Diabetes Patho- Endocrine Exam Quiz

The correct answer is A and B. This is because type I diabetes results in little if any insulin secretion, so the patient will require insulin perioperatively. Additionally, the stress of hospitalization and surgery is likely to raise her glucose levels, further necessitating the need for insulin.

The patient's high glucose level (805) and the fact that she has not been eating or drinking much for 2 weeks suggest that she has hyperosmolar hyperglycemic state (HHS). HHS is a serious condition characterized by extremely high blood glucose levels and severe dehydration. The patient will require significant fluid resuscitation to correct the dehydration and stabilize her condition. Therefore, both options A and B are correct.

Insulin resistance is a condition where the body's cells become less responsive to insulin, leading to elevated blood sugar levels. In Type II diabetes, insulin resistance commonly occurs in skeletal muscle, adipose tissue, and the liver. However, the brain is not typically considered a site of insulin resistance in Type II diabetes. Insulin plays a crucial role in regulating glucose uptake in skeletal muscle, adipose tissue, and the liver, but its role in the brain is more related to appetite regulation and cognitive function.

Hypertension (HTN) is the most important factor for the development of End-Stage Renal Disease (ESRD) with diabetes. Uncontrolled high blood pressure can damage the blood vessels in the kidneys, leading to kidney damage and eventually ESRD. Diabetes already puts the kidneys at risk, and when combined with HTN, the risk is further increased. Therefore, managing and controlling hypertension is crucial in preventing the development and progression of ESRD in patients with diabetes.

Glucagon, epinephrine, growth hormone, and cortisol all contribute to an increase in blood glucose levels. Glucagon stimulates the liver to release glucose into the bloodstream, while epinephrine stimulates the breakdown of glycogen into glucose. Growth hormone and cortisol also promote glucose production by the liver. Lactic acid and ketones, on the other hand, do not directly increase blood glucose levels. Lactic acid is produced during anaerobic exercise and ketones are produced during periods of fasting or when the body is breaking down fat for energy.

Dyslipidemia is the greatest contributing factor for the development of atherosclerosis secondary to diabetes. Diabetes is known to cause abnormal lipid metabolism, leading to elevated levels of LDL cholesterol and triglycerides, and decreased levels of HDL cholesterol. These lipid abnormalities contribute to the formation of atherosclerotic plaques in the arteries, increasing the risk of cardiovascular complications. HTN (hypertension) and ESRD (end-stage renal disease) are also common complications of diabetes, but they are not the primary factors responsible for the development of atherosclerosis in this case.

The correct answer is A & B. This is because sensory deficits in peripheral neuropathy do progress as "stocking glove," meaning that they start in the feet and progress up the legs and hands. Additionally, sensory deficits in peripheral neuropathy tend to overshadow motor deficits, meaning that the loss of sensation is more prominent than any loss of motor function.

Diabetic Autonomic Neuropathy (DAN) is a complication of diabetes that affects the autonomic nervous system. This can lead to various complications, including gastroparesis (delayed stomach emptying) and impaired baroreceptor function. Gastroparesis can cause symptoms such as nausea, vomiting, and bloating, while impaired baroreceptor function can result in abnormal regulation of blood pressure. Therefore, both options A and B are correct as they describe risks related to DAN.

A positive result for an ICA (Islet Cell Antibody) would be expected in a Type I diabetic patient. Type I diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. Islet Cell Antibodies are autoantibodies that target the islet cells of the pancreas. Therefore, it is likely that a Type I diabetic patient would have a positive result for an ICA test.

The patient is a well-controlled diabetic with hypertension and is taking NSAID for neuropathic pain, Metoprolol, and Glipizide. The peroperative medication instructions state to take Metoprolol as usual and to not take Glipizide for at least 24 hours pre-op. The correct answer, A & B, means that both instructions A and B should be followed. Therefore, the patient should continue taking Metoprolol as usual and should not take Glipizide for at least 24 hours before the surgery.

In a patient with diabetic ketoacidosis (DKA), there is a deficiency of insulin leading to high blood glucose levels. This causes the body to break down fat for energy, resulting in the production of ketones. DKA is a medical emergency that requires prompt treatment. The correct answer is "Ensure Na+ levels do not rise as hyperglycemia is being corrected" because in DKA, there is typically a deficit of total body sodium due to osmotic diuresis. Therefore, it is important to monitor and correct any electrolyte imbalances, including sodium, during the treatment of DKA.

Type II diabetes has a slow progression and there are often abnormalities years before diagnosis. This means that the patient may have had diabetes for a long time before it was actually diagnosed. In this case, the patient's high glucose level of 155 mg d/L suggests that he may have diabetes. However, it does not necessarily mean that his surgery needs to be cancelled. The decision to cancel surgery would depend on various factors and would be made by the healthcare provider in consultation with the patient.

When formulating a plan of care for a patient with diabetes, it is important to consider various factors. Difficult intubation may be a concern for patients with diabetes, as they may have coexisting conditions that can affect airway management. Increased gastric content is another consideration, as patients with diabetes may have delayed gastric emptying, which can impact medication absorption and timing of meals. Checking CBG (capillary blood glucose) every 1 hour is also important to monitor blood sugar levels and adjust treatment accordingly. However, maintaining CBG between 80-100 mg/dL is not a consideration, as this is the desired target range for blood sugar control in diabetes.