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D3 Med Manangment > Diabetes > Flashcards

Diabetes Flashcards

1
Q

type I diabetes

A
  • Formerly insulin-dependent or juvenile diabetes
  • Represents 10-15% of all diabetics in the U.S.
  • Onset usually below age 30, usually abrupt, and preceded by weight loss
  • Severely insulin deficient and, therefore, absolutely dependent on insulin therapy
  • Probably an auto-immune disorder
  • Patients are usually slender or frankly underweight
  • May occur in the elderly
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2
Q

type II diabetes

A

-Formerly adult onset or non-insulin dependent diabetes
-Represents 85-90% of all diabetics in U.S.
-Onset usually above age 30, but can occur at any age
-Pancreas produces insulin, but not sufficient to maintain normal glucose levels
-Most patients are also “resistant” to insulin action
-Onset often insidious and classic symptoms may be
absent
-May be controlled by diet and/or oral hypoglycemic drugs
-Usually obese, 65-75% / hypertensive/ hypercholesterolemia
-Genetic/familial component

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3
Q

what are the three P’s in the presentation of diabetes?

A

polyuria (peeing a lot), polydipsia (drinking a lot), polyphagia (eating a lot)

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4
Q

casual plasma glucose value that is diagnostic for diabetes

A

> 200 mg/dl + symptoms of diabetes

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5
Q

Fasting plasma glucose value that is diagnostic for diabetes

A

> 126 mg/dl

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6
Q

2-hour plasma glucose during an oral glucose tolerance test that is diagnostic for diabetes (

A

> 200 mg/dl

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7
Q

Fasting Plasma Glucose

A

FPG < 100 mg/dl = normal fasting glucose

FPG > 100 and 126 = diabetes mellitus

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8
Q

Impaired Glucose Tolerance (IGT):

A

2-hour post glucose load > 140 and <200 mg/dl

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9
Q

Glycosylated hemoglobin/Glycated hemoglobin/ HbA1C/hemoglobin A1c

A
  • Measures percentage of glycosylated hemoglobin
  • Provides estimate of approx. 90-days’ glycemic control (life cycle of an RBC)
  • Normal ranges : approx. 4 to 5.6%
  • DM: > 6.5%
  • Desired goal for diabetics : < 7% (these patients you can treat without reservation)
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10
Q

3 Acute complications for diabetes

A

ketoacidosis
Hypoglycemic
Hyperosmolar

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11
Q

Diabetic pat that has 3 P’s (polyuria, polydypsia, polyphagia), dehydration, rapid deep respirations, abdominal pain, nausea and vomiting is having what high mortality rate acute diabetic complication

A

Diabetic ketoacidosis

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12
Q

Diabetic ketoacidosis usually develops in what diabetic type patient

A

type I

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13
Q

diabetic ketoacidosis

A

Usually develops in Type 1 patient or uncontrolled Type 2 (rare)
-Less insulin leads body to use fatty acids, ketones are byproducts of fat metabolism . “acetone breath”
-Lab – hyperglycemia, acidosis, ketosis
-Usually precipitated by stress, infection, surgery, drugs, or
poor compliance
-Signs and symptoms – 3 P’s, dehydration, rapid deep respirations, abdominal pain, nausea, and vomiting
-High mortality if not rapidly treated! Refer patient immediately if diagnosis suspected

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14
Q

Diabetic acute complication that usually occurs in insulin-treated patients, but may occur in patients on oral agents usually from skipping meals, vigorous exercise, or an error in insulin dosage

A

hypoglycemia

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15
Q

your diabetic patient starts: sweating, trembling, weakness, anxiety, hunger, blurry vision, confusion, seizures, come, and death

A

hypoglycemia

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16
Q

Precipitating factors: skipping meals, vigorous exercise, error in insulin dosage

A

hypoglycemia

17
Q

txt for hypoglycemic patient

A

If patient is alert, give oral glucose.

l If stuporous, start IV line, obtain sample for glucose measure- ment, give IV glucose, and then send to ER

18
Q

hypoglycemia overview

A

Usually occurs in insulin-treated patients, but may occur in patients on oral agents
l Precipitating factors: skipping meals, vigorous exercise, error in insulin dosage
l Signs and symptoms: sweating, trembling, weakness, anxiety, hunger, visual blurring; can progress to confusion, seizures, coma, and death
l Monitor vital signs – measure blood glucose with glucometer
l If patient is alert, give oral glucose.
l If stuporous, start IV line, obtain sample for glucose measure- ment, give IV glucose, and then send to ER

19
Q

Hyperosmolar hyperglycemic non-ketotic coma (Hyperosmolar hyperglycemic state

A

Complication usually of uncontrolled type 2 DM
l Relative Insulin deficit leads to elevated serum glucose (hyperglycemia), that increases serum osmolarity.
l Hyperosmolarity in serum leads to diuresis (polyuria) that further aggravates dehydration
l Can lead to coma and is potentially fatal
l Tx with IV fluids, electrolytes, insulin

20
Q

Complication usually of uncontrolled type 2 DM
l Relative Insulin deficit leads to elevated serum glucose (hyperglycemia), that increases serum osmolarity.
l Hyperosmolarity in serum leads to diuresis (polyuria) that further aggravates dehydration
l Can lead to coma and is potentially fatal
l Tx with IV fluids, electrolytes, insulin

A

Hyperosmolar hyperglycemic non-ketotic coma (Hyperosmolar hyperglycemic state

21
Q

txt for Hyperosmolar hyperglycemic non-ketotic coma (Hyperosmolar hyperglycemic state

A

Tx with IV fluids, electrolytes, insulin

22
Q

3 Acute complications for diabetes

A

ketoacidosis
Hypoglycemic
Hyperosmolar

23
Q

Hyperglycemia:

A

Rare emergency in a dental office, takes more time to develop. Symptoms may mimic hypoglycemia. Hence glucometer is crucial in differentiating the two: small amount of extra glucose administered will have no significant effect

24
Q

3 Chronic complications of Diabetes

A

Vascular (Macro or Micro) Neuropathy (peripheral nerve disfunction)
Mixed vascular/ neuropathic

25
Q

Macrovascular Complications from diabetes

A

Coronary Artery Disease(heart attacks, angina) Cerebrovascular Disease (strokes, TIA’s)
Peripheral Vascular Disease (gangrene, amputations)

26
Q

2 Microvascular complications of Diabetes (

A

Retinopathy (visual impairment) Nephropathy (end stage renal disease)

27
Q

6 Goals of Diabetic Therapy

A

blood sugars in normal range
Avoid hypoglycemia
Achieve/maintain ideal body weight
Maintain normal growth and development in kids Allow pts to live a normal life
Prevent or postpone chronic complications

28
Q

tx for type II diabetes

A

Diet
l Exercise
l Hypoglycemic agents
– Insulin
– Oral agents
l Careful monitoring of blood glucose levels
– Self-monitoring of blood glucose
– Hemoglobin A1c (“average” blood glucose)
measurements
l Careful observation and prompt treatment of complications
l Patient education

29
Q

Very short acting Insulins (he won’t ask drug names)

A

Humalog (Lispro) Novalog

Apidra

30
Q

different classifications of diabetes

A
  • type 1 diabetes mellitus
  • type 2 diabetes mellitus
  • Impaired glucose tolerance (IGT)
  • gestational diabetes
  • other (“secondary”) types of diabetes
31
Q

what is impaired glucose tolerance (IGT)?

A
  • glucose levels are higher than normal but not clearly diagnostic of diabetes
  • patients with IGT have increased risk of atherosclerotic complications
32
Q

gestational diabetes mellitus

A
  • about 4% of pregnancies in the US are accompanied by a degree of glucose intolerance which returns to normal after delivery
  • women thus affected are at a higher risk of developing type 2 DM later in life
33
Q

secondary diabetes

A
  • endocrinopathies: hyperthryroidism,…
  • chronic steroid medication use
  • other medication use: thiazides…
  • genetic syndrome assoication: down’s, klinefelter…
34
Q

what are the different endocrinopathies that can lead to secondary diabetes?

A
  • hyperthyroidism
  • increased GH levels,
  • Cushing’s syndrome
  • Pheochromocytoma
35
Q

what medications can contribute to development of secondary diabetes?

A
  • thiazides
  • statins
  • atypical antipsychotics,
  • protease inhibitors
36
Q

what genetic syndromes are associated with secondary diabetes?

A
  • Down’s
  • klinefelter,
  • turner,
  • huntington’s…

D3 Med Manangment (2 decks)

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