Diabetes

Question 1

Glucagon

Answer 1

Secreted by alpha cells. Elevates glucose in blood.

Question 2

Insulin

Answer 2

Secreted by beta cells. Decreases blood glucose.

Question 3

Metabolic syndrome

Answer 3

Group of conditions that increase risk of heart disease, DM2, premature death. Abdominal obesity, impaired glucose metabolism, dyslipidemia, HTN.

Question 4

Total cholesterol

Answer 4

<200

Question 5

Triglycerides

Answer 5

<150

Question 6

HDL

Answer 6

> 40 - men

> 50 - women

Question 7

LDL

Answer 7

< 100 optimal. > 160 high risk for CAD

Question 8

A1C

Answer 8

4-6% normal, >6.5 = diabetes

Question 9

Diabetes diagnosis lab values

Answer 9

A1C >6.5
FPG (fasting) >126
OGTT - 2 hour >200 (pregnancy)

Question 10

Dawn phenomenon

Answer 10

Hyperglycemia upon waking from excessive release of GH and cortisol in AM.
Tx: Increase insulin dose or change time or administration

Question 11

Somogyi phenomenon

Answer 11

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.

Question 12

Rule of 15

Answer 12

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

Question 13

Tx for hypoglycemia

Answer 13

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

Question 14

Kussmaul respirations

Answer 14

deep rapid breaths, body trying to compensate by blowing of CO2

Question 15

DKA

Answer 15

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

Question 16

Signs of DKA

Answer 16

polyuria, polydipsia, weight loss, N/V, abd pain, Kussmauls breathing, fruity breath, dehydration. Late signs: neuro changes, lethargy, coma

Question 17

Lab values in DKA

Answer 17

• glucose >300
• +ketones bld and urine
• metabolic acidosis (low ph, very low HCO3, low CO2 trying to compensate)
• hyponatremia < 135
• hyperkalemia >5

Question 18

DKA tx

Answer 18

• restore circulating blood volume / treat dehydration (IV fluid)
• treat hyperglycemia with insulin IV
• correct electrolyte imbalances

Question 19

HHS (hyperosmolar hyperglycemia state)

Answer 19

extreme hyperglycemia without ketosis or acidosis - mostly seen in DM2. Gradual onset. Precipitating factors: infx, stressors, poor PO intake.

Question 20

Signs of HHS

Answer 20

neuro symptoms, dehydration or electrolyte loss

Question 21

HHS tx

Answer 21

fluid replacement, correct electrolyte imbalances, give insulin, check for infx

Question 22

Diabetic nephropathy

Answer 22

• decrease in kidney function
• assess: microalbuminuria (urine), BUN/creatinine
• intervention: prevent by controlling BG and BP, restrict dietary protein/sodium/potassium, avoid nephrotoxic medications

Question 23

Nephrotoxic meds

Answer 23

acetaminophen, aspirin, many antibiotics

Question 24

diabetic neuropathy

Answer 24

deterioration of nervous system throughout body - lose sensory perception especially in peripheral.

Question 25

diabetic retinopathy

Answer 25

impairment of retinal circulation eventually leads to vision changes/blindness

Question 26

diabetes affect on cardiovascular system

Answer 26

vessel damage, increase risk of clots, atherosclerosis causes blockages - decrease flow, increase risk of hyperlipidemia

Question 27

claudication

Answer 27

cramping pain in leg induced by exercise, caused by obstruction of arteries