03 Thera VI Management of DM Complications Mak Flashcards
Which patients have a higher risk of getting hypoglycemia?
Patients on medications that promote insulin release (Insulins, Sulfonylureas, Meglitinides)
When is hypoglycemia a concern?
In patients using fast acting and long-duration agents. Elderly with dementia. Long standing DM with defective counter-regulation (no glucagon release when glucose levels are low)
What is the primary complication of DM that leads to hospitalization?
Hypoglycemia
What is the 15-15-15 rule for hypoglycemia?
Give 15g of carbohydrates, wait 15 minutes, check glucose levels. If still low you can repeat
What are good quick carbohydrates to help with hypoglycemia?
Avoid high fat content (slows sugar absorption). Choose simple sugar (fruit juices, hard candies, glucose tablets). Glucose Gel (best choice)
What are the doses for glucagon injections (SQ, IM, IV)?
Adult: 1mg. Pediatric: 0.5mg (if over 20kg use adult dose)
What is done in the ER for hypoglycemia?
50ml D50W
What are the three main symptoms of Diabetic Ketoacidosis?
Kussmahl Breating (d/t acidosis, deep breaths). Glucose level >300s, usually >500s. Fruity breath/UA + Ketones
What type of DM is Ketoacidosis primarily found?
T1DM
What is the main contributor to the formation of Ketoacidosis?
Absolute Insulin Deficiency
What are the primary complications of HHS?
An increase in: Glucagon, Catecholamines, Cortisol, and Growth hormone. THese all lead to Hyperglycemia, which ultimately leads to Hyperosmolarity due to dehydration
What are the primary complications of DKA (Diabetic Ketoacidosis)?
Same as HHS (Hyperglycemia and Hyperosmolarity) as well as Ketoacidosis due to an absolute insulin deficiency
What type of DM patient is DKA primarily found in?
T1DM
What type of DM patient is HHS primarily found in?
More T2DM
What is the difference in symptom duration for DKA and HHS?
DKA: < 2 days. HHS: > 5 days
What is the difference in plasma glucose for DKA and HHS?
DKA: > 250. HHS: > 600
What is the difference in arterial pH for DKA and HHS?
DKA: more acidic
What are the difference in the U and S ketones for DKA and HHS?
Very high in DKA, low for HHS
What is the difference in the serum osmolality in DKA and HHS?
DKA: variable. HHS: > 320
What is the difference in the serum sodium in DKA and HHS?
DKA: 100-nl. HHS: nl-high
What is the difference in the CNS status of DKA and HHS?
DKA: alert to stupor. HHS: stupor/comatose
What is the difference in mortality for DKA and HHS?
DKA: 3-10%. HHS: 10-20%
What are the signature presentations of Diabetic Ketoacidosis (DKA)?
Moderate hyperglycemia (exacerbated 3Ps). Moderate dehydration (sunken eyes, tachycardia). Decreased Na, HCO3, pH, increased BUN/Scr. Large serum or urinary ketones
What are the precipitating factors of DKA?
Infection. Inadequate insulin dosing. Severe physical or emotional stress
What is the treatment of DKA and HHS?
Fluid replacement (need to alter therapy to avoid cerebral edema). Insulin infusion (decrease PG by 50-70 in 1st hour). Potassium replenishment. Bicarbonate (?): consider only if pH < 7.0
What should the normal diet look like?
2000 kcal/day: 60% CHO, 20% Protein, 20% Fat
Why is Fiber good for DM patients?
T2DM patients can significantly lower glucose and insulin levels (by 10%) if they eat a high fiber diet. Higher fiber content diet reduced incidence of GDM. 25g/d for women, 38g/d for men
What is the relationship between smoking and DM?
Increases risk of morbidity and premature deaths (increases macro- and microvascular complications). Associated with development of type 2 DM
What needs to be considered for DM patients and immunization?
Influenza vaccine annually to all DM patients > 6 months of age. Pneumococcal polysaccharide vaccine to ALL diabetic patients > 2 years (one time revaccination for those >64 years previously immunized < 65 years if > 5 years ago
What are the biggest risk reductions with 1% decline in annual mean A1c?
Microvascular disease (37%). PVD (43%)