Diabetes mellitus

1. Thirst in uncontrolled diabetes mellitus is due to

• Elevated blood sugar contributing to serum osmolality
• Thirst centers in the hypothalamus are insulin dependant for glucose utilization
• Contraction of extracellular fluid
• All of the above
• None of the above

2. Sugar spills in urine when blood glucose levels exceeds renal threshold of

• 250
• 180
• 140

3. Glucose contributes to serum osmolality

• 5 mOsm per 100 mg/dl
• 10 mOsm per 100 mg/dl
• 20 mOsm per 100 mg/dl

Contribution of glucose to serum osmolality is relatively limited.

4. Each gram of glucose loss in urine amounts to loss of

• 6.5 calories
• 5.2 calories
• 4.1 calories

5. Daily caloric needs for a male with body weight of 160 lbs and moderate activity level

• 2560
• 2100

10 calories per pound of body weight for basal requirements, plus 3 calories per pound for sedentary activity, 6 calories per pound for moderate activity and 9 calories per pound for intense activity.

6. Ideal body weight for a male 5 feet 9 inches tall

• 155
• 165
• 175

For men 110 lbs for 5 feet of height, and 5 lbs for each additional inch. For females it is the same, but at 100 lbs for 5 feet of height.

7. To loose 1 pound of body weight per week, you need to have a deficit of

• 3500 calories per week
• 7000 calories per week
• 1400 calories per week

It should be gradual, 500 calories deficit per day would yield loss of 3500 calories per week, which will result in loss of 1 pound.

8. Endogenous Insulin is increased by

• Glyburide
• Metformin
• Acarbose

Metformin does not induce endogenous release of insulin. It reduces insulin resistance and facilitates glucose utilization by cells.

Acarbose slows carbohydrate absorption and improves post-prandial serum glucose levels.

9. Best way to adjust insulin dose is by monitoring

• Urine glucose
• Blood glucose
• HbA1c

Urine glucose spillage occurs only when the blood glucose levels exceed renal threshold for glucose. 24 hour urine collection can give a quantitative measurement to assess diabetic control.

HbA1c is useful in giving an overall picture of metabolic control, are not helpful in making specific adjustments in insulin therapy.                                     

10. Best agent for pharmacotherapy for hypertension in a diabetic is

• Diuretic
• Beta blocker
• Calcium channel blockers
• Angiotensin converting enzyme inhibitors

Diuretics and beta blockers may cause metabolic deregulation and dyslipidemia.  Beta blockers may cause hypoglycemia unawareness and impairment of glycogen breakdown, which may interfere with correction of hypoglycemia. Calcium channel blockers and angotensin converting enzyme inhibitors are preferred agents.

11. In diabetic ketoacidosis the blood CO2 levels are

• Normal
• Low
• High

Respiratory centers are extremely sensitive to acidic pH. Ventilation increases and CO2 gets blown out. This is also a respiratory compensation for metabolic acidosis. If CO2 levels are normal, in the presence of metabolic acidosis one should suspect a co-existent obstructive lung disease.

12.In  type II diabetes there is

• Insulin deficiency
• Insulin resistance
• Both

There is relative insulin deficiency. It is not completely absent as in type I diabetes.

13. Insulin is essential for

• Glucose transport into cells
• Protein synthesis
• Free fatty acid storage in adipose tissue
• All of the above

14. Blood levels of glycosylated hemoglobin

• Useful to monitor the long-term effectiveness of diabetic therapy
• Reflects average blood glucose levels during the preceding 2 to 3 months
• Normal levels <6.5
• Not useful in adjusting insulin dose
• All of the above