Diabetes Flashcards
diabetes definition
metabolic disease resulting from the breakdown in the ability to either produce or to utilize insulin resulting in hyperglycemia
Type 1 diabetes
most common in adolescents
ketone development occurs
s/s of type 1 diabetes
poyuria
polydipsia
polyphagia
weightloss
labs/diagnostics of type 1 DM
serum fasting glucose( AT LEAST 8 hrs) > 126 or glycated hemoglobin (A1C) > 6.5
Management of Type 1 DM
treatment if individualized
Basal insulin + meal time bolus of a rapid acting or short acting insulin
inslin pumps usually with this demographic
Somogyi effect
nocturnal hypoglyecemia causes a surge of counter regulatory hormones which raises blood surgar
hypoglycemic @ 0300 but rebounds to a high glucose @ 0700
Symogyi effect treatment
reduce bedtime dose of insulin
Dawn Phenomenon
blood glucose becomes progressively increased throughout the night
Dawn Phenomenon treatment
add or increase the bedtime dose of insulin
Type 2 Diabetes is the
most common type of diabetes
circulating insulin exists enough to prevent ketoacidosis but is inadequate to meet patients insulin needs
what is syndrome x?
obesity
hypertesion
abnormal lipid panel (low HDL’s, High Triglycerides)
Metabolic syndrome
only need 3/5- to diagnose
1. waist circumfrance- 40 inch (101.6 cm) in men, >35 cm (88.9 cm) in women
2. BP 130/85
3. Triglycerides > 150
4. FBG- > 100
5. HDL < 40 in men, <50 in women
S/S of Type 2 DM
gradual onset of hyperglycemia
polyuria
polydipsia
peripheral neuropathy
recurrent vaginitis (women)
chronic skin infections
Labs/Diagnostsics of Type 2 BM
same as Type 1, except NO KETONES
Managment of Type 2 DM
- diet/exercise
- Medications
what medication is the standard of care for type 2 DM
Metformin
Blackbox warning of metformin
Lactic acidosis
presentation of lactic acidosis
muscle pain
GLP-1 agonist black back warning
thyroid cancer
REMS program warning for pancreatitis
SGLT2 inhibitor black box warnings
increased risk for foot and leg amputations
Type 1 DM complication is known as
DKA
DKA is a
intracellular dehydration that leads to elevated glucose levels
s/s of DKA
- fruity breath
- Kussmaul’s breathing (HIGH)
- poluria
- weakness/fatigue
labs/ diagnostic of DKA
hyperglycemia > 250/300
- ketonemia and or ketonuria
Hyperosmolality
management of DKA
NS (1st hr) ….1/2 NS (>500 after 1st hour)… when glucose falls < 250 –> D51/2 NS
0.1 u/kg of Regular Insulin bolus + 0.1/kg/hr
bicarb gtt (44- 48 mEq in 900 ml 1/2 NS) for acidosis < 7.1
formula for isulin drip
0.1 u/kg of Regular Insulin bolus + 0.1/kg/hr
Type 2 DM complication is known as
Hyperosmlar Hyperglycemic state (HHS)
HHS is caused by
severe intracellular dehydration WITHOUT Ketone production
patients cannot produce enough insulin to prevent hyperglycemia
s/s of HHS
polyuria
weakness
change in LOC
Signs of dehydration
labs /diagnostics of HHS
serum glucose > 600, usually > 1000
Elevated BUN/Cr
Elevated HA1c
Treatment of HHS
NS (1st hr) ….1/2 NS (>500 after 1st hour)… when glucose falls < 230 –> D51/2 NS
0.1 u/kg of Regular Insulin bolus + 0.1/kg/hr
