Keck School of Medicine
Orientation In-Class Exercise - ANSWERS
Exercise 1
Using the resources listed below, answer the following questions related to a 13 year old female with
Diabetes Mellitus, type 1.
Resources: MedlinePlus, AccessMedicine, ACP Medicine, ACS Surgery
Access these resources from the Year I Medical Student Portal:
http://www.usc.edu/hsc/nml/portals/students/yr1.html
1. Symptoms: What symptoms are associated with type 1 diabetes?
Hint: MedlinePlus, AccessMedicine
Answer: (MedlinePlus):
 Being very thirsty
 Urinating often
 Feeling very hungry or tired
 Losing weight without trying
 Having sores that heal slowly
 Having dry, itchy skin
 Losing the feeling in your feet or having tingling in your feet
 Having blurry eyesight
Answer: (AccessMedicine)
 Increased thirst (polydipsia)
 Increased urination (polyuria)
 Increased appetite (polyphagia) with weight loss
 Ketoacidosis
 Paresthesias
 Recurrent blurred vision
 Vulvovaginitis or pruritus
 Nocturnal enuresis
 Postural hypotension from lowered plasma volume
MedlinePlus:
 Search: type 1 diabetes (OR) diabetes mellitus type 1. (Not a Boolean operator OR; don’t OR
phrases together.)
 Select: Diabetes Type 1
AccessMedicine:
 Search: type 1 diabetes (OR) diabetes mellitus type 1. (Not a Boolean operator OR; don’t OR
phrases together.)
 Topic outline on left pane → symptoms and signs
 Select: Symptoms and Signs (Quick Answers)
2. Diagnosis: What lab tests are recommended in the diagnosis of type 1 diabetes?
Hint: AccessMedicine
Answer: (AccessMedicine)
 Fasting plasma glucose
 Ketonemia, ketonuria, or both
 Glucosuria (Clinistix, Diastix)
 Ketonuria (Acetest, Ketostix)
 Glycosylated hemoglobin (hemoglobin A1c)
 Serum fructosamine
 Lipoprotein abnormalities
AccessMedicine:
 Search: type 1 diabetes (OR) diabetes mellitus type 1. (Not a Boolean operator OR; don’t OR
phrases together.)
 Topic outline on left pane → lab tests
 Select: Laboratory Tests (Quick Answers)
3. Management: what is the best treatment for diabetes type 1?
Hint: ACP Medicine
Answer: (ACP Medicine)
 Daily self-management by the patient, many lifestyle adaptations
 Frequent contact with physician
o Illness, unusual stress, ketosis require consultation
 Insulin Replacement…see resource for more detail
 Insulin Preparations…see resource for more detail
 Pramlintide (Amylin) …see resource for more detail
 Lifestyle Measures…see resource for more detail
 Diabetic Emergencies….lists treatments
ACP Medicine:
 Search: type 1 diabetes (OR) diabetes mellitus type 1 (OR) diabetes type 1
 Select: Section 09 Chapter I Type 1 Diabetes Mellitus
 Choose Best Dx/Best Rx tab at top. Scroll down to Best Therapy.
4. Preoperative management: what are the recommendations for preoperative care in patients with
diabetes?
Hint: ACS Surgery
Answer: (ACS Surgery)
 Metabolic monitoring
 Admission may have to be scheduled for the day before the operation
 Target blood glucose levels before operation should be less than 125 mg/dl (6.9 mmol/L) during
fasting and less than 180 mg/dl (10.0 mmol/L) postprandially



Long-acting insulins should be replaced with intermediate-acting insulins
Use of metformin should be stopped
Dehydrated should be corrected before operation
ACS Surgery:
 Search: type 1 diabetes (OR) diabetes mellitus type 1. (Not a Boolean operator OR; don’t OR
phrases together.)
 Select: Section 08 Chapter 10 Endocrine Problems
Exercise 2
Using the resources listed below, answer the following questions related to a 13 year old female with
Diabetes Mellitus, type 1.
Resources: UpToDate, ACP Pier, Essential Evidence Plus, OvidSP MEDLINE (Basic Search)*
*When searching OvidSP MEDLINE, choose the 1950-2009 database and change search to Basic Search
Access these resources from the Year I Medical Student Portal:
http://www.usc.edu/hsc/nml/portals/students/yr1.html
1. How might you predict which patients will develop type 1 diabetes?
Hint: UpToDate
Answer: (UpToDate)
genetic markers, immunologic markers (3 kinds), metabolic markers
UpToDate:
 Search: type 1 diabetes (OR) diabetes mellitus type 1. (Not a Boolean operator OR; don’t OR
phrases together.)
 Select: Prediction of type 1 diabetes mellitus
 Topic outline on left pane → Use of markers to predict type 1 diabetes
2. What non-drug therapies are recommended for patients with type 1 diabetes?
Hint: ACP Pier
Answer: (ACP Pier)
1. Individualize diet and exercise regimens for each patient.
2. Inform patients who are in good control and do not have serious complications how to exercise
safely.
3. Emphasize to patients the importance of smoking cessation.
4. Follow and treat retinopathy to prevent vision loss.
5. Treat foot ulcers quickly and aggressively.
ACP Pier:



Search: type 1 diabetes (OR) diabetes mellitus type 1. (Not a Boolean operator OR; don’t
OR phrases together.)
Select ACP Pier & AHFS DI Essentials
Topic outline on left pane → Non-drug therapy
3. Epidemiology: What is the cumulative risk for type 1 diabetes in siblings of patients with childhoodonset diabetes?
Hint: Essential Evidence Plus
Answer: (Essential Evidence Plus)
The cumulative risk of type 1 diabetes up to ages 10, 20, 30, 40, and 50 years in brothers and sisters of
patients with childhood-onset diabetes is 1.5%, 4.1%, 5.5%, 6.4%, and 6.9%.
Essential Evidence Plus:
 Search: type 1 diabetes (OR) diabetes mellitus type 1. (Not a Boolean operator OR; don’t OR
phrases together.)
o EE+ will auto-fill diabetes mellitus, type 1
 Refine your results by (left pane)
o Choose Epidemiology
 Select: Familial risk of type 1 diabetes among siblings
4. Can vitamin D supplementation given to children early on in life offer protection against the
development of type 1 diabetes?
Hint: OvidSP MEDLINE
Answer: (OvidSP MEDLINE, basic search)
Vitamin D supplementation in early childhood may offer protection against the development of type 1
diabetes. The evidence for this is based on observational studies. Adequately powered, randomized
controlled trials with long periods of follow-up are needed to establish causality and the best
formulation, dose, duration and period of supplementation.
OvidSP MEDLINE, basic search:
 Search: type 1 diabetes (OR) diabetes mellitus type 1 (OR) type 1 diabetes vitamin d (OR) type 1
diabetes vitamin d children. Must search ‘children’ not ‘childhood’. (Not a Boolean operator
OR; don’t OR phrases together.)
 Select: Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic
review and meta-analysis.