Pathophysiology of Diabetes Mellitus (Harrison’s Principles of Internal Medic...Batoul Ghosn
This presentation talks about the Pathophysiology part of Diabetes Mellitus I & II as well as Diabetic Ketoacidosis & Hyperglycemic Hyperosmolar State and Finally with Medical Nutrition Therapy in DIabetes Mellitus. It is made entirely from the Harrsion's Book 19th edition.
Pathophysiology of Diabetes Mellitus (Harrison’s Principles of Internal Medic...Batoul Ghosn
This presentation talks about the Pathophysiology part of Diabetes Mellitus I & II as well as Diabetic Ketoacidosis & Hyperglycemic Hyperosmolar State and Finally with Medical Nutrition Therapy in DIabetes Mellitus. It is made entirely from the Harrsion's Book 19th edition.
General introduction to diabetes mellitusSnigdha Maity
Its very important topic in periodontology as Diabetes Mellitus has high impact on periodontium. So before going into details how it act on periodontium, we have to know what it is and how it is detected in blood. Here is the vast knowledge on diabetes mellitus
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
Diabetes Mellitus(Past,Present and Future)Vikas Reddy
This is an integrated and evidence based presentation on Diabetes Mellitus covering all the aspects of its pathology,clinical features,classification,complications,diagnosis,treatment and recent advances.
General introduction to diabetes mellitusSnigdha Maity
Its very important topic in periodontology as Diabetes Mellitus has high impact on periodontium. So before going into details how it act on periodontium, we have to know what it is and how it is detected in blood. Here is the vast knowledge on diabetes mellitus
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
Diabetes Mellitus(Past,Present and Future)Vikas Reddy
This is an integrated and evidence based presentation on Diabetes Mellitus covering all the aspects of its pathology,clinical features,classification,complications,diagnosis,treatment and recent advances.
Learning objectives of this lesson:
Understand the definition of Diabetes.
Understand the pathogenesis of Diabetes.
Identify the types of Diabetes.
Understand the general symptoms of Diabetes?
Understand the definition of pre-diabetes.
Understand the causes of Diabetes.
Drug of Choice of various Infections is a very important topic for pg entrance....so all important points and mcqs with images have been given here....do make use of it
Plasmodium and antimalarial drugs is a very important topic for pg entrance....so all important points and mcqs with images have been given here....do make use of it
Mycology is a small topic in microbiology where questions appears less in pg entrance but still we need to know it and learn about it in safe side... so here is a ppt with detailed explanation and images
fine motor milestones is a very important topic for pg entrance....so all important points and mcqs with images have been given here....do make use of it
Definition : Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia resulting from impaired insulin secretion, insulin action [ insulin resistance ] or both .
The chronic hyperglycemia in DM is associated with long term damage dysfunction and failure of various organs
Is based on etiology not on type of treatment or age of the patient.
Type I(Beta cell destruction-absolute insulin deficiency)
Immune mediated Idiopathic
Type II
predominant insulin resistant with relative insulin deficiency
predominant secretory defect with insulin resistance
Introduction to Diabetes & anti diabetic drug screening methodsAnurag Raghuvanshi
Diabetes is one of the most common life long disese now days & there are various works done in pharma. how dugs are developed & the animals used in this methodolgy is well brief in these slides.
Exercise Testing in Cardiology : Dr. Akif Baigakifab93
The testing modality and protocol should be selected in accordance with the patient’s estimated functional capacity based on age, estimated physical fitness from the patient’s history, and underlying disease
Several exercise test protocols are available for both treadmill and stationary cycle ergometers
Patients who have low estimated fitness levels or are deemed to be at higher risk because of underlying disease (e.g., recent MI, heart failure) should be tested with a less aggressive exercise protocol
Treadmill and cycle ergometers may use stepped or continuous ramp protocols
Work rate increments (stages) during stepped protocols can vary from 1 to 2.5 METs
Ramp protocols are designed with stages that are no longer than 1 minute and for the patient to attain peak effort within 8 to 12 minutes
The natriuretic peptide system works antagonistically to the RAAS and has favorable effects on the pathogenesis of heart failure
Natriuretic peptides are broken down by an enzyme called neprilysin
Neprilysin is also responsible for the breakdown of other substances, including bradykinin and angiotensin II
Sacubitril/valsartan is a combination product
Sacubitril is a pro-drug that, upon activation, acts as a neprilysin inhibitor
It works by blocking the action of neprilysin, thus preventing the breakdown of natriuretic peptides
This leads to a prolonged duration of the favorable effects of these peptides
Coronary heart disease (CHD) remains a leading cause of death worldwide, accounting for 16% of total deaths globally .
Atherosclerosis plays a central role, with early fatty streaks progressing to late complex atheromas
Vascular calcification, the pathogenic and process of ectopic bone production, specifically was shown to strongly correlate with degree of atherosclerosis (both calcified and noncalcified)
Vascular calcification was shown independently to predict cardiovascular morbidity and mortality
These associations, combined with the radio-opaque appearance of calcium hydroxyappatite on CT images, have led to extensive investigation of the quantification, or scoring, of coronary artery calcium (CAC).
CAC scoring has emerged as a widely available and powerful tool for stratifying cardiovascular risk, predicting patient outcomes, and guiding preventive therapy
A coronary bifurcation consists of a flow divider (carina) and three vessel segments:
The proximal main vessel (PMV)
The distal main vessel (DMV) and
The side branch (SB).
A bifurcation lesion is a major epicardial coronary artery stenosis next to and/or including the ostium of a significant side branch
A significant SB is a branch whose severe narrowing or acute occlusion before or during intervention can cause considerable ischemia or a new infarction area that will worsen the clinical course of a particular patient.
Other important elements to consider that are not inherent in the bifurcation classifications include:
Extent of disease on the SB (limited to the ostium or involving the vessel beyond the ostium)
Its size (over 2.5mm in reference diameter)
Bifurcation angle, and
Disease distribution
Left ventricular (LV) dysfunction remains one of the
best prognostic determinants of survival in patients
with coronary artery disease (CAD)
⚫ It was originally thought that dysfunctional
myocardium after an infarction was irreversibly
damaged
⚫ However, it was later recognized that some of the
involved tissue remained viable and contractility may
be restored with revascularization
HCM is a common genetic heart disease reported in populations globally
Inherited in an autosomal dominant pattern
The distribution of HCM is equal by sex, although women are diagnosed less commonly than men
The prevalence of unexplained asymptomatic hypertrophy in young adults has been reported to range from 1:200 to 1:500
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Ventricular septal defects occur either as an isolated defect or as a component of a more complex lesion
It occurs in 50 percent of all children with CHD and in 20 to 30 percent as an isolated lesion
Most common congenital cardiac anomaly in children
Second most common congenital abnormality in adults, second only to bicuspid aortic valves
They are more common in premature infants and those born with low weight
VSDs are slightly more common in females (56%)
Patients with peripheral artery disease who have undergone lower-extremity revascularization are at high risk for major adverse limb and cardiovascular events
The efficacy and safety of rivaroxaban in this context are uncertain
Most common cyanotic heart defect seen in children beyond infancy, accounting for a third of all congenital heart disease (CHD) in this age group
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Bentracimab (also known as PB2452) is a neutralizing recombinant human immunoglobulin G1 monoclonal antibody antigen-binding fragment that binds ticagrelor and its major active circulating metabolite with high affinity and specificity
Chlorthalidone for hypertension in advanced ckdakifab93
Chlorthalidone, a thiazide-like diuretic, reduces cardiovascular morbidity, such as the incidence of stroke and heart failure, and cardiovascular mortality
However, its efficacy and safety among patients with advanced chronic kidney disease remain poorly understood
An acute illness caused by an autoimmune response to infection with group A Streptococcus, leading to a range of possible symptoms and signs affecting any or all of heart, joints, brain, skin and subcutaneous tissues
Amyloidosis is a group of protein-folding disorders in which >1 organ is infiltrated by proteinaceous deposits known as amyloid. Amyloid involvement of the heart (cardiac amyloidosis) carries the worst prognosis of any involved organ, and light-chain (AL) amyloidosis is the most serious form of the disease
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. HbA1C
VALUE CONDITION
<5.6% Normal Hb1AC
5.6-6.4% Impaired glucose tolerance
>/= 6.5% Diabetes mellitus
-It tells us about average blood sugar of previous 8-12wks
-Retrospective study
-Best investigation of choice for diagnosing Diabetes Mellitus.
-Good diabetes control = Hb1AC levels <7%
3. DIABETES
Fasting 2hrs Post
prandial
Normal 60-100mg/dl <140mg/dl
Impaired glucose
tolerance
100-126mg/dl 140-199mg/dl
Diabetes mellitus >126mg/dl >200mg/dl
Fasting is defined as no calorie intake for at least 8hr
2hrs post-prandial: an oral glucose tolerance test with 75gm of
glucose
1 mmol/lit of blood sugar = 18 mg% of blood sugar
4. 1) A young man has normal blood sugar & normal HbA1C but has glycosuria.
Most likely diagnosis is?
A Renal Glycosuria
B Pancreatic insufficiency
C Alimentary glycosuria
D High carbohydrate diet taken in the morning.
5. Ans. A Renal Glycosuria
Important points:
1. Glycosuria + Ketonuria : seen only in diabetes.
2. Only glycosuria (without diabetes) : is seen in a normal young adult,
pregnancy, hyperthyroid.
(Note: In hyperthyroid it is known as alimentary glycosuria)
3. Only ketonuria : seen in prolong starvation.
4. Renal glycosuria:is a benign condition, found in some young adults.
No treatment required. Blood sugar is normal. It is self limiting.
6. TYPE-1 DIABETES
- Ratio of type I & type II diabetes in India. = 5% : 95%
-Patient has normal Weight or under weight
- Presence of autoantibodies: islet cell antibodies (lCA) and anti-glutamic acid
decarboxylase (GAD) antibodies;
- Ketonuria on urine dipstick.
- Family history +/-
- Serum insulin levels are low
- HLA DR3, DR4
- Main treatment is insulin.
8. LATENT AUTOIMMUNE
DIABETES OF ADULTS (LADA)
- Also known as Type 1.5 DM
- Is a form of Type 1 DM, with slower progression to insulin dependence in later life.
-Initially there is not much need of insulin administration and patient can
be managed on hypoglycemic drugs but later in adulthood insulin
dependence occurs.
-Since initially it behaves as type 2 DM and later as Type 1DM , It is known
as Type1.5DM.
9. -Patient has over Weight
- No HLA association
- No autoantibodies
-Ketosis is uncommon.
-Non ketotic hyper osmolar coma is common.
-Family history strongly positive but not always positive.
- Insulin resistance is the main cause
- Serum insulin levels are very high ( hyper insulinemia )
- Treatment include weight loss, oral drugs & insulin
TYPE-2 DIABETES
10. 2.Q. A 29 years old person is known diabetic on oral hypoglycemic agents since
3 years. He has lost weight and never had DKA. His grand father is diabetic but
his father is nondiabetic. Which is the likely diagnosis: (AIIMS May 09)
A MODY
B DM type I
C DM type II
D Pancreatic diabetes
12. 3.Q. A 29 years old person is known diabetic on oral hypoglycemic agents since
3 years. He has lost weight and never had DKA. His grand father and father
both are diabetic. Which is the likely diagnosis: (AIIMS Nov 09)
A )MODY
B )DM type I
C)DM type II
D ) Pancreatic diabetes
13. Ans. A MODY
In type II diabetes there is strong family history but in MODY there is definite
family history because it is autosomal dominant.
That’s why the answer of Q. 2 is C and
answer of Q 3 is A.
Because in Q. 2 Father is not diabetic but Grand Father is diabetic but
Q. 3 both Father and Grandfather are diabetic.
14.
15. MATURITY ONSET
DIABETES OF YOUNG (MODY)
-Age of presentation = 25yrs
-6types (Type1-6)
-MC MODY in India = Type-3
-No antibodies
-No obesity
-DKA uncommon
-No insulin resistance
-Gene defect = HNF1
-Autosomal Inheritance
-Family history of sucessive
generations
22. POTENTIAL DIABETES
Person himself at present is non-diabetic but has a strong family history
of type 2 diabetes.
LATENT DIABETES
A person becomes diabetic under stressful conditions like pregnancy.
Person again becomes non-diabetic when stress is removed.
23. BRITTLE DIABETES
It is seen in children with type 1 diabetes. Some times patient’s sugar becomes very
high leading to DKA,
sometimes patient goes into hypoglycemia
ACUTE FULMINANT
DIABETES MELLITUS
It is acute onset diabetes, can occur in any age, occurs after viral infection. Serum
insulin level are reduced but there are no antibodies against insulin or beta cell.
(PNQ)
The viral infections associated with diabetes are :
Mumps, Measles, Coxsackie virus, Cytomegalovirus, Rubella, EB virus
24. TROPICAL DIABETES
-Diabetes mellitus associated with chronic malnutrition and, sometimes, chronic
pancreatitis.
-Also called malnutrition-related diabetes.
-Chronic pancreatitis patient are usually in Africa where they consume Casava.
25. Recent advances in Pathology of
Type II diabetes
-Genes for type II diabetics that cause the insulin resistance and the beta cell
failure- a gene on chromosome 2 encoding a cysteine protease, calpain –10, has
been reported in some patient.
- Several adipokines, secreted by fat cells, can affect insulin Action.
-Example of adipokines
1. Leptin
2. Adiponectin
3. TNF
4. Resistin
i. Adipokines which reduce insulin resistance - a. Leptin b. Adiponectin.
ii. Adipokines which increase insulin resistance – a. TNF-alpha b. Resistin
26. INITIAL MANAGEMENT
OF DIABETES
Treatment of diabetes mellitus (H-18th Pg-2990)
1. Patient Education : For any obese type II diabetic patient initial therapy is
diet therapy and exercise.
(a) (Reduce weight to maintain normal BMI)
BMI = body weight (kg) / height in meters2
BMI > 25 overweight
30 obese
(b) In Obesity down regulation of insulin receptors occurs.
(c) Avoid food of high glycemic index (i.e. any food like sugar, glucose powder etc.
which are absorbed immediately in GIT and raised blood sugar very fast).
30. Complications Of DM
1) Somogyi phenomenon
2) Dawn phenomenon
3) Diabetic Ketoacidosis
4) Non-ketotic hyperosmolar coma
5) Diabetic retinopathy
6) Diabetic neuropathy
7) Diabetic nephropathy
31. 1)SOMOGYI PHENOMENON
-Early morning (3-4am) hypoglycemia due to excess administration of
Insulin at night but again at morning around 6-7am there will be hyperglycemia.
Explanation of 6am hyperglycemia is given below
When the blood glucose level falls below normal, the body responds by releasing the
endocrine hormone glucagon as well as the stress hormones epinephrine, cortisol
and growth hormone.
- Glucagon facilitates release of glucose from the liver that raises
the blood glucose immediately, and
- the stress hormones cause insulin resistance for several hours,
sustaining the elevated blood sugar.
33. 1)SOMOGYI PHENOMENON
Normal glucose at night
High Insulin given at 9pm
Leads to hyperglycemia
In morning
Glucagon and other stress
hormones are released
Due to hypoglycemic stress
Leads to hypoglycemia
At around 2-3pm
36. DIABETIC KETOACIDOSIS
CLINICAL FEATURES –
Symptoms –
Nausea,
vomiting,
Abdominal pain
Altered mental function.
Shortness of breath
Signs –
1. Tachycardia
2. Dry mucous membrane
3. Dehydration
4. Hypotension
5. Kussmaul respiration Q
6. Tachypnea
7. Abdominal tenderness
8. Fever. May be there
9. Fruity odour of the breath
37. INVESTIGATIONS Of DKA
1. Hyperglycemia – Blood sugar 400 – 600 mg%
2. TLC – Leucocytosis. It is a feature of DKA. It does not indicate infection.
Presence of fever indicate infection
3. K+ - increase (shifting of K+ from intracellular to extracellular compartment
due to decrease Insulin)
4.S. Osmolality 300 – 320mosm/Kg
5.Urine ketones – Positive
6. Metabolic acidosis - Low HCO-
3
7. increase anion gap.
38. Q. Which of the following is the best parameter to know about the control of DKA?
A Random blood sugar
B pH of the blood
C Urine ketone
D Serum potassium
40. Treatment Of DKA
a. Fluids → 0.9% saline.
b. Insulin → Regular Insulin is given I/V in DKA. It is not given
subcutaneous.
c. Treat precipitating events → Non compliance, infection by antibiotics.
d. K+ replacement → Initially when patient comes initially he is hyperkalemic,
later on when patient is treated with insulin, serum potassium level goes down
and may required potassium replacement.
e. Injection HCO3 I/V if Ph <7
Note : Insulin causes movement of K+ from ECF to ICF leading to hypokalemia
For Pg entrance this is enough ….if u want to know more about
management read in harrison/ davidson latest edition
41. Q. A diabetic patient with blood glucose of 600 mg/dL and Na 122 mEq/L was
treated with insulin. After giving insulin the blood glucose decreased to 100 mg/dL.
What changes in blood Na level is expected? (LQ)
A Increase in Na+ level
B Decrease in Na+ level
C No change would be expected
D Na+ would return to previous level spontaneously on correction of blood glucose.
42. Ans. A Increase in Na + level
In diabetes pseudohyponatremia occurs i.e. the measured serum sodium
is reduced as a consequence of the hyperglycemia.
i. There is a reduction of (1.6 meq) of serum sodium for each 100 mg/Dl
rise in the serum glucose.
ii. A normal serum sodium in the setting of DKA indicates a more
profound water deficit.
So when we treat a case of DKA, as the blood glucose level falls then
measured serum sodium rises.
(Ref. Harrison, 18th edition, 2978)
Extra Edge::
Causes of pseudohyponatremia:
1. Severe hyperglycemia (DKA, NKHOC)
2. Hyperlipidemia
3. Hyperproteinemia (Multiple myeloma)
43. Complications of DKA
i. Cerebral edema (most dangerous complication, seen mostly in children)
ii. Venous thrombosis
iii. ARDS
iv. MI
v. Acute gastric dilatation
Acidosis leads to damage of blood brain barrier and thus leads to
cerebral edema
44. Q. Mr. Ram Lal, 80 years, a known case of diabetes, was brought to
emergency ward in unconscious state. His blood sugar was 900 mg%,
dry tongue. BP; 80/50. Urine ketones negative. Which of the following fluid
you will give to treat his marked dehydration.
A Injection RL
B Injection N/2 saline
C Give plain water by Ryle’s tube
D Injection N saline
45. Ans. D Injection N saline
This is a case of NKHOC.
Ideal replacement fluid in this condition N/2 saline but in this case the patient
BP is 80/50 i.e. he is in hypovolemic shock so to begin with in this case N saline
should be given.
Once the systolic BP is above 90mmHg then N/2 saline should be started.
Supposed in this question patient’s BP was 110/70 i.e. normal BP than best answer
would have been N/2 saline.)
46. Q. A 70 years old patient was brought to emergency ward in a comatose state.
His ABG was done and findings are as follows Na = 132 meq/lit,
K = 6.5 meq / lit, HCO3 = 10 meq/ lit, blood glucose 20 mmol/lit
BUN = 4 mmol/lit
What is your diagnosis. (AIIMS Nov 09)
A Non ketotic hyperosmolar diabetic coma
B D.K.A
C Hypoglycemic coma
D Lactic acidosis
47. Ans. D Lactic acidosis
In this case the RBS is 20mmol/lit i.e. 20 X 18 = 360 mg%.
So this is not a case of hypoglycemia.
Here in this question HCO3 is 10meq/lit so it is not a case of NKHOC.
So because this case has metabolic acidosis either it is a case of DKA or lactic acidosis.
But as patient age is 70 years it is more likely to be lactic acidosis.
Supposed in this question patient age was 17 year than the answer was DKA !!!)
Normal HCO3 levels = 22-26meq/l
48. LACTIC ACIDOSIS
-Lactic acidosisis characterized by low pH in body tissues and blood.
-Lactic acidosis is characterized by lactate levels >5 mmol/L and serum pH <7.35.
-It is very common in type 2 diabetic patient who are on metformin therapy.
-Associated with Vitamin b1 deficiency
-Signs:
a. Deep and rapid breathing
b. Vomiting
c. Abdominal pain.
Treatment:
1. Lactic acidosis is typically associated with tissue hypoperfusion.
Appropriate measures include treatment of shock, restoration of circulating fluid
volume, improved cardiac function, identification of sepsis source
2. Sodium bicarbonate is given I/V
3. Thiamine
49. NON KETOTIC
HYPEROSMOLAR COMA (NKHOC)
Symptoms –Classically patient is
i. Elderly
ii. H/O polyuria of several weeks with weight loss and decrease oral intake.
iii. Mentally confused
Signs –
a. Tachycardia
b. Hypotension
c. Dehydration
d. Altered sensorium, coma
Extra Edge:
Nausea, Vomiting, Abdominal Pain, Kussmaul respiration & Ketosis are
not the features of NKHOC.
50. Investigation of NKHOC
a. Blood sugar 900 – 1100 mg/dl
b. Serum osmolality > 350mosm/kg
c. Pseudo hyponatremia
e. pH normal i.e. no acidosis
f. Ketonuria is absent. i.e. no ketosis
51. Treatment of NKHOC
1. Fluid → Total fluid deficit (9 – 10L) should be reversed over 1 –2 day
Initially give normal saline to stabilize the patients hemodynamically
Then Give 0.45% saline
2. Regular Insulin to be given intravenous
3. Subcutaneus heparin because these patients are prone to venous
thrombosis.
52. Q. Complication in Diabetics mellitus type-II occurs around: (LQ)
A 5 years of onset
B 10 years of onset
C 15 years of onset
D 20 years of onset
53. Ans. B 10 years of onset In type II diabetes the chronic complication usually
start after 10 years of onset of diabetes.
54. Chronic Complications of diabetes are:
1. Vascular:
a. Micro vascular
b. Macro vascular
1. Microvascular
i. Eye: a. Retinopathy b. Macular edema
ii. Neuropathy
iii. Nephropathy
2. Macrovascular
i. CAD
ii. PAD
iii. CVA
3. Non vascular
i. Gastrointestinal
ii. Genitourinary
iii. Dermatologic
iv. Infectious
v. Cataracts
vi. Glaucoma
vii. Periodontal disease
55. 1. Vascular disease
i. Cardiovascular disease is increased in individuals with type 1 or type 2
DM.
ii. The Framingham Heart Study revealed a marked increase in PAD, CHF,
CAD, MI, and sudden death (risk increases from one- to fivefold) in DM.
iii. MI is 3-5 times commoner in and is more likely to be 'silent' (without
classic symptoms). Diabetes is a major risk factor for CAD.
iv. CAD is the commonest cause of death in diabetic.
v. Earliest dyslipidemia to occur is diabetes is raised Tg.
- In both the DCCT (type 1 diabetes) and the UKPDS (type 2 diabetes),
cardiovascular events were not reduced immediately by intensive treatment
during the trial but were reduced at follow-up 10–17 years later (this effect
has been termed legacy effect or metabolic memory).
56. Q. The most characteristic finding in diabetic nephropathy is: (LQ)
A Diffuse glomerulosclerosis
B Nodular glomerulosclerosis
C Armani-Ebstein reaction
D Fibrin caps
57. 1. ↑GFR is the 1st manifestation of diabetic nephropathy.
2. Then is the stage of Microalbuminuria.
It is the most reliable marker of diabetic nephropathy.
-diabetes is the commonest cause of CRF
-Protein restriction is helpful in diabetic nephropathy – (H, 18th Pg- 2985)
(8) Dietary advice- Protein intake = 0.8 gm/kg/day in micro Albuminuria,
< 0.8 gm/ kg /day = in macro albuminuria
B) Nodular glomerulosclerosis
58. Pathology of Diabetic nephropathy
(1) Capillary BM thickening
(2) Diffuse glomerulosclerosis (Most common). In this there is increase in
mesangial matrix.
(3) Nodular glomerulosclerosis. (It is the most characteristic feature).
(4) It is accompanied by accumulation of hyalin material.
(5) If it is within capillary loop (Fibrin cap) or it is attached to Bowman
capsule (Capsular drop)
(6) Armani Ebstein Reaction : Collection of glycogen clumps within the
renal tubules found in diabetic nephropathy
59.
60.
61.
62.
63.
64. Q. In diabetic patient fundus examination should be checked how
frequently? (AIIMS May 09)
A 6 Months
B 1 year
C 2 years
D 5 years
65. Ans. B 1 year.
Diabetic retinopathy will be discussed in ophtho.
66. Q. The most common presentation of diabetic neuropathy is: (LQ)
A Amyotrophy
B Mononeuropathy
C Symmetrical sensory neuropathy
D Autonomic neuropathy
72. Skin involvement in DM
a. Pigmented pretibial papules
b. Necrobiosis lipoidica
c. Acanthosis nigricans
d. Granuloma annulare
e. Lipoatrophy and lipohypertrophy
f. Scleredema
g. Dupuytren’s contracture.
Extra edge: Protease inhibitor can cause lipodystrophy.