Diabeetus
DKA vs HHS
Chronic complications
Hypoglycemia
Survivor
100
The diagnostic criteria for Diabetes (4)
What is:
1. A1c >6.4
2. Hyperglycemic symptoms/crisis AND BS >200
3. Fasting glucose >125
4. 2-hour OGTT >200
100
Inciting factors for DKA (6)
What is infection, MI, nonadherence, stress, trauma, medications?
100
This chronic complication of DM bears the highest associated morbidity and mortality
ASCVD (HTN, HLD, smoking, FHx, albuminuria)
100
These are the common symptoms of hypoglycemia (name 5)
Sweating, tremors, anxiety, tachycardia, AMS, dysarthria, obtundation, seizures, death
100
This 27 yo survived having his right arm pinned by a boulder in Canyonlands National Park. He lived for five days on packed food and water. He then amputated his trapped arm with a pocket multi-tool and began a 7 mile hike back to his truck (was found in route)
Who is Aron Ralston?
200
Screening criteria for Diabetes
Adults with BMI >25 (>23 Asian ancestry) with risk factor:
-1st degree relative with diabetes, High risk ethnicity (black, latino, asian, native), CVD, inactivty, HTN, HLD, PCOS
-Test at 35 yo in all pts
200
Typical patients for DKA vs HHS
DKA- DM1 <65 yo, or DM2 under stress
HHS- DM2 >65 yo
200
These treatments prevent to progression of diabetes associated dementia/cognitive decline
Reduce episodes of hypoglycemia
So not too much, oof
200
Treatment of acute hypoglycemia
Without AMS- 15 g fast carbs, wait 15 mins and recheck, repeat
With AMS- IV 25 g of D50, No IV glucagon and/or glucose gel
200
This 1912 Antarctic explorer lost his friend and colleague Belgrave Ninnis into a crevasse along with most of the teams supplies and dogs. Over 30 days he and his companion (Xavier Mertz who died in route) made their way back to base camp missing the retrieval ship by hours.
Sir Douglas Mawson (on the Australian $100 bill)
300
1 kg of weight loss reduces risk of progression of diabetes
What is 16% over 3.2 years
300
DAILY MEME!
300
These medication categories are recommended to slow to progression of diabetic kidney disease
ACE/ARB (+HTN, GFR <60)
SGLT2 (+CKD, GFR >20)
GLP-1
300
DAILY MEME!
300
In 1994 this 39 yo long-distance runner was competing in the "Marathon of the Sands" in Morocco (Sahara desert), a six-day race. A sandstorm drove him off course. He slits his wrists in despair, but the wounds clotted in the dry air of the desert. He survived for 9 days subsisting on insects and reptiles he could catch. He drank his own urine, licked dew off rocks, and sucked the moisture from his wet wipes (not sponsored)
Mauro Prosperi (later returned and completed the marathon)
400
These DM2 medication classes have the potential to cause weight gain (3)
What is pioglitazone, sulfonylureas, and insulin?
400
Key infusions for DKA and HHS
Insulin, IV Fluids with D5 added, K, sometimes bicarb
400
The American Academy of Neurology approves these categories of medications to treat diabetic neuropathy
Gabapentinoids (gabapentin, pregabalin, duloxetine), SNRI, TCA, Na channel blockers (valproic acid, oxcarbazepine, lamotrigin, lacosamide)
FDA only approved pregabalin, duloxetine, capsaicin
400
Laboratory testing for postprandial hypoglycemia
Baseline- BG, c-peptide, serum insulin, plasma proinsulin
Then BG every 30 mins for 5 hours (oof, long day)
400
In 2012-13 this Salvadoran fisherman survived 13 months (438 days) at sea. Embarking on a 30-hour tour with Ezequiel Cordoba a storm struck driving them off course. The weather disable the ships radio and damaged the engine. They survived on raw fish, turtles, and jellyfish; drinking collected rainwater and turtle blood. Cordoba died from illness and he survived 9 additional months eventually reaching the Marshall Islands, a journey of 5500-6700 miles.
Jose Salvador Alvarenga
500
These categories of medications can cause hyperglycemia
Glucocorticoids, immunosuppressants (calcineurin inhibitors), Chemotherapy, antiretrovirals, B-blockers, Thiazides, vasopressors, OCP, Antipsychotics, ABx (moxifloxacin, gatifloxacin)
500
These are the key laboratory differences between DKA and HHS (5)
Glucose higher in HHS, Acidic pH in DKA, elevated Beta in DKA, Gap in DKA, Elevated Osm in HHS
500
These are the fundal findings in non-proliferative vs proliferative retinopathy
Non-proliferative (in the retina)- Dot hemorrhages, yellow exudates
Proliferative (vitreous or retinal inner surface)- ruptured microaneurysms, drusen
500
Causes of hypoglycemia in non-diabetics (Name 5/10)
Medications, EtOH, illness, organ dysfunction (kidney or liver), hormonal deficiencies (adrenal insufficiency), malnutrition, insulinoma, endogenous hyperinsulinemic hypoglycemia, post–gastric bypass hypoglycemia (nesidioblastosis), insulin autoimmune hypoglycemia
500
In 2006 this 35 yo Australian was drugged by hitchhikers in the outback and woke up in a shallow grave wrapped in plastic wrap with dingoes scratching at him. He survived 71 days in the outback building a basic shelter to protect him from wildlife and surviving off frogs, leeches, snakes, and his own urine. He was eventually discovered by cattle ranchers having lost 100 lbs.
Ricky Megee