BCADM exam prep
excessive hepatic glucose production, rebound hyperglycemia, dawn phenomena -
ANSWER✅✅✅reasons for AM hyperglycemia
Rebound hyperglycemia (Somogyi effect) -ANSWER✅✅✅hypoglycemia during sleep
protease inhibitors (HIV treatment), corticosteroids, thiazide diuretics, calcineurin
inhibitors (anti-rejection meds), fluoroquinolone antibiotics, beta-blockers, atypical
antipsychotics -ANSWER✅✅✅medications associated with hyperglycemia
Atenolol/metroprolol/propranolol -ANSWER✅✅✅beta blockers
beta blockers -ANSWER✅✅✅decrease heart rate and dilate arteries by blocking beta
receptors; used for CVD and high BP
Hyperglycemic Hyperosmolar State (HHS) -ANSWER✅✅✅severe dehydration, usually
with older adults with comorbidities, relative insulin deprivation
Diabetic Ketoacidosis (DKA) -ANSWER✅✅✅absolute insulin depravation
characteristics of HHS -ANSWER✅✅✅usually >60 years old, >5 days symptoms,
glucose >600, beta hydroxybutyrate <3, urine ketones <2, ph normal, bicarb more than
18, serum osmolality 300+, usually type 2, 10-20% mortality
causes of HHS -ANSWER✅✅✅massive fluid loss from osmotic diuresis (burns,
hyperglycemia, diarrhea, hemodialysis, diurectics, steroids), heart attack, infections,
hypertonic feedings, medications
HHS -ANSWER✅✅✅hyperosmolar hyperglycemic state
clinical signs of HHS -ANSWER✅✅✅polydipsia, polyuria, weakness, wt loss,
hypothermia, hypotension, tachycardia, altered sensorium
treatment for HHS -ANSWER✅✅✅labs (especially K+), rehydrate, correct glucose
(insulin), correct lytes
resolution of HHS -ANSWER✅✅✅pH 7.3+, bicarb 18+, glucose less than 250,
osmolality less than 300, urine output .5mg/kg/hr, improved cognition
, DKA and hyperglycemic crisis -ANSWER✅✅✅type 1 in youth, highest in persons <45,
often a cry for help
DKA -ANSWER✅✅✅profound insulin deficiency; accounts for 14% of all hospital
admits for T1; in young people accounts for 50% all admits; 16% DM related fatalities;
incidence ~2 episodes per 100 pt years of DM
DKA precipitating factors -ANSWER✅✅✅40% illness and infection; 25% inadequate
insulin dosage; emotional stress (especially with teens, neglect, mismanagement);
disordered eating; pregnancy; hyperglycemia inducing meds; insulin omission (fear of
hypo or wt gain); stress; can't afford insulin; drug use
DKA labs/presentation -ANSWER✅✅✅glucose 200+, osmolality 300+, dehydration,
ph<7.3, beta-hydoxybutyrate (3 mmol/L+), 2+ ketones in urine, bicarb less than 18
DKA clinical signs -ANSWER✅✅✅polydipsia, polyuria, weakness, wt loss, N/V/abd
pain, ileus, kussmaul breathing, acetone breath, hypothermia, tachypnea, tachycardia,
altered sensorium
SGLT-2 inhibitor -ANSWER✅✅✅when combined with insulin, what med increases risk
of DKA in T1DM and T2DM?
SGLT-2 inhibitor meds -ANSWER✅✅✅farxiga, jardiance, steglatro, brenzavvy,
invokana
Euglycemic diabetic ketoacidosis -ANSWER✅✅✅BG 200+, uncommon complication
associated with surgery, pregnancy, anorexia, gastroparesis, fasting, alcohol use
disorder, SGLT-2 inhibitors, pancreatitis, surgery, infection, cirrhosis
EDKA mechanism -ANSWER✅✅✅secondary to carb deficit resulting in generalized
decreased serum insulin and excess counter regulatory hormones like glucagon,
epinephrine, and cortisol; increased glucagon/insulin ratio leads to increased lipolysis,
increased free fatty acids, and ketoacidosis
lower -ANSWER✅✅✅EDKA is more common in those with _______ BMI and
decreased glycogen stores.
signs and symptoms of EDKA -ANSWER✅✅✅N/V, SOB, generalized malaise,
lethargy, loss of appetite, fatigue, abd pain (NOT polydipsia or polyuria)
labs for EDKA -ANSWER✅✅✅pH less than 7.3, serum bicarb less than 18, beta-
hydroxybutyrate 3+, urine ketones 2+, BG 200+
excessive hepatic glucose production, rebound hyperglycemia, dawn phenomena -
ANSWER✅✅✅reasons for AM hyperglycemia
Rebound hyperglycemia (Somogyi effect) -ANSWER✅✅✅hypoglycemia during sleep
protease inhibitors (HIV treatment), corticosteroids, thiazide diuretics, calcineurin
inhibitors (anti-rejection meds), fluoroquinolone antibiotics, beta-blockers, atypical
antipsychotics -ANSWER✅✅✅medications associated with hyperglycemia
Atenolol/metroprolol/propranolol -ANSWER✅✅✅beta blockers
beta blockers -ANSWER✅✅✅decrease heart rate and dilate arteries by blocking beta
receptors; used for CVD and high BP
Hyperglycemic Hyperosmolar State (HHS) -ANSWER✅✅✅severe dehydration, usually
with older adults with comorbidities, relative insulin deprivation
Diabetic Ketoacidosis (DKA) -ANSWER✅✅✅absolute insulin depravation
characteristics of HHS -ANSWER✅✅✅usually >60 years old, >5 days symptoms,
glucose >600, beta hydroxybutyrate <3, urine ketones <2, ph normal, bicarb more than
18, serum osmolality 300+, usually type 2, 10-20% mortality
causes of HHS -ANSWER✅✅✅massive fluid loss from osmotic diuresis (burns,
hyperglycemia, diarrhea, hemodialysis, diurectics, steroids), heart attack, infections,
hypertonic feedings, medications
HHS -ANSWER✅✅✅hyperosmolar hyperglycemic state
clinical signs of HHS -ANSWER✅✅✅polydipsia, polyuria, weakness, wt loss,
hypothermia, hypotension, tachycardia, altered sensorium
treatment for HHS -ANSWER✅✅✅labs (especially K+), rehydrate, correct glucose
(insulin), correct lytes
resolution of HHS -ANSWER✅✅✅pH 7.3+, bicarb 18+, glucose less than 250,
osmolality less than 300, urine output .5mg/kg/hr, improved cognition
, DKA and hyperglycemic crisis -ANSWER✅✅✅type 1 in youth, highest in persons <45,
often a cry for help
DKA -ANSWER✅✅✅profound insulin deficiency; accounts for 14% of all hospital
admits for T1; in young people accounts for 50% all admits; 16% DM related fatalities;
incidence ~2 episodes per 100 pt years of DM
DKA precipitating factors -ANSWER✅✅✅40% illness and infection; 25% inadequate
insulin dosage; emotional stress (especially with teens, neglect, mismanagement);
disordered eating; pregnancy; hyperglycemia inducing meds; insulin omission (fear of
hypo or wt gain); stress; can't afford insulin; drug use
DKA labs/presentation -ANSWER✅✅✅glucose 200+, osmolality 300+, dehydration,
ph<7.3, beta-hydoxybutyrate (3 mmol/L+), 2+ ketones in urine, bicarb less than 18
DKA clinical signs -ANSWER✅✅✅polydipsia, polyuria, weakness, wt loss, N/V/abd
pain, ileus, kussmaul breathing, acetone breath, hypothermia, tachypnea, tachycardia,
altered sensorium
SGLT-2 inhibitor -ANSWER✅✅✅when combined with insulin, what med increases risk
of DKA in T1DM and T2DM?
SGLT-2 inhibitor meds -ANSWER✅✅✅farxiga, jardiance, steglatro, brenzavvy,
invokana
Euglycemic diabetic ketoacidosis -ANSWER✅✅✅BG 200+, uncommon complication
associated with surgery, pregnancy, anorexia, gastroparesis, fasting, alcohol use
disorder, SGLT-2 inhibitors, pancreatitis, surgery, infection, cirrhosis
EDKA mechanism -ANSWER✅✅✅secondary to carb deficit resulting in generalized
decreased serum insulin and excess counter regulatory hormones like glucagon,
epinephrine, and cortisol; increased glucagon/insulin ratio leads to increased lipolysis,
increased free fatty acids, and ketoacidosis
lower -ANSWER✅✅✅EDKA is more common in those with _______ BMI and
decreased glycogen stores.
signs and symptoms of EDKA -ANSWER✅✅✅N/V, SOB, generalized malaise,
lethargy, loss of appetite, fatigue, abd pain (NOT polydipsia or polyuria)
labs for EDKA -ANSWER✅✅✅pH less than 7.3, serum bicarb less than 18, beta-
hydroxybutyrate 3+, urine ketones 2+, BG 200+
