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CCFP Review PART 2 (largest) with Complete SolutionsCCFP Review PART 2 (largest) with Complete SolutionsCCFP Review PART 2 (largest) with Complete SolutionsCCFP Review PART 2 (largest) with Complete SolutionsCCFP Review PART 2 (largest) with Complete Solutionswhen target not met w/ lifestyle change...

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  • October 6, 2024
  • 238
  • 2024/2025
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  • ccfp review part 2 largest with complete solutio
  • ccfp review part 2 largest stuvia
  • when target not met w lifestyle change metformi

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CCFP Review PART 2 (largest)

with Complete Solutions


when target not met w/ lifestyle change, metformin and other orals OR if in

HHS/DKA or very symptomatic hyperglycemia (remain on metformin, not

combined w/ most other orals)

often start long acting at hs, ~10u of glargine (or detemir)

go until am FBG <7

can add rapid acting (aspart or lispro) to 10 mins prior to meals (decr hypo

compared to short acting) - ANSWER-When to use insulin in DM2

How to add to DM2 regimen




BS >14mmol/L, presence of urinary or plasma ketones, pH <7.3 and serum

bicarbonate <18mmol/L




Absence of insulin = decr glucose utilization = incr'd triglyceride breakdown

to free FAs = ketone production - ANSWER-DKA dx criteria and mechanism

,T1DM

T2DM w/ african american/latino, male, middle aged, overweight/obese, FHx

DN, new Dx

Poor adherence, depression, wt control, money issues

Not monitoring BS - ANSWER-RF for DKA




Viral studies - rarely done

Stool gram stain, culture & sens - if immunocompromised, IBD, bloody

diarrhea or persistent diarrhea

Ova, cyst and parasites - travel hx, persistent diarrhea

C diff toxin - recent Abx or persistent diarrhea - ANSWER-Investigations for

acute diarrhea




Fever --> salmonella, shigella, campylobacter , enteric viruses, clostridium

difficile, entamoeba histolytica




Blood --> Escherichia coli, entamoeba histolytica, campylobacter, salmonella

- ANSWER-Which microrgansims are involved when diarrhea is accompanied

by fever?

,With bloody diarrhea?




If no red flags

Rehydration and supportive care

Avoid solid food or dairy

BRAT diet (banana, rice, apple sauce, toast)

Abx in the following circumstances:

- severe traveller's diarrha (>4 unformed stools/d, fever and blood, pus or

mucous in the stool)

- >8 stools/d

- sx >1 wk

- immunocompromised

- hospitalized patients

Probiotics

Loperamide if no fever or bloody stool - ANSWER-Tx of acute diarrhea




Infection (UTI, PNA, sepsis) ~30%, EtOH, psych stress, pregnancy, CV events

(CVA.MI), trauma, Rx (steroids, thiazide), Cushing's, acute GI illness,

idiopathic in ~40% - ANSWER-Precipitants of DKA

, polyuria or polydipsia, fatigue, lethargy, decr appetite, h/a, n/v, abdo pain




decr skin turgor, decr sweat, postural hypoTN, kussmaul breathing, fruity

smelling breathing




ALWAYS LOOK FOR PRECIPITANT - ANSWER-Sx/signs of DKA




Ketosis -

starvation ketosis - G close to n

EtOH ketoacidosis - N/decr gluc, osmolar gap

pseudo ketosis - N gluc, N gap

rhabdomyolysis - N gluc, ketones




Acidosis -

lactic

salicylate - N/decr gluc

methanol - low ket, blurry vision, osmolar gap

ethylene glycol - N ket, osmolar gap

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