Diabetes Flashcards
Diabetic ketoacidosis
History:
May have no PMH - Maybe first presentation diabetes
Other physiologic stressor -> DKA
-Missed insulin doses
-Major stressor: MI, PNA, Meningitis, or Other an infection
S/S:
Polydipsia, polyuria
Nausea, vomiting, abdominal pain
Neuro: AMS, coma
Exam:
Volume depleted - Tachycardic, hypotensive
Kussmaul breathing - Regular, deep, labored breathing; Compensating for metabolic acidosis
Sweet/fruity breath
Tests: ABG - evaluate acidosis Urine ketones plasma ketones plasma osmolality elevated 2/2 hyperglycemia CBC UA CXR ECG LFTs - w/ abdominal pain, n/v HgbA1c
Management: Admitted to ICU Central IV access IV regular insulin - Insulin drip IV normal saline IV potassium Stop insulin drip when the anion gap is normalized Search for the underlying causes DKA
Key differences in T1DM and T2DM
- Pathophysiology
- Body habitus
- Age of onset
- Acute complication
T1: Pathophysiology - Beta cell destruction Body habitus - normal/thin Age of onset - Childhood or adolescence Acute Complication - DKA
T2:
Pathophysiology - Insulin resistance, acanthosis nigricans
Body habitus - Overweight or obese
Age of onset - Older are usually over 40
Acute complication - Hyperosmolar hyper glycemic state
Features of HHS That help distinguish from DKA
More gradual onset - Several days Minimal ketosis No acidosis Worst hyperglycemia - >800 Common Worst hyperosmolarity -> neuro sxs - obtunded, coma Tx: ICU, IVF, IV insulin, replete K+
diagnostic criteria for diabetes
FBG > or = 126
Random glucose >200 with hyperglycemia symptoms
2 hr OGTT >200
A1c 6.5+
Repeat testing if one is positive
Type II diabetes treatment
Lifestyle modification First line - Metformin diagnosis Sulfonylureas - glimpride, glipizide Thiazolidinediones (TZDs) - pioglitazone, rosiglitazone DDP4i GLP-1 agonists SGLT2 inihibitors Insulin
Screening and management of chronic diabetes complication of hyperglycemi
A1c q6 mo, if not at goal q3 mo
Mgmt: Blood glucose control, lifestyle modification, medications
Screening and management of chronic diabetes complication of Hypertension
Macrovascular complication
Measure the pressure every visit
Management:
Lifestyle modification if BP > 120/80
Medication if BP > 140/90 - ACE/ARB, asa
Screening and management of chronic diabetes complication of Hyperlipidemia
Annual FLP
if over 40 or any CVD risk factors (LDL > 100, HTN, tobacco use, CKD, premature ASCVD) - Treat with statins
Screening and management of chronic diabetes complication of Nephropathy
Measure urine micro albumin:Creatinine ratio annually
If elevated - ACE/ARB
Screening and management of chronic diabetes complication of Retinopathy
Annual dilated eye exam
Tx: intravitreal Injections or laser photocoagulation
Screening and management of chronic diabetes complication of Peripheral neuropathy
Annual foot exam
Tx: Pregabalin, duloxetine
Screening and management of chronic diabetes complication of Gastroparesis
no screening test
Metoclopramide, erythromycin may be used short term
Screening and management of chronic diabetes complication of Autonomic Neuropathy (hypotension, ED)
no screening test
Tx as indicated
Prevention of infections with vaccines in diabetes
Animal flu shot
pneumococcal vaccine
hep B
