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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

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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)

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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

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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)

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4
Q

Sx of cataracts

A

look up

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5
Q

Exudates and cotton

A

look up

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6
Q

silver copper nicking

A

HTN

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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

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8
Q

Cerebrovascular complications of DM

A

Increased generalized athrosclerosis (would that cause CAD?)

Increased stroke incidence

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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

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10
Q

gastroparesis is a sx of which complication of DM

A

Neuropathy

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

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11
Q

HTN is a sx of which complication in DM

A

NEPHROpathy

also: proteinuria, decreased GFR -> renal failure

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12
Q

What is the #1 cause of renal fail

A

DM

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13
Q

which drug decreases proteinuria and slows progression of renal dz

A

ACE I

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14
Q

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

A

iodinated contrast agents

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15
Q

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

A

neuropathy

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16
Q

Increased atherosclerosis is a sx of which complication of DM

A

Macrovascular complication

along with CAD

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17
Q

Cataracts is a sx of which complication

A

ocular/ retinopathy?

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18
Q

Which are the diabetic ERs

A

Hypoglycemia - rapid, life threatening, death in minutes

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

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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.

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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

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21
Q

Neuroglycopenic sx of hypoglycemia

A

Low CNS glucose:

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

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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

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23
Q

Adrenergic sx of hypoglycemia

A

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

24
Q

clouded vision is a sx of

A

neuroglycopenic sx of hypoglycemia (low sugar in cns)

25
Q

Somogyi Phenomenon

A

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
Q

Tx for Somogui phenomenon

A

Decrease insulin the night before and take a bedtime snack

27
Q

WHat are the 3 causes of AM HYPERglycemia

A

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
Q

Dawn phenomenon is due to

A

GH increases between 3-7 am and increases BS -> hyperglycemia

29
Q

Brittle Diabetes

A

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
Q

D Ketoacidosis

A

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
Q

3 key sx of DM plus other

A

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
Q

In mild to mod DM exam may be

A

normal

33
Q

What will be the findings in PE in more advanced DM

A

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
Q

DM ERs are

A

Hypoglycemia
DKA ketoacidosis
Nonketotic hyperosmolar syndrome (NKHS)

35
Q

What are the criteria to Dx DM (KNOW)

A

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
Q

Normal vs Imparied Fasting Gl vs Impaired Gl TOlerance

A

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
Q

Prediabetic HbA1c is

A

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
Q

HbA1C ranges

A

4-6 normal
5.7 - 6.4 preDM
>= 6.5 DM

in DM, if s well controlled
if 9 - poor control

39
Q

Macrosomia

A

large birth wgt infant due to Gestational DM
URINE gl monitoring is NOT HELPFUL!
SMBG (self monitoring) is VERY impt in pregs

40
Q

Goal for DM

A

pre meal gl - 80-130

peak PP <7 %

41
Q

Goal for pregs DM

A

pre meal: <= 120

42
Q

WHICH TESTS TO ORDER

A

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
Q

High rist pts for DM

A

HTN (>-140/90)
Hyslipidemic pts (HDL <=40)
Preious impaired glucose tolerance (140-199) or imparied fasting glucose (100-125)

44
Q

impaired fasting glucose (IFG) range

A

100-125

45
Q

Impaired glucose tolerance (IGT) range

A

140-199

46
Q

Dipstick will detect

A

sugar
macroalbuminuria if >300
ketones

47
Q

Admit pt if see what in serum

A

Serum KETONES - admit!

48
Q

What would be a clue in the blood work that a pt has metabolic acidosis/DKA (KNOW)

A

LOW CO2 is IMPORTANT CLUE!!!

as well as if SERUM ketones (not just urine ketones) are present = DKA -> admit!!!

49
Q

Ketones

A

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
Q

what are the causes of ketones in urine

A

could be non-diabetic: dehydration, malnutrition, intense exercise

51
Q

When to check insulin levels

A

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
Q

Insulin Antibodies

A

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
Q

C-peptide is only useful if

A

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
Q

If you have low FBS fasting BS and high Insulin and high C-peptide, its

A

INSULINOMA

55
Q

if you have low Fasting BS, high insuline and low C peptide, you have

A

factitious ins injection

56
Q

if you have low Fasting BS, high insulin and high C peptide, you have

A

factitious oral hypoglycemia (don’t understand this one!! Ask)

57
Q

Classic sx of DKA

A

high BS and urine
LOW CO2
+ urinary ketones
+ serum ketones

58
Q

Tx of DKA

A

Look up
Give fluid with insulin? till decrease BS then add dextrose
WATCH K+ when giving fluids

Clin Med II Liza (6 decks)

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