In which type of diabetes (1 or 2) does the body become insulin resistant?
Type 2
What is diabetes?
a. disorder of insulin
b. term for disease that has excessive urination
c. disease caused by increased weight
d. A and B
B (diabetes is just the general term)
Individuals with acute stress, pancreatitis, cushing's disease, and diabetes mellitus will likely have: hyperglycemia or hypoglycemia
hyperglycemia
diabetes mellitus is a chronic or acute disroder
chronic
about how much of the US poplation had diabetes mellitus in 2014
a. 5%
b. 7%
c. 8%
d. 9%
e. 10%
D (9.3% of the population, with 35% at prediabetes)
Normal range of adult serum glucose?
70-100 (mg/dL)
If an individual has a blood glucose of 110 from a fasting glucose test they are in which range:
a. normal
b. prediabetes
c. diabetes mellitus
d. panic values
B (101-125 fasting aka impaired fasting glucose)
If an individual has a blood glucose of 185 2 hours after eating they have
a. normal values
b. impaired glucose tolerance
c. diabetes melitus
d. prediabetes
e. B and D
E (140-199 2 hrs after eating indicates pre-diabetes this is impaired glucose tolerance)
A blood glucose of 130 fasting indicates
a. concern but need more testing
b. diabetes mellitus
c. diabetes mellitus only if also has blood glucose of 200 after GTT
d. pre diabetes
A (need to have fasting glucose >126 on more than 2 occasions for DM diagnosis)
Blood glucose greater than or equal to _____ at 2 hrs post GTT is diagnostic for DM?
200 (mg/dL)
Hemoglobin A1C greater than or equal to _____% ,on more than 2 occasions is diagnostic for DM?
6.5%
How long do you have to fast before a fasting blood glucose test?
8 hours
Modern home glucose monitoring uses _______ , lab's use ______
a. plasma; whole blood
b. plasma; plasma
c. whole blood; whole blood
d. whole blood; plasma
D (newer home glucose monitoring will calculate so you still get plasma values though)
When monitoring glucose using whole blood, your results will be ________(lower, higher, or equal to) results using plasma
Lower (by about 12%)
Panic values for blood glucose are less than ________mg/dL or greater than __________ mg/dL
40; 400
To administer a glucose tolerance test pt. must _____ for 8-12 hours prior
fast
A GTT is done by administering ______g of oral glucose
75
How long after oral glucose administration does one check the blood glucose for a GTT?
2 hours
Each 1% increase in Hbg A1C corresponds to a ______% increase in blood sugar
30
Hgb A1C gives you an indication of:
a. fasting blood glucose
b. blood glucose over average on last month
c. average blood glucose levels over prior 2-3 weeks
d. average blood glucose levels over prior 2-3 months
D (b/c lifespan of RBC is 120 days)
If patient has A1C of 7% and fasting blood glucose of 210, you should next:
a. wait 2 months to repeat A1C
b. wait 2 weeks to repeat fasting blood glucose
c. perform a GTT
d. no more testing, this is diagnostic
D (A1C plus a blood sugar diagnostic test is diagnostic of diabetes)
Why is converting A1C percentage to blood glucose correlation helpful to the patient?
it allows them to understand their average over time
Your diabetic pt. presents to the office with a 4% A1C, within the normal range, this is:
a. good b/c decreased risk of vascular complications
b. good b/c blood sugar is successfully low over long time
c. bad because may have been too much transient hypog
C (a diabetic's 4% is dangerous b/c they may be depriving themselves to achieve low blood glucose at risk of transient hypoglycemia)
Insulin levels are helpful for:
a. diagnosing diabetes
b. monitoring blood glucose levels
c. monitoring insulin treatment
d. differentiating between type I and type II diabetes
D (also for evaluating Insulin Resistance and Insulin secreting tumor)
Why might insulin levels be hard to measure at urgent care?
Have to pack it on ice
You have a young patient who is obese and has parents with Type II diabetes, you will likely want to test:
a. blood glucose
b. Hgb A1C
c. Insulin levels
D. A and B
E. all of the above
E (especially with young patients they might look like a type II but a insulin test will indicate if it's actually Type I)
when is C-peptide level useful? to identify patients with _______
severe insulin deficiency
In a pt. with recently onset diabetes mellitus will C-peptide be elevated or decreased?
elevated (as pancreas tries to compensate, then as pancreas gets tired will decrease insulin production)
When might you use a tyrosine phosphatase or insulin autoantibody test?
to differentiate Type 1 vs Type 2
Type I diabetes can be an _________ disease, where the _____________________ in the pancreas are destroyed
autoimmune
islets of langerhan
Diabetic ketoacidosis occurs because the body needs fuel, which it would normally get from _______
glucose
hyperglycemia in the context of diabetes leads to ketoacidosis because what organ becomes impaired d/t osmotic diuresis?
Kidneys (renal function is impaired b/c body is trying to get rid of glucose, so gets rid of too much water and impairs kidneys)
Diabetic ketoacidosis is best monitored with non-invasive repeated urine ketone analysis. T/F
false (as ketoacids are decreasing it will look like increasing b/c the break down products are increasing)
Nitroprusside reaction tests for:
a. acetone
b. Beta-hydoxybuterate
c. acetoacetate
d. A and C
D (Beta-hydroxybuterate NOT detected)
As ketones are cleared acetone and acetoacetate levels increase or decrease?
Increase (but still improving!)