Diabetes Flashcards
Glucagon
Secreted by alpha cells. Elevates glucose in blood.
Insulin
Secreted by beta cells. Decreases blood glucose.
Metabolic syndrome
Group of conditions that increase risk of heart disease, DM2, premature death. Abdominal obesity, impaired glucose metabolism, dyslipidemia, HTN.
Total cholesterol
<200
Triglycerides
<150
HDL
> 40 - men
> 50 - women
LDL
< 100 optimal. > 160 high risk for CAD
A1C
4-6% normal, >6.5 = diabetes
Diabetes diagnosis lab values
A1C >6.5
FPG (fasting) >126
OGTT - 2 hour >200 (pregnancy)
Dawn phenomenon
Hyperglycemia upon waking from excessive release of GH and cortisol in AM.
Tx: Increase insulin dose or change time or administration
Somogyi phenomenon
Hypoglycemia around 2-3am –> bld glucose rebounds to hyperglycemic state by 7am. Can cause early AM headache, night sweats, nightmares.
Tx: decrease bedtime insulin or increase bedtime snack.
Rule of 15
15g carb (1/2 banana, 1/2 cup OJ, 1 tbsp sugar or honey, 4-5 crackers, 1 slice of bread)
- recheck BG after 15 min
- if still hypo, repeat
Tx for hypoglycemia
If can’t eat - IM or subq glucagon 1mg. Onset 10 min, duration 60-90 min
or IV dextrose (injectable glucose) onset immediately, duration 30 min
Kussmaul respirations
deep rapid breaths, body trying to compensate by blowing of CO2
DKA
life threatening comp of DM1
hyperglycemia, acidosis, ketonuria
sudden onset. Factors that can contribute to it: infx, stressors, inadequate insulin dose, new onset diabetes, MI
Signs of DKA
polyuria, polydipsia, weight loss, N/V, abd pain, Kussmauls breathing, fruity breath, dehydration. Late signs: neuro changes, lethargy, coma
Lab values in DKA
- glucose >300
- +ketones bld and urine
- metabolic acidosis (low ph, very low HCO3, low CO2 trying to compensate)
- hyponatremia < 135
- hyperkalemia >5
DKA tx
- restore circulating blood volume / treat dehydration (IV fluid)
- treat hyperglycemia with insulin IV
- correct electrolyte imbalances
HHS (hyperosmolar hyperglycemia state)
extreme hyperglycemia without ketosis or acidosis - mostly seen in DM2. Gradual onset. Precipitating factors: infx, stressors, poor PO intake.
Signs of HHS
neuro symptoms, dehydration or electrolyte loss
HHS tx
fluid replacement, correct electrolyte imbalances, give insulin, check for infx
Diabetic nephropathy
- decrease in kidney function
- assess: microalbuminuria (urine), BUN/creatinine
- intervention: prevent by controlling BG and BP, restrict dietary protein/sodium/potassium, avoid nephrotoxic medications
Nephrotoxic meds
acetaminophen, aspirin, many antibiotics
diabetic neuropathy
deterioration of nervous system throughout body - lose sensory perception especially in peripheral.
diabetic retinopathy
impairment of retinal circulation eventually leads to vision changes/blindness
diabetes affect on cardiovascular system
vessel damage, increase risk of clots, atherosclerosis causes blockages - decrease flow, increase risk of hyperlipidemia
claudication
cramping pain in leg induced by exercise, caused by obstruction of arteries
