes)? What is the third? What are normal fasting and post-prandial blood sugars?
200
1.0% drop in A1C
What is the maximum A1C reduction achievable with a single oral agent?
200
154, 183, 212, and 240 mg/dl%
What are the mean plasma glucoses corresponding to A1C levels of 7, 8, 9, and 10%?
200
LDL < 100, HDL > 50, TG < 150 without treatment
When is it ok to check lipids every 2 years rather than yearly?
200
42 yo M HTN, hypokalemia; plasma aldosterone:renin ratio 32; saline infusion test shows plasma aldosterone 18, PRA <0.6; MRI adrenals slightly prominent. The next step is...
What is selective adrenal vein sampling?
300
Under age 45 and BMI > or = to 35, plus 2 or more RFs: FH 1st degree relative PCOS, acanthosis HDL < 35 or TG > 250 Physical inactivity HTN Pre-diabetes GDM or big baby High risk ethnicity hx of CAD OR >45 yrs plus BMI > or = to 35
What are the risk factors that should lead one to consider screening for DM2? If the screen is negative, when/how often should it be repeated?
300
There is a gradual decline in beta cell function (decreased insulin production) over years; coupled with increasing insulin resistance.
What is the reason that more medication is gradually needed the longer the duration of DM2?
300
Study of outpatient management which compared A1C target of <6% vs 7-7.9% for impact on CV outcome (Achieved median A1Cs were 6.4% and 7.5%)
What is ACCORD? What were the enrollment criteria (a1C, age, comorbidities)? What were the key findings of the study? What were achieved A1C targets in DCCT and UKPDS?
300
Known CAD OR No CAD, but >40 yrs, plus 1 or more risk factors AND MAYBE < 40 yrs with LDL > 100 or multiple risk factors
What are criteria for statin therapy in diabetes? What is LDL target if no CAD plus 1 or more risk factors?
300
45 yo F malaise, fatigue, weight gain. On levothyroxine with recent normal TSH; K 5.5+, free T4 1.4, calcium 10.4, skin darkening in axillae and in scars.
What is Addison's? What are the clues in this case? What is the first diagnostic test needed?
400
Pancreatic beta cell autoimmune distruction (anti-GAD, anti-islet, anti-insulin, anti IA2 anti IA2-beta antibodies)
What is the only diagnostic finding or event never seen in Type 2 diabetes but necessary in Type 1? Which antibody is most prevalent?
400
Metformin, orlistat, acarbose, and pioglitazone.
What medications have been shown to delay onset of DM2 by up to 3 years? What are the trade names of these meds and their mechanisms?
400
Study of inpatient diabetes management in critically ill patients which compared glycemic target of 81-108 mg/dl vs. 144-180 mg/dl
What is NICE-SUGAR? What were the study findings? Is there a study comparing a target of 140-180 to 180-220?
400
A primary prevention strategy in those without CVD but with >10% 10-yr risk of CVD
What is aspirin therapy? 5 major risk factors include: FH, dyslipidemia, HTN, smoking, and ....?
400
52 yo M hypotensive following ankle surgery. History of occasional dizziness, fatigue, erectile dysfunction. BP and P low, decreased body hair Na+132, K+ 4.3
What is secondary adrenal insufficiency? What diagnostic tests should be done?
500
Mutations in glucokinase or hepatocyte nuclear factor (HNF1-alph)
What are 2 of the 6 identified mutations that cause MODY?
500
2-4 hrs vs 45-90 minutes
When do Regular vs. Analog insulins (Lispro/Aspart/Glulisine) peak? What are the trade names of these insulins? When do NPH and Glargine peak?
500
Clinical trial which achieved and sustained 8.6% weight reduction, 0.3% A1C reduction, and reduced CV risk factors but was stopped due to no impact on primary CVD outcome at 11 years
What is the Look AHEAD study?
500
This common condition is 2X more likely in diabetes, is an independent risk factor for CAD, and adversely impacts glycemic control, but is treated in only 1/3 of affected persons
What is depression?
500
36 yo F weight gain, 22 lbs in 18 months and fatigue, IGT, violaceous striae, central obesity, 24 hr urine cortisol 3x ul normal. Imaging 3 cm right adrenal mass; tumor removed; patient hypotensive post-op
What is adrenal suppression due to autonomously functioning tumor? What are the clinical clues that distinguish this type of Cushings from pituitary Cushings?
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