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First Aid/
First Aid for the USMLE Step 2 CK (10th Ed.)/
Disorders of Glucose MetabolismAce Your First Aid for the USMLE Step 2 CK (10th Ed.) Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Medicine (MD/DO) Students
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First Aid for the USMLE Step 2 CK (10th Ed.) | Medicine (MD/DO) School Study Aid
Diabetic Ketoacidosis (DKA) Signs and Symptoms
- Kussmaul respirations
- Dehydration
- Abdominal Pain
- Nausea/vomiting
- Psychosis
- Fruity breath Odor
1 min
Diabetic Ketoacidosis (DKA) Diagnosis and Labs
- Diagnosis
- Blood glucose Increased > 250 mg/dL
- Anion gap metabolic acidosis
- Decreased pH < 7.3
- Decreased serum bicarbonate < 18
- Plasma ketones
- Other Labs
- Hyperkalemia
1 min
Diabetic Ketoacidosis (DKA) Treatment
- Initial Management
- IV Normal Saline
- Regular Insulin Drip
- Subsequent Management (correction of electrolytes)
- Potassium (K+)
- Glucose
- Treat Underlying Cause
- Monitoring
- Venous pH
- Serum Bicarbonate (HCO3)
1 min
Diabetes Interventions
- Early Diagnosis
- Insulin
- Oral Hypoglycemics
- Glucose Monitoring
- Routine Exercise
- Diabetic Diet
- Monitor for Complications
- Insulin Therapy
- Diabetic Ketoacidosis (DKA)
2 mins
Insulin
- Rapid Acting
- Insulin Lispro (Humalog)
- Insulin Aspart (Novolog)
- Insulin Glulisine (Apidra)
- Short Acting
- Regular Insulin (Humulin R)
- Intermediate Acting
- Isophane NPH (Humulin N)
- Long Acting
- Detemir (Levemir)
- Glargine (Lantus)
2 mins
Pregnant Diabetic Patient Interventions
- First Trimester
- Increase Insulin then Decrease
- Metformin
- Nutrition
- Exercise
- Second Trimester
- Increase Insulin
- More Likely to Develop Hypoglycemia than Hyperglycemia
- Third Trimester
- Double or Quadruple Insulin
- Early Delivery
- Postpartum
- Drastically Decrease Insulin
- Monitor Neonate for Hypoglycemia
3 mins
Hyperosmolar Hyperglycemic State
- Characteristics
- Insulin Present
- Increased Serum Osmolality
- Glucose >600 mg/dL
- No Significant Acidosis or Ketosis
- Clinical Features
- Severe Dehydration
- Altered Neurological Status
- Tachycardia and Hypotension
- Management
- IV Fluids
- Insulin
- Treat Underlying Disorder
3 mins
Hyperglycemia
- Mechanism
- Insulin Resistance
- Too Little Insulin/Medication
- Infection/Illness
- Corticosteroids
- Assessment
- Elevated Blood Glucose
- Polyphagia
- Polydipsia
- Polyuria
- Hypotension
- Fatigue/Drowsiness
1 min
Diabetes Assessment
- Assessment Type 1
- Juvenile Onset
- Absent Insulin Production
- Ketosis Prone
- Assessment Type 2
- Adult Onset
- Insulin Resistance
- Obesity
- Gestational Diabetes
- Onset During Pregnancy
- Glucose Intolerance
- Complications
- Retinopathy
- Peripheral Vascular Disease
- Nephropathy
- Neuropathy
2 mins
Metformin
- Indications
- Diabetes Mellitus Type 2
- Polycystic Ovary Syndrome (PCOS)
- Mechanism of Action
- Decreased Gluconeogenesis
- Increased Insulin Sensitivity
- Side Effects
- Lactic Acidosis
- GI Distress
- Weight Loss
- B12 Deficiency
- Contraindication
- GFR < 30 ml/min
2 mins
Diabetic Glomerulonephropathy
- Pathophysiology
- Nonenzymatic Glycosylation of Glomerular Basement Membrane
- Nonenzymatic Glycosylation of Arterioles
- Hyperfiltration
- Increased GFR
- Histological Findings
- Hyaline Arteriolosclerosis
- Mesangial Expansion
- Type IV Collagen Deposition
- Kimmelstiel Wilson Lesions
- Presentation
- Nephrotic
2 mins
Gestational Diabetes
- Signs and Symptoms
- Usually Asymptomatic
- Fetal Macrosomia
- Polyhydramnios
- Diagnosis
- Glucose Intolerance After 24 Weeks Gestation
- 3-hr 100g Glucose Tolerance Test
- Treatment
- Diet and Exercise
- Close Glucose Monitoring
- Insulin
- Ultrasound (or Nonstress Test (NST))
- Delivery
2 mins
Diabetes Education
- Self-Monitoring (Blood Glucose)
- SubQ Injection Technique
- Lifestyle Changes
- Symptoms of Hyperglycemia and Hypoglycemia
- Sick Day Care
- Foot Care
- Exercise Therapy
- Medication
1 min
Nonproliferative Diabetic Retinopathy
- Characteristics
- Increased Capillary Permeability and Leakage
- Often Asymptomatic
- Fundoscopic Findings
- Retinal Microaneurysms
- Flame-shaped Hemorrhages
- Cotton Wool Spots
- Hard Exudates
- Macular Edema
- Management
- Treat Diabetes
- Laser Photocoagulation
- Bevacizumab
3 mins
Proliferative Diabetic Retinopathy
- Characteristics
- Angiogenesis
- Increased VEGF
- Asymptomatic Until Late-stage
- Fundoscopic Findings
- Vitreous Hemorrhage
- Retinal Detachment
- Glaucoma
- Findings of Nonproliferative Diabetic Retinopathy
- Management
- Laser Photocoagulation
- Surgery
- Bevacizumab
2 mins
Metabolic Syndrome
- Assessment
- Dyslipidemia
- Central Obesity
- Insulin Resistance
- Hypertension
- Increased C-Reactive Protein (CRP)
- Increased Fibrinogen
- Considerations
- Increased Risk Cardiovascular Disease
1 min
Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)
- Mechanisms
- 1st Generation Sulfonylureas
- Stimulate Release of Insulin
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Possible Cardiovascular Toxicity
- Weight Gain
- Considerations
- Exacerbated Hypoglycemia with Beta-blockers
- Avoid During Pregnancy and Breast Feeding
- Avoid Alcohol
2 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
- Mechanisms
- 2nd Generation Sulfonylureas
- Blocks Potassium Channels in Beta Cells
- Stimulate Release of Insulin
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Considerations
- More Potent
- Beta Blockers Reduce Effects
- Avoid Alcohol
- Avoid Breastfeeding
2 mins
Pioglitazone (Thiazolidinediones)
- -glitazones Suffix
- Mechanism
- Binds PPAR-Gamma
- Decreases Insulin Resistance
- Indications
- Type 2 Diabetes
- Side Effects
- Weight Gain
- Heart Failure
- Myalgia
- Hypoglycemia
- Upper Respiratory Infection
- Considerations
- Increased Risk of Bladder Cancer
- Increased Fracture Risk in Women
- Monitor Liver Enzymes
2 mins
Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)
- -gliptin Suffix
- Mechanisms
- DPP-4 Inhibitor
- Increases Insulin Release
- Indications
- Type 2 Diabetes
- Side Effects
- Pancreatitis
- Upper Respiratory Infection and Inflammation
- Stevens-Johnson Syndrome
- Considerations
- Used as Add-on Agents
2 mins
Exenatide (Byetta)
- Mechanism
- Incretin Mimetic
- GLP-1 Synthetic Analog
- Indications
- Type 2 Diabetes
- Side Effects
- Hypoglycemia
- Nausea and Vomiting
- Diarrhea
- Thyroid Cancer
- Pancreatitis
- Renal Failure
- Considerations
- (Give Exenatide) One Hour After Other Medications
- Adjunct Therapy
3 mins
SGLT2 Inhibitors
- "-gliflozin" Suffix
- Mechanism of Action
- Blocks Glucose Reabsorption in Proximal Tubule
- Indications
- Type 2 Diabetes Mellitus
- Side Effects
- Weight Loss
- Lower Blood Pressure
- Hyperkalemia
- Urinary Tract Infections (UTIs)
- Considerations
- Contraindicated in Chronic Kidney Disease
1 min
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
- Mechanisms
- Alpha Glucosidase Inhibitors
- Delays Absorption of Carbohydrates
- Indications
- Type 2 Diabetes
- Side Effects
- Flatulence
- Diarrhea
- Anemia
- Cramps
- Considerations
- Monitor LFTs
- Oral Glucose for Hypoglycemia
2 mins
Hypoglycemia Intervention
- Interventions
- Mild to Moderate Hypoglycemia
- Simple Carbohydrate (Oral Dextrose, Fruit Juice, Candies)
- Complex Carbohydrate (Whole Grains, Vegetables)
- Severe Hypoglycemia or Unconscious
- 50% Dextrose
- Glucagon
- Considerations
- Monitor Blood Glucose Q 10-15 Minutes
- Give Small Meal After Intervention
- Patient Education
- Hypoglycemia Prevention
- Encourage Self-Monitoring
3 mins
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