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Diabetes Practice Questions

Diabetes Practice Questions

1. The risk factors for type 1 diabetes include all of the following except: a. Diet b. Genetic c. Autoimmune d. Environmental 2. Type 2 diabetes accounts for approximately what percentage of all cases of diabetes in adults? a. 55%-60% b. 35%-40% c. 90-95% d. 25-30% 3. Risk factors for type 2 diabetes include all of the following except: a. Advanced age b. Obesity c. Smoking d. Physical inactivity 4. What percentage of women with gestational diabetes is diagnosed with type 2 diabetes following pregnancy? a. 25%-30% b. 5%-10% c. <5% d. 20%-25% 5. Untreated diabetes may result in all of the following except: a. Blindness b. Cardiovascular disease c. Kidney disease d. Tinnitus 6. Prediabetes is associated with all of the following except: a. Increased risk of developing type 2 diabetes b. Impaired glucose tolerance c. Increased risk of heart disease and stroke d. Increased risk of developing type 1 diabetes 7. Diabetics are at increased risk of heart disease if they also: a. Smoke b. Have high HDL cholesterol levels c. Take aspirin d. Consume a high-fiber diet 8. Blood sugar is well controlled when Hemoglobin A1C is: a. Below 7% b. Between 12%-15% c. Less than 180 mg/dL d. Between 90 and 130 mg/dL 9. Excessive thirst and volume of very dilute urine may be symptoms of: a. Urinary tract infection b. Diabetes insipidus c. Viral gastroenteritis d. Hypoglycemia 10. Among female children and adolescents, the first sign of type 1 diabetes may be: a. Rapid weight gain b. Constipation c. Genital candidiasis d. Insomnia 11. Untreated hyperglycemia may lead to all of the following complications except: a. Hyperosmolar syndrome b Vitiligo c. Diabetic ketoacidosis d. Coma 12. Hyperinsulinemia may be caused by all of the following except: a. An insulinoma b. Nesidioblastosis c. Insulin Continue reading >>

They Are Available As Monotherapy Or Combination Therapies, With The Latter Involving Two (or, Less Commonly, Three) Antidiabetic Drugs And/or

They Are Available As Monotherapy Or Combination Therapies, With The Latter Involving Two (or, Less Commonly, Three) Antidiabetic Drugs And/or

Antidiabetic drugs (with the exception of insulin) are all pharmacological agents that have been approved for hypoglycemic treatment in type 2 diabetes mellitus (DM). If lifestyle modifications (weight loss, dietary modification, and exercise) do not sufficiently reduce A1C levels (target level: ∼ 7%), pharmacological treatment with antidiabetic drugs should be initiated. These drugs may be classified according to their mechanism of action as insulinotropic or non-insulinotropic. They are available as monotherapy or combination therapies, with the latter involving two (or, less commonly, three) antidiabetic drugs and/or insulin. The exact treatment algorithms are reviewed in the treatment section of diabetes mellitus. The drug of choice for all type 2 diabetic patients is metformin. This drug has beneficial effects on glucose metabolism and promotes weight loss or at least weight stabilization. In addition, numerous studies have demonstrated that metformin can reduce mortality and the risk of complications. If metformin is contraindicated, not tolerated, or does not sufficiently control blood glucose levels, another class of antidiabetic drug may be administered. Most antidiabetic drugs are not recommended or should be used with caution in patients with moderate or severe renal failure or other significant comorbidities. Oral antidiabetic drugs are not recommended during pregnancy or breastfeeding. Continue reading >>

Differences Between Dawn Phenomenon Or Somogyi Effect

Differences Between Dawn Phenomenon Or Somogyi Effect

The dawn phenomenon and the Somogyi effect increase fasting (aka morning) blood glucose levels for people with diabetes, but for different reasons. Both occurrences have to do with hormones that tell the liver to release glucose into your blood stream while you sleep. The difference is why the hormones are released. Arandom elevated blood sugar could be a result of a variety of things: perhaps you ate too many carbohydrates the night before , you took less medicine than you're supposed to or you forgot to take it altogether . But,if you've noticed a pattern of elevated blood sugars in the morning, it could be a result of the dawn phenomenon or the Somogyi effect. Find out what causes this hormonal hyperglycemia and how you can prevent and can treat it. The dawn phenomenon is caused by a surge of hormones that the body puts out in the early morning hours. According to the American Diabetes Association, "everyone has the dawn phenomenon if they have diabetes or not. People with diabetes don't have normal insulin responses to adjust for it and that is why their blood sugars go up." This happens because: During the evening hours the body is making less insulin. Hormones trigger the liver to put out more glucose. Lack of insulin results in a blood sugar rise in the a.m. The Somogyi effect (or rebound hyperglycemia)results in morning high blood sugar ( hyperglycemia ) as a result very low bloodsugar (hypoglycemia) during the night. It's a very rare phenomenon and most often occurs in people with Type 1 diabetes. It occurs: More commonly in people who take night-time insulin , as a result of taking too much; Or if you are required to eat a snack before bed to keep your blood sugars stable and you skip it. The abundance of insulin in the blood and lack of glucose, causes the b Continue reading >>

Diabetes Mellitus - Endocrine - Medbullets Step 2/3

Diabetes Mellitus - Endocrine - Medbullets Step 2/3

(M2.EC.4754) A 63-year-old male presents to the emergency department complaining of worsening nausea. He reports that the nausea began several months ago and is accompanied by occasional bloating and heartburn. He reports that he frequently feels full even after eating only a little at each meal, and occasionally he will vomit if he eats too much. The vomit is non-bloody and contains bits of undigested food. A review of systems is notable for occasional headaches, tingling in his distal extremities, and constipation. His medical history is significant for Parkinsons disease diagnosed 3 years ago, hypertension diagnosed 8 years ago, and type II diabetes mellitus diagnosed 10 years ago. The patient reports that he was given prescriptions for both his blood pressure and diabetes medications, but he has not taken either for months because one of them was causing erectile dysfunction. He reports he regularly takes his levodopa. An endoscopy is performed, which rules out cancer. In addition to restarting medications for his hypertension and diabetes, what of the following is most appropriate treatment for the patients symptoms? Review Topic Continue reading >>

Diabetic Gastroparesis

Diabetic Gastroparesis

Gastroparesisis defined by objective delaying of gastric emptying without any evidence ofmechanical obstruction. Diabetic gastroparesis is a potential complication that occurs in the setting of poorly controlled diabetes,resulting from dysfunctionin the coordination and function of the autonomic nervous system, neurons and specialized pacemaker cells (interstitial cells of Cajal, ICC) of the stomach and intestine, and the smooth muscle cells of the gastrointestinal tract. Hyperglycemia (blood glucose greater than 200 mg/dL), commonly seen in the setting of poorly controlled diabetes, has been associated with diabetic gastroparesis that occurs as a result of neuropathy in the setting of chronic hyperglycemia and does not resolve with improved glycemic control. Acute hyperglycemia, on the other hand, though it can also result in delayed gastric emptying, is often reversible with improved glycemic control. Gastric emptying requires coordination of fundal tone and antral phasic contraction with simultaneous inhibition of pyloric and duodenal contractions. This coordination also requires interactions between the enteric and autonomic nervous systems, smooth muscle cells, and the specialized pacemaker cells (ICC) of the stomach. The gastric motor dysfunction that is encountered in the setting of diabetes may occuras a result of autonomic neuropathy (both sympathetic and parasympathetic), enteric neuropathy (both excitatory and inhibitory neurons), ICC abnormalities (intrinsic neuropathy), acute blood glucose fluctuations, use of incretin-based medications, or psychosomatic factors. As a result, most diabetic patients tend tohave dysfunction at multiple points in the process of gastric emptying.This includes abnormal postprandial proximal gastric accommodation and contraction Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

There are two types of diabetes that occur in pregnancy: Gestational diabetes. This term refers to a mother who does not have diabetes before becoming pregnantbut develops a resistance to insulin because of the hormones of pregnancy. Pregestational diabetes. This term describes women who already have insulin-dependent diabetes and become pregnant. With both types of diabetes, there can be complications for the baby. It is very important to keep tight control of blood sugar during pregnancy. The placenta supplies a growing fetus with nutrients and water. It alsoproduces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can block insulin. This usually begins about 20 to 24 weeks into the pregnancy. As the placenta grows, more of these hormones are produced, and insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results. Pregnancy also may change the insulin needs of a woman with preexisting diabetes. Insulin-dependent mothers may require more insulin as pregnancy progresses. Who is affected by diabetes in pregnancy? About 5 percent of all pregnant women in the U.S. are diagnosed with gestational diabetes. Gestational diabetics make up the vast majority of pregnancies with diabetes. Some pregnant women require insulin to treat their diabetes. The mother's excess amounts of blood glucose are transferred to the fetus during pregnancy. This causes the baby's body to secrete increased amounts of insulin, which results in increased tissue and fat deposits. The infant of a diabetic mother is often larger than expec Continue reading >>

Somogyi Effect Vs. Dawn Phenomenon: The Difference Explained

Somogyi Effect Vs. Dawn Phenomenon: The Difference Explained

For people who have diabetes , the Somogyi effect and the dawn phenomenon both cause higher blood sugar levels in the morning. The dawn phenomenon happens naturally, but the Somogyi effect usually happens because of problems with your diabetes management routine. Your body uses a form of sugar called glucose as its main source of energy. A hormone called insulin , which your pancreas makes, helps your body move glucose from your bloodstream to your cells. While you sleep , your body doesnt need as much energy. But when youre about to wake up, it gets ready to burn more fuel. It tells your liver to start releasing more glucose into your blood . That should trigger your body to release more insulin to handle more blood sugar . If you have diabetes, your body doesnt make enough insulin to do that. That leaves too much sugar in your blood, a problem called hyperglycemia . High blood sugar can cause serious health problems, so if you have diabetes, youll need help to bring those levels down. Diet and exercise help, and so can medications like insulin. If you have diabetes, your body doesnt release more insulin to match the early-morning rise in blood sugar. Its called the dawn phenomenon, since it usually happens between 3 a.m. and 8 a.m. The dawn phenomenon happens to nearly everyone with diabetes. But there are a few ways to prevent it, including: Dont eat carbohydrates before you go to bed. Take insulin before bedtime instead of earlier in the evening. Ask your doctor about adjusting your dose of insulin or other diabetes medicines. Continue reading >>

Steroid Diabetes

Steroid Diabetes

Steroid diabetes (also "steroid-induced diabetes") is a medical term referring to prolonged hyperglycemia due to glucocorticoid therapy for another medical condition. It is usually, but not always, a transient condition. Medical conditions[edit] The most common glucocorticoids which cause steroid diabetes are prednisolone and dexamethasone given systemically in "pharmacologic doses" for days or weeks. Typical medical conditions in which steroid diabetes arises during high-dose glucocorticoid treatment include severe asthma, organ transplantation, cystic fibrosis, inflammatory bowel disease, and induction chemotherapy for leukemia or other cancers. Insulin[edit] Glucocorticoids oppose insulin action and stimulate gluconeogenesis, especially in the liver, resulting in a net increase in hepatic glucose output. Most people can produce enough extra insulin to compensate for this effect and maintain normal glucose levels, but those who cannot develop steroid diabetes. Criteria[edit] The diagnostic criteria for steroid diabetes are those of diabetes (fasting glucoses persistently above 125 mg/dl (7 mM) or random levels above 200 mg/dl (11 mM)) occurring in the context of high-dose glucocorticoid therapy. Insulin levels are usually detectable, and sometimes elevated, but inadequate to control the glucose. In extreme cases the hyperglycemia may be severe enough to cause nonketotic hyperosmolar coma. Treatment[edit] Treatment depends on the severity of the hyperglycemia and the estimated duration of the steroid treatment. Mild hyperglycemia in an immunocompetent patient may not require treatment if the steroids will be discontinued in a week or two. Moderate hyperglycemia carries an increased risk of infection, especially fungal, and especially in people with other risk factors s Continue reading >>

Diabetic Foot Ulcers

Diabetic Foot Ulcers

Ulceration in diabetic foot due to lack of protective sensation Epidemiology incidence approximately 12% of diabetics have foot ulcers most common medical complication causing diabetics to get medical treatment foot ulcers are responsible for ~85% of lower extremity amputations risk factors factors associated with decreased healing potential uncontrolled hyperglycemia inability to offload the affected area poor circulation infection poor nutrition factors associated with increased healing potential serum albumin > 3.0 g/dL total lymphocyte count > 1,500/mm3 Pathophysiology neuropathy has largest effect on diabetic foot pathology sensory dysfunction leads to lack of protective sensation and is primary risk factor for ulcer development autonomic dysfunction leads to drying of skin due to lack of normal glandular function net effect is increased mechanical and axial stress on skin that is more prone to injury due to drying angiopathy lesser effect than neuropathy >60% of diabetic ulcers have decreased blood flow due to peripheral vascular disease Associated conditions infection / osteomyelitis high rates of associated osteomyelitis if bone is able to be probed, or is exposed at the base of the ulcer organisms usually polymicrobial gram-positive most common pathogens are aerobic gram positive cocci (s. aureus) gram-negative increased gram-negative organisms are found in chronic wounds and wounds recently treated with antibiotics anaerobes obligate anaerobic pathogens with ischemia or gangrene deep cultures and bacterial biopsies help guide management Prognosis diabetic foot ulceration is considered the most likely predictor of eventual lower extremity amputation in patients with diabetes mellitus Classification Wagner Classification and Treatment Description Treatment Grade Continue reading >>

Diabetes Drugs - Endocrine - Medbullets Step 1

Diabetes Drugs - Endocrine - Medbullets Step 1

Metformin is absolutely contraindicated in patients with renal failure due to the risk of lactic acidosis. An elevated serum creatinine suggests a decrease in GFR and the presence of renal failure. Metformin is a drug in the biguanide class used to treat diabetes mellitus type II. Metformin treats hyperglycemia by inhibiting gluconeogenesis. Metformin carries no risk of hypoglycemia, but is known to occasionally cause lactic acidosis in patients with renal failure, liver dysfunction, CHF, alcoholism, and sepsis. Vecchio et al. reviews metformin-induced lactic acidosis. They report that metformin is overall a safe drug when correctly used but is associated with lactic acidosis in rare cases. The most common condition in which this condition occurs is with renal insufficiency. Recent evidence has called into question the significance of the risk of lactic acidosis while using metformin. According to an April 2012 Cochrane review by Salpeter et al., there is no evidence from comparative trials or from observational cohort studies that metformin is associated with an increased risk of lactic acidosis when compared to other anti-hyperglycemic treatments. Illustration A depicts the actions of metformin on the liver, adipose tissue, muscle and pancreas. Answers 1-4: Hyperkalemia, hypernatremia, metabolic alkalosis, and hyperglycemia do not affect the physiology of metformin and are not a contraindication to its use. Continue reading >>

Hyperosmolar Hyperglycemic State (hhs)

Hyperosmolar Hyperglycemic State (hhs)

By Erika F. Brutsaert, MD, Assistant Professor, Albert Einstein College of Medicine; Attending Physician, Montefiore Medical Center Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus (DM) characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 DM, often in the setting of physiologic stress. HHS is diagnosed by severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis. Treatment is IV saline solution and insulin. Complications include coma, seizures, and death. Hyperosmolar hyperglycemic state (HHSpreviously referred to as hyperglycemic hyperosmolar nonketotic coma [HHNK] and nonketotic hyperosmolar syndrome) is a complication of type 2 diabetes mellitus and has an estimated mortality rate of up to20%, which is significantly higher than the mortality for diabetic ketoacidosis (currently < 1%). It usually develops after a period of symptomatic hyperglycemia in which fluid intake is inadequate to prevent extreme dehydration due to the hyperglycemia-induced osmotic diuresis. Acute infections and other medical conditions Drugs that impair glucose tolerance (glucocorticoids) or increase fluid loss (diuretics) Serum ketones are not present because the amounts of insulin present in most patients with type 2 DM are adequate to suppress ketogenesis. Because symptoms of acidosis are not present, most patients endure a significantly longer period of osmotic dehydration before presentation, and thus plasma glucose (> 600 mg/dL [> 33.3 mmol/L]) and osmolality (> 320 mOsm/L) are typically much higher than in diabetic ketoacidosis (DKA). The primary symptom of HHS is altered consciousness varying from confusion or disorientation to coma, usually as Continue reading >>

Diabetes Mellitus In Pregnancy

Diabetes Mellitus In Pregnancy

(Gestational Diabetes; Pregestational Diabetes) By Lara A. Friel, MD, PhD, Associate Professor, Maternal-Fetal Medicine Division, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Medical School at Houston, McGovern Medical School Pregnancy aggravates preexisting type 1 ( insulin-dependent) and type 2 (non insulin-dependent) diabetes but does not appear to exacerbate diabetic retinopathy, nephropathy, or neuropathy ( 1 ). Gestational diabetes (diabetes that begins during pregnancy [ 2 ]) can develop in overweight, hyperinsulinemic, insulin-resistant women or in thin, relatively insulin-deficient women. Gestational diabetes occurs in at least 5% of all pregnancies, but the rate may be much higher in certain groups (eg, Mexican Americans, American Indians, Asians, Indians, Pacific Islanders). Women with gestational diabetes are at increased risk of type 2 diabetes in the future. Diabetes during pregnancy increases fetal and maternal morbidity and mortality. Neonates are at risk of respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, and hyperviscosity. Poor control of preexisting (pregestational) or gestational diabetes during organogenesis (up to about 10 wk gestation) increases risk of the following: Poor control of diabetes later in pregnancy increases risk of the following: Fetal macrosomia (usually defined as fetal weight > 4000 g or > 4500 g at birth) However, gestational diabetes can result in fetal macrosomia even if blood glucose is kept nearly normal. Guidelines for managing diabetes mellitus during pregnancy are available from the American College of Obstetricians and Gynecologists (ACOG [ 1 , 2 ]). 1. Committee on Practice BulletinsObstetrics : ACOG Practice Bulletin No. 60: Clinical man Continue reading >>

Somogyi Effect: Causes And Prevention

Somogyi Effect: Causes And Prevention

The Somogyi effect, also known as the rebound effect, occurs in people with diabetes. Hypoglycemia or low blood glucose in the late evening causes a rebound effect in the body, leading to hyperglycemia or high blood glucose in the early morning. This phenomenon, known as the Somogyi effect, is widely reported but remains controversial due to a lack of scientific evidence. It is reported more by people with type 1 diabetes than by people with type 2 diabetes. Contents of this article: What is the Somogyi effect? Named after Michael Somogyi, a Hungarian-born researcher who first described it, the Somogyi effect is the body's defensive response to prolonged periods of low blood sugar. A dose of insulin before bed that is too high can be a cause. When insulin reduces the amount of glucose in the blood by too much, it causes hypoglycemia. In turn, hypoglycemia makes the body stressed, triggering the release of the stress hormones epinephrine (adrenaline), cortisol, and growth hormone. The endocrine hormone glucagon is also released. Glucagon triggers the liver to convert stores of glycogen into glucose, which can send blood glucose levels into a rebound high. The stress hormones keep the blood glucose levels raised by making the cells less responsive to insulin. This is known as insulin resistance. Controversy The Somogyi effect is widely cited among doctors and people with diabetes, but there is little scientific evidence for the theory. For example, one small study found that hyperglycemia upon waking is likely to be caused by not enough insulin before bed. Researchers also found that participants who appeared to have rebound hyperglycemia did not have higher levels of growth hormone, cortisol, or glucagon than others. A 2007 study of 88 people with type 1 diabetes using c Continue reading >>

Treatment Of Type 2 Diabetes Mellitus In The Elderly

Treatment Of Type 2 Diabetes Mellitus In The Elderly

Go to: Abstract The prevalence of type 2 diabetes is expected to increase gradually with the prolongation of population aging and life expectancy. In addition to macrovascular and microvascular complications of elderly patients of diabetes mellitus, geriatric syndromes such as cognitive impairment, depression, urinary incontinence, falling and polypharmacy are also accompanied by aging. Individual functional status in the elderly shows heterogeneity so that in these patients, there are many unanswered questions about the management of diabetes treatment. The goals of diabetes treatment in elderly patients include hyperglycemia and risk factors, as in younger patients. comorbid diseases and functional limitations of individuals should be taken into consideration when setting treatment targets. Thus, treatment should be individualized. In the treatment of diabetes in vulnerable elderly patients, hypoglycemia, hypotension, and drug interactions due to multiple drug use should be avoided. Since it also affects the ability to self-care in these patients, management of other concurrent medical conditions is also important. Keywords: Diabetes mellitus, Oral antidiabetic drugs, Insulin, Elderly Core tip: Diabetes mellitus (DM) is one of the most common lifelong chronic diseases in the world and its ratio is increasing by aging population. Elderly patients with type 2 DM have an increased risk for coronary heart disease, stroke and vascular diseases. While determining the treatment target and treatment options in elderly individuals, the functional capacity of the individual, comorbid diseases and treatment compliance should be evaluated together. Go to: INTRODUCTION The prevalence of type 2 diabetes is expected to increase gradually with the prolongation of population aging and Continue reading >>

Sliding Scale Therapy

Sliding Scale Therapy

Sliding scale therapy approximates daily insulin requirements. The term "sliding scale" refers to the progressive increase in pre-meal or nighttime insulin doses. The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements. Common sliding scale regimens: Long-acting insulin (glargine/detemir or NPH), once or twice a day with short acting insulin (aspart, glulisine, lispro, Regular) before meals and at bedtime Long-acting insulin (glargine/detemir or NPH), given once a day Regular and NPH, given twice a day Pre-mixed, or short-acting insulin analogs or Regular and NPH, given twice a day The general principles of sliding scale therapy are: The amount of carbohydrate to be eaten at each meal is pre-set. The basal (background) insulin dose doesn’t change. You take the same long-acting insulin dose no matter what the blood glucose level. The bolus insulin is based on the blood sugar level before the meal or at bedtime Pre-mixed insulin doses are based on the blood sugar level before the meal The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. You still need to count carbohydrates. Sliding scales are less effective in covering a pre-meal high blood sugar, because the high blood glucose correction and food bolus cannot be split. Points To Remember! Sliding scale regimens may include a bedtime high blood sugar correction. As the nighttime scale only considers the amount of insulin required to drop your blood sugar level back into the target range, it should not be used to cover a bedtime snack. When using a sliding scale, eat the same amount of carbohydrat Continue reading >>

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