Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Med II Liza > Diabetes > Flashcards

Diabetes Flashcards

0
Q

Nephropathy complications of DM

A

Proteinuria
HTN
Reduced GFR -> progressive renal fail
-need tight glucose control and ACEI: reduces PROTEINURIA and slows progress of renal dz
-DM is #1 cause of renal fail
-DM pts are at bigger risk for renal problems after admin of contrast agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Microvascular complication of DM

A

Retinopathy (cataract: complain of blurriness, harder to focus HS; proliferative : bunch of smaller vessels with bigger one in the disc?; exudates)
Nephropathy (kidney dz: reduced GFR -> renal fail; HTN, Proteinuria)
Neuropathy (slow, long axons, peripheral: numbness/tingle in feet, cramps, sens/insens to touch, loss of balance; autonomic: urinary incontinence, loss of sex, gastric stasis, ortho hypotension when get up quickly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Neuropathy sx in DM

A

microvascular: progresses slowly and preferentially affects long axons
Pherpheral:
numb/tingling in feet, cramps, sensitivity/insens to touch, loss of balance/coordination
Autonomic sx:
urinary INCONTINENCE, loss of sexual response (erect dysfx, no orgasm in female), gastic stasis (gastroparesis: decreased peristalsis due to nerve damage), orthostatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

orthostatic hypotension is a sx of

A

neuropathy

Ask if get lightheaded when suddenly stand up after sitting (due to lack of vasocontriction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sx of cataracts

A

look up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Exudates and cotton

A

look up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

silver copper nicking

A

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Macrovascular complications of DM

A

1) CAD: DM is equal to CHD in risk factor for statin dose (MI)
2) Cerebrovascular Dz: increased general atherosclerosis
increased stroke
3) Peripheral vascular dz: amputations and ulcers, gangrene with necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cerebrovascular complications of DM

A

Increased generalized athrosclerosis (would that cause CAD?)

Increased stroke incidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

which of the macrovascular complication has a significant risk in DM

A

CAD Coronary Artery Dz

DM is considered to be equivalent of CHF in risk estimation or what dose of statin to give

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

gastroparesis is a sx of which complication of DM

A

Neuropathy

decrease parestalsis -> food builds up -> pt feels bloated, full

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

HTN is a sx of which complication in DM

A

NEPHROpathy

also: proteinuria, decreased GFR -> renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the #1 cause of renal fail

A

DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which drug decreases proteinuria and slows progression of renal dz

A

ACE I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DM pt are at higher risk of renal problems after administration of what?

A

iodinated contrast agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Loss of balance/coord is a sx of which complication of DM

A

neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Increased atherosclerosis is a sx of which complication of DM

A

Macrovascular complication

along with CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cataracts is a sx of which complication

A

ocular/ retinopathy?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which are the diabetic ERs

A

Hypoglycemia - rapid, life threatening, death in minutes

Hyperglycemia - longer, gradual, life-threatening if accompanied by ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hypoglycemic reactions sx (KNOW)

A

Adrenergic sx are related to Epi release:
sweating, tremor, tachycardia, anxiety, weakness, hunger

Neuroglycopenic sx due to low CNS glucose:
Dizziness, HA, clouded/blurred vision, blunted mental acuity, confusion, abnormal behavior, SEIZURES, COMA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx of hypoglycemia

A

If poss, check BS stat
Give glucose asap
if awake and can swallow: give sugar drinks, milk, candy bar, fruit, coke, juice, cheese and crackers take longer - ok for mild

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Neuroglycopenic sx of hypoglycemia

A

Low CNS glucose:

dizzy, HA, confused, blurred vision, blunted mental acuity, abnormal beh, SEIZURES, COMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Tx of hypoglycemia if pt can’t swollow

A

Glucagon 1 mg IM or SQ (Vomiting as SE, so try to prevent aspiration if vomiting occurs)
IV dextrose 20-5-ml of 50% dextrose (D50W) followed by continuous infusion of D5W or D10W to maintain BS above 100 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Adrenergic sx of hypoglycemia

A

sweating, tremor (shakes), tachycardia, ansiety ,weakness, and hunger

24
clouded vision is a sx of
neuroglycopenic sx of hypoglycemia (low sugar in cns)
25
Somogyi Phenomenon
rebound HYPERglycemia due to nocturnal HYPOglycemia (at 2 am due to too high a dose the previous night) and subsequent release of CORTISOL, GLUCAGON, GH ("counter-regulatory Hs) - tx: reduce supper or bedtime insulin dose and/or take a bedtime snack
26
Tx for Somogui phenomenon
Decrease insulin the night before and take a bedtime snack
27
WHat are the 3 causes of AM HYPERglycemia
Waning of insulin action - prior evening insulin dose has worn off : tx - increase dose or change timing of insulin Dawn phenomenon - due to increased GH secretion between 3 and 7 am: GH increases BS. Tx: same as above, increase dose, change timing SOmogyi phenom - rebound hyperglycemia due to hypoglycemia at 2 am due to too high a dose at bedtime -> increase cortisol, glucagon and GH to counter hypoglycemia -> results in hyperglycemia Tx: reduce dose , take snack
28
Dawn phenomenon is due to
GH increases between 3-7 am and increases BS -> hyperglycemia
29
Brittle Diabetes
BS counce from one extreme to other small change in dose -> disproportionate change in BS Must educate patients well ab Dz and how to tx hypoglycemia
30
D Ketoacidosis
life threatening med ER' almost always - type 1 Due to low insulin, infections or other stressors (MI, pregs) SS: N/V!!!! Alert with DM Abd pain Hyperventilation (Kussmaul respirations) natural reaction to acidosis to get rid of CO2 Hypotension/shock/DEHYDRATION Metabolic acidosis with increased ANION GAP Elevated glucose and serum Ketones (must ask lab to order ketones) If have urinary ketones but not serum ketones, it's not DKA (must have serum ketones to have DKA) 3 P: polyuria, polydipsia, polyphagia (+ blurred vision - comes and goes, vaginitis, skin infections, delayed wound healing)
31
3 key sx of DM plus other
Polyuria, polydipsia, polyphagia (later stage: increased app with increased caloric intake) Other: blurred vision - COMES AND GOES vaginitis (vaginal yeast infections) skin infection delayed wound healing
32
In mild to mod DM exam may be
normal
33
What will be the findings in PE in more advanced DM
1) Retinal changes:, dry mucous, feet cataracts (halos around lights, diff't to see at night, blurred/dim vision, sensitivity to light), cotton wool spots (white spots on retina due to nerve damage) / exudates, proliferative retinopathy (growth of new blood vessels that can bleed) 2) Dry mucous membrane 3) Skin/foot changes if infection
34
DM ERs are
Hypoglycemia DKA ketoacidosis Nonketotic hyperosmolar syndrome (NKHS)
35
What are the criteria to Dx DM (KNOW)
1) HbA1c > or = 6.5 2) Fasting pl glucose >= 126 (at least 8 hrs without food) OR 3) 2 hr pl glucose of >=200 after 75 gram oral glucose tolerance test 4) random pl glucose >=200 in a pt with sx of hyperglycemia 5) If no sx of hyperglycemia, confirm first 3 tests by repeating them.
36
Normal vs Imparied Fasting Gl vs Impaired Gl TOlerance
Normal: Fasting <100 Impaired Fasting gl (IFG): 100-125 fasting Impaired Gl tolerance (IGT): 2 hr PP 140-199 after ingesting 75 gr of oral glucose
37
Prediabetic HbA1c is
HbA1c 5.7-6.4 enough to dx with preDM Pt has IFG and IGT advise pt to make lifestyle changes and diet changes. At risk for DM and CVD
38
HbA1C ranges
4-6 normal 5.7 - 6.4 preDM >= 6.5 DM in DM, if s well controlled if 9 - poor control
39
Macrosomia
large birth wgt infant due to Gestational DM URINE gl monitoring is NOT HELPFUL! SMBG (self monitoring) is VERY impt in pregs
40
Goal for DM
pre meal gl - 80-130 | peak PP <7 %
41
Goal for pregs DM
pre meal: <= 120
42
WHICH TESTS TO ORDER
dipstick (detects macroalbumin only >300, urine S, urine ketones) micral test for microalbuminuria (24 hr or spot) can detect btw 30-300 UACR >=30 (Urine Albumine/creat ratio) !!!! Electrolytes (serum CO2 will be LOW)!!! Serum ketones (ask lab) C peptide to ddx type 1 (low) from type 2 or to eval pt with hypoglycemia Classic DKA: high BS, high urine S, LOW CO2, + urinary and SERUM KETONES!!
43
High rist pts for DM
HTN (>-140/90) Hyslipidemic pts (HDL <=40) Preious impaired glucose tolerance (140-199) or imparied fasting glucose (100-125)
44
impaired fasting glucose (IFG) range
100-125
45
Impaired glucose tolerance (IGT) range
140-199
46
Dipstick will detect
sugar macroalbuminuria if >300 ketones
47
Admit pt if see what in serum
Serum KETONES - admit!
48
What would be a clue in the blood work that a pt has metabolic acidosis/DKA (KNOW)
LOW CO2 is IMPORTANT CLUE!!! | as well as if SERUM ketones (not just urine ketones) are present = DKA -> admit!!!
49
Ketones
when body can't use sugar for fuel due to lack of insulin, body burns fat and byproducts are ketones _> build up in blood and spill over to urine
50
what are the causes of ketones in urine
could be non-diabetic: dehydration, malnutrition, intense exercise
51
When to check insulin levels
when hypoglycemia and can't figure out why: if hypoglycemic and insulin 6: it suggests : INSULINOMA (insulin secreting tumor) FACTITIOUS INS OR SULFONYLUREA USE INS ANTIBODIES or ins receptor ABs (reducing insulin effectiveness)
52
Insulin Antibodies
50% of pts using insuline will develop no clin significanse unless create ins resistance which will require larger doses of insulin to get adequate insulin lowering effect
53
C-peptide is only useful if
pt has endogenous insulin - NOT used in type 1 can be used to DDx type 1 from 2 (very low in type 1) can be used to further eval hypoglycemic pt and see if has type 1 or type 2
54
If you have low FBS fasting BS and high Insulin and high C-peptide, its
INSULINOMA
55
if you have low Fasting BS, high insuline and low C peptide, you have
factitious ins injection
56
if you have low Fasting BS, high insulin and high C peptide, you have
factitious oral hypoglycemia (don't understand this one!! Ask)
57
Classic sx of DKA
high BS and urine LOW CO2 + urinary ketones + serum ketones
58
Tx of DKA
Look up Give fluid with insulin? till decrease BS then add dextrose WATCH K+ when giving fluids

Clin Med II Liza (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions