Diabetes DIAL Flashcards
What is the most definitive diagnosis of diabetes?
HbA1c of 7.2% or greater
What is the fastest way to check a patient’s blood sugar level?
Dipstick blood glucose
What is the most accurate way to check a patient’s current blood sugar level?
Serum glucose test
If a patient has RBCs with a shortened lifespan what would be considered as a reliable substitute to A1c test to check blood sugar levels?
Serum fructosamine test
What constitutes “severe” hypoglycemia?
Altered mental state AND blood sugar of 40 mg/dL or less (must be symptomatic for “severe”)
What are the typical signs and symptoms of hypoglycemia?
Sweating
Bizarre behavior
Tremor
Coma
What is the best treatment for mild hypoglycemia?
Food
What patient would glucagon be most ineffective?
Alcoholic with low blood sugar
What is glucagon not effective in an alcoholic?
Because glycogen is absent in alcoholics
Why is glycogen absent in alcoholics?
Because ethanol is made into acetyl CoA and then FAs and cannot be formed into glycogen
What oral hypoglycemic agent is the most dangerous in an overdose for pediatrics?
Glipizide (sulfonylurea)
Why are sulfonylureas dangerous in overdose?
The onset can be up to 8 hours and even later, the problems may arise after patient left the ER and is already back home
What is the first line of treatment in the hospital if a patient has low plasma glucose?
Give IV glucose
What is the appropriate pediatric dose of glucose?
0.5-1 g/kg
What is meant by D10W, D25W and D50W?
D10= 10% volume is glucose D25= 25% volume is glucose D50= 50% volume is glucose W= rest of the volume is water
What is the osmolarity of 5% glucose and the calculation?
280 mM
5g/mL x 1 mol/180g x 1000mL/1 L= 280
Why does DKA occur?
Insulin deficiency
What typically is the initial cause of DKA?
GI infections
What are typical signs of DKA?
Tachycardia Tachypnea Fever Hypotension Depressed mental status
Why does hypotension and fever occur in DKA?
Hypotension: GI infection leads to diarrhea and dehydration
Fever: GI infection
What hormone plays the largest role in ketosis?
Glucagon
What two metabolic acids are formed in the blood during DKA?
Acetoacetate
Beta-hydroxybutyrate
What is the dominant ketone body in circulation?
Beta-hydroxybutyrate
Why is acetoacetate not dominate in blood circulation?
Because it is not stable
What occurs to acetoacetate?
Breaks down losing a CO2 and is breathed out
What are typical inciting events for DKA?
MI
Sepsis
Inadequate insulin
What are the values of K and Na in metabolic acidosis?
K: high
Na: low
Anion gap in metabolic acidosis?
High (Na+K)-(Cl+HCO3)
Which ketone is tested for in urine dipstick and why?
Acetoacetate since it reacts with the sodium nitroprusside
