Diabetes Pales Flashcards
DKA
hyperglycemia >250
acidosis <15
serum ketone positive
DKA path
body needs energy - liver breaks down fats into ketones
DKA in DM I and II
only in insulin deficient states
DM I - kids - presentation
-college kid forgets to take insulin
DM II - late stage beta cell failure - during stress
-very high blood glucose
DKA clinical
high mortality
polyuria/polydipsia weak decreased appetite nausea/abdominal pain mental status changes
kussmauls respirations
DKA
fruit breath
ketones
-DKA
potassium in DKA
high in serum
decreased total body K
develop arrhythmia
important to replace K early with insulin therapy
insulin and K
drives back into cells
DKA tx
IV insulin
most important** - normalization of anion gap
also give glucose - to correct low sugars
patient with DKA dies from
low pH
-so use insulin to treat the acidosis
hyperosmolar hyperglycemic non-ketotic state
hyperosmolar coma
hyperglycemia >600 serum osm >310 (thick) no acidosis** bicarb >15 normal anion gap
hypovolemic shock
only DM II
patient dehydrated with no acidosis
hyperosmolar coma
osmotic diuresis - increased serum osm - causes hyperglycemia - cycle continues
older patient neglected, lives at home
hyperosmolar hyperglycemic non-ketotic state
high glucose with no acidosis
hyperosmolar hyperglycemic non-ketotic state
tx hyperosmolar hyperglycemic non-ketotic state
IV fluids**
some insulin
electrolytes
ventilation
DKA
insulin tx
hyperosmolar hyperglycemic non-ketotic state
fluid tx
hypoglycemic coma
blood glucose <80
BG <50
coma/passing out
beta blockers
mask hypoglycemic response
-tachy, sweating
hypoglycemia unawareness
hypoglycemia
symptom - not diagnosis
hungry, headache, shaky, confused, dizzy, grumpy, sweaty
hypoglycemia
tx hypoglycemic coma
oral glucose
IV dextrose
glucagon subQ
microvascular complications of DM
neuropathy
nephropathy
retinopathy
macrovascular complications of DM
atherosclerosis
- MI
- stroke
- amputations
- bowel ischemia
non-proliferative retinopathy
most common DM II
aka background
microaneurysms, dot hemorrhages, retinal edema
proliferative retinopathy
most common DM I
growth of new caps and fibrous tissue within retina
-cotton wool spots
DM I
more microvascular
DM II
more macrovascular
diabetic cataracts
more quickly than non-DM
lens swelling
ocular complication of DM
high BG draws fluid into lens - blurry vision
diabetic nephropathy
focal, segmental, glomerulosclerosis
lots of fluid to kidney (osmotic diuresis) - infiltration - increased pressure and scarring
screen for albumin**
peripheral neuropathy
often first complication of DM
stocking-glove pattern
positive and negative signs
motor neuropathy - in advanced cases
severe pain on front of thigh and quad weakness
femoral nerve
-diabetic neuropathy
monofilament test
one sharp sensation in multi spots
test for diabetic neuropathy
charcot foot
collapse of midfoot
diabetic neuropathic atrophy
4 conditions of charcot foot formation
1 loss of sensation
2 initial trauma
3 repetitive trauma
4 good blood flow to foot
postural hypotension
autonomic neuropathy
-complication of diabetes
no tx
diabetic gastroparesis
weight loss, malnutrition, N/V
complication of diabetes
diagnosis of diabetic gastroparesis
gastric emptying study
neurogenic bladder, impotence, sweating, temp dysregulation
complication of diabetes
-autonomic neuropathies
heart disease and stroke
2-4x more likely to have heart disease with diabetes
4x more likely to have stroke
metabolic complications of diabetes
dyslipidemia
high LDL
high triglycerides
low HDL
dermatologic complications of diabetes
chronic pyogenic infections
frequent boils from immune dysregulation
yeast infections
necrobiosis lipoidica diabetorum
derm complication of diabetes
can be treated with steroids - mistaken for cellulitis
blood sugar finger stick
just gives a snapshot of particular time
but several throughout day can give trend
measure of HbA1c
measure of blood sugar over last 8-12 weeks
goal is 7%
correlates with risk of complications
HgA1c
conditions that shorten RBC life span**
will falsely decrease HbA1c
hemolytic anemia
hypersplenism
frequent transfusions
aplastic anemia
RBC live longer
-gives false rise in HbA1c
continuous glucose monitoring
gives you a graphy over about 3 days of monitoring
study conclusion
intensive control of DM - positive effect on decreasing microvascular complications
modest positive effect on rate of macrovascular complications
goal of HbA1c = 7**
sulfonylurea
increase insulin secretion - block K channels of beta cells in pancreas
glyburide - 2nd generation -
-excreted by kidney - renal disease - get hypoglycemia
adverse effect sulfonylurea
hypoglycemia
chronic renal failure
use 1st gen sulfonylurea
-glipizide/glimepride
meglitinides
close ATP dependent K channels on beta cells
take with meals - skip meal/skip dose
very short acting***
biguanides
metformin - DOC
decresed glucose production by liver**
increased insulin sensitivity of receptors
promote weight loss and no hypoglycemia
averse of biguanides
lactic acidosis
TZD
increased insulin sensitivity**
decreased hepatic gluconeogenesis
may cause weight gain
lots of weight gain
with TZDs
alpha glycosidase inhibitor
decreased absorption at brush border
CI - GI disorder
tx approach to DM
diet and lifestyle mods
plus metformin
if fail oral hypoglycemics - insulin
insulin therapy
longer effect with renal insufficiency
sabojyi effect
rebound hyperglycemia
- high dose of insulin at night
- high drop in BP
- stimulate cortisol secretion
- very high glucose in morning
night sweats
tx - decrease meds
dawn phenomenon
morning - spike of hormones that work against insulin - high blood glucose
tx - increase meds
