Acute Diabetes Complications

Question 1

DKA favors what diabetes?

Answer 1

type 1

Question 2

HHS favors what diabetes?

Answer 2

type 2

Question 3

which of DKA or HHS has higher mortality?

Answer 3

HHS

Question 4

what is the anti catabolic effect of insulin?

Answer 4

prevents breakdown of large molecule storage forms into energy fuels

Question 5

when there is insulin present in fed state, what happens to free fatty acids?

Answer 5

they are turned into triglycerides

Question 6

when no insulin is present in fed state, what happens to the triglycerides we eat?

Answer 6

they are turned into free fatty acids and ketone bodies

Question 7

how long does it take to develop DKA?

Answer 7

quick…days

Question 8

aside from insulin omission, what are other causes of DKA?

Answer 8

infeciton, steroids, cocaine, glucagon

Question 9

what is a common GI symptom of DKA?

Answer 9

nausea/vomiting with abdominal pain

Question 10

what happens to HR in DKA?

Answer 10

tachycardic

Question 11

what happens to volume status in DKA?

Answer 11

dehydrated with thirst polyuria

Question 12

what happens to blood glucose in DKA?

Answer 12

increases

Question 13

increased free fatty acid delivery to liver in DKA leads to what?

Answer 13

TCA cycle will become overwhelmed and will start to shunt into the ketone formation

Question 14

the high serum glucose leads to what with the kidneys in DKA?

Answer 14

osmotic diuresis

Question 15

what is the kidneys defense to DKA?

Answer 15

ketone body excretion and buffered in urine

Question 16

what is the lungs response to DKA?

Answer 16

kussmaul breathing…hyperventialation

Question 17

what is the indicator of severity in DKA? what is the secon dindicator?

Answer 17

anion gap size is first and level of acidosis is second

Question 18

what are the unmeasured anions in DKA?

Answer 18

the ketones

Question 19

does HHS affect older or younger?

Answer 19

older

Question 20

does onset of HHS take longer or shorter than DKA?

Answer 20

longer

Question 21

how do patients present with HHS?

Answer 21

in a shock like state with dehydration

Question 22

name some common precipitating factors of HHS

Answer 22

infection
vascular thromboses
hemorrhage
pancreatitis
burn
renal failure

Question 23

what are some medications that cause HHS?

Answer 23

steroids
thiazides
phenytoin

Question 24

what is an elderly issue that can lead to HHS?

Answer 24

dementia if patient not accessing H20 well

Question 25

what is seen with blood glucose in HHS?

Answer 25

super high like over 600

Question 26

how is serum osmolality in HHS compared to DKA?

Answer 26

much higher in HHS..over 320

Question 27

how is serum sodium in HHS compared to DKA?

Answer 27

higher

Question 28

what electrolyte has to be replaces in HHS?

Answer 28

potassium

Question 29

what is first step in management of DKA and HHS?

Answer 29

give isotonic fluid for hypotension

Question 30

what is second step after isotonic fluid in DKA and HHS rx?

Answer 30

give hypotonic fluid and add glucose and insulin

Question 31

what must be given in DKA?

Answer 31

IV insulin infusion

Question 32

when do you stop IV insulin infusion in DKA?

Answer 32

once anion gap closed sufficiently

Question 33

what might potassium levels be during DKA? why?

Answer 33

serum potassium may be high because of H+ shifting them out of cells

Question 34

is total body potassium low or high during DKA?

Answer 34

actually low even though you see high serum potassium levels