Term
| characterized by absolute insulin deficiency |
|
Definition
|
|
Term
| what is also completely deficient in a pt with type 1 diabetes? |
|
Definition
|
|
Term
| characterized as a relative insulin deficiency |
|
Definition
|
|
Term
| in which DM are genetic factors stronger? |
|
Definition
|
|
Term
| what are the components of dysmetabolic syndrome? |
|
Definition
insulin resistance
hyperinsulinemia
obesity
hypertension
dyslipidemia |
|
|
Term
| any degree of glucose intolerance in which onset occurs during pregnancy |
|
Definition
|
|
Term
| why are insulin requirements increased during pregnancy? |
|
Definition
presence of insulin antagonists
promotion of lipolysis
decreased glucose use
production of insulinase by the placenta |
|
|
Term
| what cells in the pancreas secrete insulin? |
|
Definition
|
|
Term
| what causes insulin resistance? |
|
Definition
structure and function of insulin receptor
Type A insulin resistance
Leprechaunism |
|
|
Term
| what are incretin hormones? |
|
Definition
play a significant role in glucose tolerance, they are synthesized and secreted by specialized gut cells. Glucagonlike peptide-1 (GLP-1)
Glucose dependent insulinotropic polypeptide (GIP) |
|
|
Term
| what s DPP-4, how is it involved in metabolism? |
|
Definition
| DDP inactivates the incretin hormones GLP-1 and GIP. Newer diabetes meds seek to inhibit DDP-4 thus allowing the incretin hormones to do their job. |
|
|
Term
| when is reclassification performed for gestational diabetes? |
|
Definition
|
|
Term
| how does GDM affect lifetime risk? |
|
Definition
| lifetime risk of IGT and DM is increased substantially |
|
|
Term
| leading cause of end stage renal disease |
|
Definition
|
|
Term
| leading cause of preventable blindness |
|
Definition
|
|
Term
| DM increases the risk for what? (3) |
|
Definition
| stroke, neuropathy, gangrene |
|
|
Term
| what are GDM consequences for the baby? |
|
Definition
| increased risk for DM 2 and obesity |
|
|
Term
|
Definition
| polyuria, polydipsia, polyphagia |
|
|
Term
| after presentation with ketoacidosis (DM1), the pt may briefly revert to normoglycemia without requiring therapy, what is this called? |
|
Definition
|
|
Term
| this condition is characterized by severe dehydration secondary to osmotic diuresis from hyperglycemia? and is associated with what? |
|
Definition
| hyperosmolar nonketotic coma associated with DM2 |
|
|
Term
| antecendent hx in a DM pt might include? (4) |
|
Definition
frequent or recurrent infections
poor wound healing
blurring of vision
numbness or tingling sensations in the extremities |
|
|
Term
| the categories of impaired glucose tolerance and impaired fasting glucose are together termed |
|
Definition
|
|
Term
| what are Kussmaul respirations? |
|
Definition
| rapid deep breathing seen in DM pts trying to breathe off the excess acid |
|
|
Term
| common eye findings in DM pts (4) |
|
Definition
pupillary abnormalities
cataract
refractory errors
retinopathy |
|
|
Term
| what skin condition is associated with Type A insulin resistance? |
|
Definition
| acanthosis nigricans = hyperpigmentation and skin thickening of flexural areas |
|
|
Term
|
Definition
| index of hyperglycemia thoughout the 6-8 weeks that precede measurement |
|
|
Term
| HbA1C measurements for diabetes and pre-diabetes |
|
Definition
diabetes = > 6.5%
prediabetes = 5.7 - 6.4% |
|
|
Term
| why is HbA1C important to measure? |
|
Definition
| it is highly specific as evidence of chronic hyperglycemia and is a predictor of chronic complications |
|
|
Term
| ADA criteria for normal glucose homeostasis |
|
Definition
fasting glucose < 100
2 hr OGTT < 140 mg/dL after a 75-g oral glucose load |
|
|
Term
| ADA diagnostic criteria for impaired fasting glucose |
|
Definition
| fasting glucose of 100-126mg/dL |
|
|
Term
| ADA diagnostic criteria for impaired glucose tolerance |
|
Definition
| 2 hr OGTT of 140-200mg/dL |
|
|
Term
| ADA diagnostic criteria for DM |
|
Definition
fasting plasma glucose of 126mg/dL or higher
random plasma glucose of 200mg/dL or greater on 2 occasions
classic sxs plus a 2 hr OGTT of 200mg/dL or higher |
|
|
Term
| when should screening for DM2 be considered? at what intervals? |
|
Definition
| 3 year intervals for all individuals older than 45 years |
|
|
Term
| when is early screening fo DM2 recommended? |
|
Definition
pts who are overweight (BMI > 25)
habitual physical inactivity
first degree relative with DM
high risk ethnic background
delivery of a LGA baby (> 9 lb)
HTN, 140/90 or greater
HDL < 35
triglycerides > 250
PCOS
clinical conditions with insulin resistance - severe obesity, acanthosis nigricans
hx of CV disease |
|
|
Term
| what might be present in the urine of a pt with diabetic nephropathy? |
|
Definition
|
|
Term
| what is a marker of early renal impairment and endothelial dysfunction? |
|
Definition
|
|
Term
| what type of acidosis is common in DM? |
|
Definition
|
|
Term
| ketoacidosis can cause what on CBC? |
|
Definition
|
|
Term
| major goal in the mangement of glucose intolerance |
|
Definition
|
|
Term
| what TLC can be made in DM pts? |
|
Definition
diet
exercise
counseling for smoking cessation and alcohol use
reversal of drug-related causes |
|
|
Term
| all pts with DM 1 are treated with what? |
|
Definition
|
|
Term
| what is contraindicated in GDM? |
|
Definition
| oral agents, it must be treated with insulin |
|
|
Term
| when should pharmacologic therapy be considered with impaired glucose tolerance? |
|
Definition
failure of lifestyle mods and
fasting glucose > 126 mg/dL or
OGTT > 160mg/dL or
HbA1C > 7% |
|
|
Term
| oral antidiabetic med that stimulates insulin release |
|
Definition
| secretagogues - sulfylureas, meglitinides |
|
|
Term
| oral antidiabetic meds that reduce insulin resistance |
|
Definition
| insulin sensitizers - biguanides, thiazolidinediones |
|
|
Term
| oral antidiabetic meds that slow the digestive/absorptive process |
|
Definition
| alpha glucosidase inhibitors |
|
|
Term
| oral antidiabetic med that inhibits the enzymes that inactivate incretin hormones GLP-1 and GIP |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| microvascular changes associated with DM |
|
Definition
retinal changes
renal changes
neuropathic changes |
|
|
Term
| what are the macrovascular changes associated with DM? |
|
Definition
| coronary and peripheral vascular changes |
|
|
Term
| when does the "clock start ticking" for microvascular changes? |
|
Definition
|
|
Term
| when does the "clock start ticking" for macrovascular changes |
|
Definition
| some antecedent point, presumably with the onset of insulin resistance |
|
|
Term
|
Definition
|
|
Term
| what is the BP goal in diabetics with > 1g/day proteinuria and renal insufficiency |
|
Definition
|
|
Term
| acceptable inital therapy for HTN in the presence of DM |
|
Definition
| ACEI, ARB, diuretics, BB, CCB are all considered acceptable |
|
|
Term
| what is the preference for tx of HTN in the presence of DM? |
|
Definition
| ACEI or ARB because they are renally protective |
|
|
Term
| what class of insulin has the most rapid onset? |
|
Definition
|
|
Term
| what insulins are usually administered together? |
|
Definition
|
|
Term
| what are the rapid acting insulins? |
|
Definition
regular insulin
lispro
aspart insulin |
|
|
Term
| what are intermediate acting insulins? |
|
Definition
|
|
Term
| what are the long acting insulins? |
|
Definition
|
|
Term
|
Definition
| synthetic analogue of human amylin which slows gastric emptying, suppresses postprandial glucagon secretion, and regulates food intake owing to centrally mediated appetite modulation. |
|
|
Term
| normal tendency of blood glucose to rise in the early morning before breakfast is termed |
|
Definition
dawn phenomenon
may be due to nocturnal spike in GH causing insulin resistance. Probably enhanced by incrased hepatic gluconeogenesis secondary to the diurnal increase in serum cortisol. |
|
|
Term
| nocturnal hypoglycemia that is followed by a marked increase in fasting plasma glucose with an increase in plasma ketones |
|
Definition
|
|
Term
| characterized by rebuond hyperglycemia from nocturnal hypoglycemia |
|
Definition
|
|
Term
|
Definition
slurred speech
blurred/double vision
light headedness
dizziness
confusion
shakiness
sweating
headache |
|
|
Term
|
Definition
60-90 calories PO q 15 min until glucose > 100mg/dL OR
glucagon 1mg IM OR
25mL 50% dextrose q 5-10 min until pt awakens, then 5% dextrose IV until glucose > 100mg/dL |
|
|
Term
|
Definition
first 24-48 hrs = ICU
goal = correction of fluid loss
correctino of hyperglycemia w/insulin
correction of electrolyte disturbances (particularly potassium loss)
correction of acid-bas balance
tx of concurrent infection if present |
|
|
Term
|
Definition
| serum osmolality of > 320 mOsm/kg plasma glucose > 600 mg/dL profound dehydration (~9L) pH of 7.3 HCO3 > 15 mEq/L absence of severe ketosis |
|
|
Term
|
Definition
rapid and aggressive IV volume replacement is always indicated as the first line therapy
insulin therapy results in circulatory collapse if fluid has not been replaced first! |
|
|
Term
| main goals in the tx of HNS |
|
Definition
vigorously rehydrate
correct hyperglycemia
tx underlying disease
monitor and assist CV, pulmonary, renal, and CNS function |
|
|
Term
| initial presentation of MEN1 |
|
Definition
| cutaneous lesions --> cutaneous tumors (multiple angiofibroma, collagenomas, lipomas) |
|
|
Term
| aside from skin lesions, what is another common first presentation of MEN1 |
|
Definition
|
|
Term
| MEN 1 may be accompanied by hypersecretion of what hormones? |
|
Definition
hyperparathyroidism - hypercalcemia and recurrent nephrolithiasis
hypergastrinemia - ZES syndrome
hyperinsulinemia - hypoglycemia
hyperprolcatinemia - amenorrhea
excess growth hormone - acromegaly |
|
|
Term
|
Definition
nephrocalcinosis
osteoperosis
ZES |
|
|
Term
|
Definition
| surgery to remove the tumor |
|
|
Term
| who is MEN2a (Sipple's syndrome) more common in? |
|
Definition
|
|
Term
|
Definition
medullary thyroid cancer
pheochromocytoma
hyperparathyroidism |
|
|
Term
|
Definition
|
|
Term
| how should MEN2 be dx? when? |
|
Definition
RET mutation testing before age 5.
if positive - prophylactic thyroidectomy wiht lymph node dissection is recommended |
|
|
Term
|
Definition
medullary thyroid cancer
pheochromocytoma
associated abnormalities include:
mucosal neuromas (bigger lips)
ganglioneuromas (GI tract -> constipation or diarrhea)
Marfanoid habitus |
|
|
Term
|
Definition
|
|
Term
| person's with Grave's disease are at increased risk of what other disorders? (5) |
|
Definition
Addison's disease
Alopecia areata
celiac disease
cardiomyopathy
hypokalemic periodic paralysis |
|
|
Term
| heat intolerance, sweating, weight loss, increased appetite, nervousness, loose stools, frequent urination, muscle cramps, irritability, fatigue, weakness, dyspnea on exertion, mesntrual abnormalities |
|
Definition
|
|
Term
| abrupt onset of more florid sxs of thyrotoxicosis |
|
Definition
|
|
Term
| goiter, exopthalmos, pretibial myxedema |
|
Definition
|
|
Term
| triggers of thyroid storm (3) |
|
Definition
stressful illness
thyroid surgery
radioactive iodine administration |
|
|
Term
| what is the most sensitive indicator of thyroid disease? |
|
Definition
|
|
Term
| TSH findings in primary hyperthyroidism |
|
Definition
|
|
Term
| antibodies associated with Grave's disease |
|
Definition
TSH receptor antibody
antithyroglobulin
antithyroperoxidase
ANA
anti-double stranded DNA |
|
|
Term
|
Definition
BB to control sxs
thiourea drugs (methimazole or PTU) |
|
|
Term
| DOC for hyperthyroidism in pregnancy or breast feeding |
|
Definition
|
|
Term
| is atrial fibrillation likely to convert electrically when a pt has hyperthyroidism? |
|
Definition
No, digoxin may be used in large doses and BB with caution.
anticoagulation with warfarin is used to prevent thromboembolism |
|
|
Term
|
Definition
| administration of BB and hydrocortisone, supportive therapy, and attempts to control hyperthyrodism iwth a thiourea drug followed by iodine |
|
|
Term
| hypothyroidism is almost always from 1 or what 3 conditions? |
|
Definition
autoimmune thyroiditis
previous thyroid surgery
radiation therapy |
|
|
Term
| TSH levels in primary hypothyroidism |
|
Definition
|
|
Term
| what confirms the presence of autoimmune thyroiditis? |
|
Definition
| presence of anti-TPO and antithyroglobulin antibodies |
|
|
Term
| MC thyroid disorder in the US |
|
Definition
|
|
Term
| Hashimoto's is often associated with what? |
|
Definition
| other autoimmune disorders |
|
|
Term
| postpartum thyroiditis manifests when? and lasts how long? |
|
Definition
| 1-6 months after delivery and lasts 1-2 months |
|
|
Term
| how is subacute thyroiditis tx? |
|
Definition
|
|
Term
| MC form of thyroid cancer |
|
Definition
|
|
Term
| most aggressive thyroid cancer |
|
Definition
|
|
Term
| what is a sign specific to anaplastic thyroid carcinoma |
|
Definition
| recurrent laryngeal nerve palsy (hoarseness) |
|
|
Term
| in regards to thyroid cancer and radionuclide scanning, what is the saying? |
|
Definition
"if it's hot it's not"
hot nodules are usually benign |
|
|
Term
| what is often elveated in metastatic papillary and follicular thyroid cancer? |
|
Definition
|
|
Term
| when is hypoparathyroidism MC found? |
|
Definition
|
|
Term
| hypothyroidism plus congenital facies and cardiac anomalies |
|
Definition
|
|
Term
| tetany, carpopedal spasm, cramping, convulsions, circumoral and distal extremity tingling, and irritability |
|
Definition
|
|
Term
| facial muscle contraction after tapping the facial nerve |
|
Definition
| Chvostek's sign - hypoparathyroidism |
|
|
Term
| carpal spasm with blood pressure cuff inflation |
|
Definition
| Trousseau's sign - hypoparathyroidism |
|
|
Term
| tx of acute hypoparathyroidism |
|
Definition
airway management and administration of IV calcium gluconate. Maintenance = oral calcium and vitamin D
Magnesium supplement may be required |
|
|
Term
| what meds should be avoided with acute hypoparathyroidism? |
|
Definition
| phenothiazines and furosemide |
|
|
Term
| MC cause of hyperparathyrodism |
|
Definition
|
|
Term
| common location of cystic bone lesions in hyperparathyroidism? |
|
Definition
|
|
Term
| bones, stones, abdominal groans, psychic moans, with fatigue overtones |
|
Definition
|
|
Term
| hallmark lab finding of hyperparathyroidism |
|
Definition
| hypercalcemia (> 10.5 mg/dL) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| chronic adrenal insufficiency |
|
|
Term
|
Definition
| autoimmune destructino of the adrenal cortex |
|
|
Term
| cause of secondary adrenocortical insufficiency |
|
Definition
|
|
Term
| Called "bronze diabetes" due to the skin hyperpigmentation that is associated |
|
Definition
|
|
Term
| tx of primary adrenocortical insufficiency |
|
Definition
oral hydrocortisone or prednisone
DHEA may be given to women with adrenal insufficiency |
|
|
Term
|
Definition
aggressive IV saline
glucose
glucocorticoids
tx of the underlying cause |
|
|
Term
|
Definition
|
|
Term
| Cushing's disease vs. Cushing's syndrome? |
|
Definition
syndrome = exogenous (use of corticosterods)
disease = endogenous (excess secretion of ACTH by the pituitary) |
|
|
Term
| centripetal obesity, buffalo hump, moon facies, supraclavicular fat pads, pigmneted striae |
|
Definition
|
|
Term
| diagnostic lab criteria for Cushing's |
|
Definition
free cortisol in the urine > 125mg/dL in 24 hrs
> 95 mcg of cortisol/gram of creatinine |
|
|
Term
| test used to diagnose Cushing's |
|
Definition
| dexamethasone suppression test |
|
|
Term
| what can cause false positives on a dexamethasone suppression test? |
|
Definition
| rifampin, phenytoin, primidone, phenobarbital, carbamazepine, fenofibrate, estrogens, and pregnancy |
|
|
Term
| preferred method to ID pituitary tumors |
|
Definition
|
|
Term
|
Definition
|
|
Term
| difference between acromegaly and gigantism |
|
Definition
both are caused by excessive GH
gigantism = before epiphyseal closure
acromegaly = after epiphyseal closure |
|
|
Term
| doughy, moist hand shake, macroglossia, deep/coarse voice, goiter, HTN, cardiomegaly, wt gain, arthralgias, hyperhydrosis |
|
Definition
|
|
Term
| MC nonlethal type of dwarfism |
|
Definition
|
|
Term
| short limbs, long and narrow trunks, large heads with midface hypoplasia, prominent brows, normal intelligence |
|
Definition
|
|
Term
| phenotype of constitutional growth delay |
|
Definition
| small but otherwise normal appearance |
|
|
Term
| caused by a deficiency or resistance for vasopressin (antidiuretic hormone) |
|
Definition
|
|
Term
|
Definition
| vasopressin challenge test |
|
|
Term
|
Definition
central = not enough ADH secretion
peripheral = ADH resistance |
|
|
Term
| tx of choice for central DI |
|
Definition
|
|
Term
|
Definition
| may respond to indomethacin either alone or in combo with HCTZ, desmopressin, or ameloride |
|
|
Term
| drugs that can induce osteomalacia |
|
Definition
| phenytoin, carbamazepine, valproate, and barbituates |
|
|
Term
| Milkman lines or Looser zones (pseudofractures) are diagnostic of |
|
Definition
|
|
Term
| common sites of involvement for Paget's disease (6) |
|
Definition
| spine, pelvis, femur, humerus, tibia, skull |
|
|
Term
|
Definition
| cyclic administration of bisphosphonates |
|
|
