Sugar Busters
Which class of medication has shown to reduce the progression of chronic kidney disease in Type 2 diabetics?
What is SGLT2 inhibitors.
SGLT2 inhibitors are recommended for people with stage 3 or higher chronic kidney disease (CKD) and type 2 diabetes, as they slow CKD progression, reduce cardiovascular events, and reduce heart failure risk independent of glucose management.
Side-effects: B12 deficiency, may predispose to DKA, increases fractures, risk of foot amputation, increased UTI's and genital infections.
How many weeks after levothyroxine dosage change should you recheck TSH?
What is 5-6 weeks.
"steady state"
Low TSH, High T4, with radioactive thyroid uptake scan showing diffuse uptake...what is the diagnosis?
Irregular menses, galactorrhea, prolactin 310. What is the next step in workup?
What is a MRI of brain.
Prolactin >200 almost always a prolactinoma (<25 normal)
What is the average insulin dosing in units/kg/day?
What is 0.6-0.8 units/kg/day
*half for basal needs and half with meals
(ex. 40-50 units for a 70 kg man)
The USPTF recommends that all nonpregnant adults between the age of ____ to ____ and are overweight and obese be screened for diabetes and prediabetes.
What is 35 to 70.
***early screening indicated for patients with FHx of diabetes, GDM, PCOS, and groups with higher rates of diabetes (i.e. Native Americans, Asian Americans, Hispanic/Latino, Black, or Native Hawiian)
Name 2 potential consequences of over-treating hypothyroidism.
What is the treatment of choice for Grave's Disease?
What is radioactive iodine.
Symptomatic management: methimazole, PTU, Beta-blockers
Central obesity, Ecchymoses, Plethora, Proximal weakness, Osteopenia/osteoporosis, Hypertension, Purple Striae...Diagnosis?
What is Cushing's Syndrome.
What 3 immunizations are particularly important in diabetics?
What is influenza, pneumococcal, and hep B
What lab should be checked prior to starting someone on metformin?
What is creatinine/GFR
Stop if GFR < 30
Do not start if GFR < 40
What is the initial dosing of levothyroxine in adults < 60 years of age with primary hypothyroidism?
What is 1.6 mcg per kg per day.
1.0-1.25 mcg per kg per day in patients over the age of 60.
What is the initial workup for thyroid nodules?
What is TSH...US.
Low TSH/US + I-123 Scan = cold nodule -- FNA
Low TSH/US +I-123 Scan = hot nodule -- endocrine/surgery
Normal/High TSH/US -- FNA
Name four laboratory tests that can be used to determine the source of hypercortisolemia.
Name 3 rapid acting insulins.
What are lispro (humalog), aspart, glulisine.
Onset 15 min, peak 1-3 hours, duration 2-5 hours
What is GLP-1.
Side-effects: nausea, vomiting, diarrhea, weight loss, pancreatitis, thyroid c-cell tumor risk
Treat subclinical hypothyroidism if TSH is greater than ____, attempting conception, or positive thyroid peroxidase antibody.
What is 10.
What "score" can be used to help diagnosis a thyroid storm?
What is the Burch-Wartofsky score.
Thermoregulatory dysfunction, Centeral Nervous System Effects, Gastrointestinal-Hepatic Dysfunction, Cardiovascular dysfunction, CHF, Precipitant Hx.
Hyperpigmentation, Low blood pressure, Weight loss, Nausea/Vomiting, Muscle Cramps, Irregular menses,Salt craving, Malaise/fatigue...Diagnosis?
What is Addison's Disease.
Name 4 long-acting insulins.
What are NPH, glargine, detemir, degludec.
NPH: 16-24 hours (2/3 in AM and 1/3 in PM)
Glargine (lantus, basalgar, toujeo): 24 hours (best approach for geriatric patients in long-term care facilities...predictable control)
Detemir (levemir): 24 hours (less weight gain)
Degludec (tresiba): 42 hours (fewer hypoglycemic events)
What diabetes medication can improve cerebrovascular outcomes?
What is pioglitazone (actos).
Precautions: cardiopulmonary disorders (black box for CHF), hepatic dysfunction, osteoporosis, category C in pregnancy.
Women already of levothyroxine should increase dose by ___ to ___ % during pregnancy.
What is 25-50%.
Goal TSH in pregnancy < 3.0
Name 5 causes of hyperthyroidism.
What is Grave's disease, Functional thyroid nodules (adenoma vs multinodular goiter), Thyroiditis (Hashimoto, postpartum), Ingestion (amiodarone, iodine), Metastatic Thyroid Cancer, Hyperemesis Gravidarum.
What 5 labs should be routinely monitored in a patient with secondary hyperparathyroidism due to CKD?
Insulin dosing in DKA?