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CCFP Review 2025 PART 2 (largest)- Questions and Answers
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CCFP Review 2025 PART 2 (largest)- Questions andAnswers
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) Correct Ans-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 Correct Ans-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 Correct Ans-RF for DKA
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% Correct Ans-
Precipitants of DKA
, CCFP Review 2025 PART 2 (largest)- Questions and
Answers
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 Correct Ans-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
CKD - icnr Cr, hx Correct Ans-Ddx of ketosis/acidosis
glucose (incr, 1-7% N esp w/ SGLT2)
Na, K, HCO3 (anion gap)
, CCFP Review 2025 PART 2 (largest)- Questions and
Answers
ABG/VBG - pH <7.3, bicarb <18mmol/L
Serum/urine for ketones/hydroxybutyrate
Look for secondary
WBC, hgb, Cr, urea, lipase, U/A, UCx, BCx, CXR if suspicious, ECG (MI and hyperkalemia)
Correct Ans-Investigations of DKA
Monitor electrolytes, AG, Cr, plasma osmolality, fluid balance, LOC q2-4 hrs
Tx precipitating factors
Fluid replacement
- if in shock: 1-2L of 0.9% NaCl
- mild to mod 500ml x4H then 250ml x4H
- once euvolemic: if hypernatremic switch to 0.45% NaCl
- once BG <14 mmol/L, add D5W to fluids to maintain BG 12-14
Serum potassium
- if <3.3 mmol/L --> give 40 mmol/L of KCl and hold insulin
- if 3.3 -5.5 mmol/L --> give 10-40 mmol/L and continue insulin, less w/ CKD
, CCFP Review 2025 PART 2 (largest)- Questions and
Answers
Acidosis
- if potassium >3.3 start short acting insulin 0.1u/kg/h IV and adjust so control glucose and
close AG
- when glucose <11.1, titrate insulin down to 0.02-0.05u/kg/h, can switch to sc insulin once
eating
- if pH <7, give 1amp bicarbonate
- AVOID HYPOKALEMIA IN INSULIN AND BICARBONATE TX Correct Ans-Mgmt of DKA
glucose <11.1, bicarb >15, pH >7.3, AG <12
Cerebral edema, hypoglycemia, hypokalemia/hypophosphatemia Correct Ans-When is the
resolution of DKA?
complications of tx?
HHS glucose >33, DKA >13.9
pH >7.3 in HHS, dka <7.3
HHS bicarb >/=18, dka <18
Urine Ketones low in HHS, higher in DKA
Serum ketones normal or low in HHS, high in DKA
AG variable in HHS, DKA >10
Mental status can be variable for DKA, HHS usually is stuporous Correct Ans-Difference
b/w HHS and DKA
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