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Endo II Exam 2 > Diabetes Pales > Flashcards

Diabetes Pales Flashcards

1
Q

DKA

A

hyperglycemia >250
acidosis <15
serum ketone positive

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2
Q

DKA path

A

body needs energy - liver breaks down fats into ketones

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3
Q

DKA in DM I and II

A

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

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4
Q

DKA clinical

A

high mortality

polyuria/polydipsia
weak
decreased appetite
nausea/abdominal pain
mental status changes
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5
Q

kussmauls respirations

A

DKA

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6
Q

fruit breath

A

ketones

-DKA

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7
Q

potassium in DKA

A

high in serum
decreased total body K

develop arrhythmia

important to replace K early with insulin therapy

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8
Q

insulin and K

A

drives back into cells

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9
Q

DKA tx

A

IV insulin

most important** - normalization of anion gap

also give glucose - to correct low sugars

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10
Q

patient with DKA dies from

A

low pH

-so use insulin to treat the acidosis

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11
Q

hyperosmolar hyperglycemic non-ketotic state

A

hyperosmolar coma

hyperglycemia >600
serum osm >310 (thick)
no acidosis**
bicarb >15
normal anion gap

hypovolemic shock

only DM II

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12
Q

patient dehydrated with no acidosis

A

hyperosmolar coma

osmotic diuresis - increased serum osm - causes hyperglycemia - cycle continues

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13
Q

older patient neglected, lives at home

A

hyperosmolar hyperglycemic non-ketotic state

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14
Q

high glucose with no acidosis

A

hyperosmolar hyperglycemic non-ketotic state

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15
Q

tx hyperosmolar hyperglycemic non-ketotic state

A

IV fluids**

some insulin
electrolytes
ventilation

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16
Q

DKA

A

insulin tx

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17
Q

hyperosmolar hyperglycemic non-ketotic state

A

fluid tx

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18
Q

hypoglycemic coma

A

blood glucose <80

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19
Q

BG <50

A

coma/passing out

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20
Q

beta blockers

A

mask hypoglycemic response
-tachy, sweating

hypoglycemia unawareness

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21
Q

hypoglycemia

A

symptom - not diagnosis

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22
Q

hungry, headache, shaky, confused, dizzy, grumpy, sweaty

A

hypoglycemia

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23
Q

tx hypoglycemic coma

A

oral glucose
IV dextrose

glucagon subQ

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24
Q

microvascular complications of DM

A

neuropathy
nephropathy
retinopathy

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25
Q

macrovascular complications of DM

A

atherosclerosis

  • MI
  • stroke
  • amputations
  • bowel ischemia
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26
Q

non-proliferative retinopathy

A

most common DM II

aka background

microaneurysms, dot hemorrhages, retinal edema

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27
Q

proliferative retinopathy

A

most common DM I

growth of new caps and fibrous tissue within retina
-cotton wool spots

28
Q

DM I

A

more microvascular

29
Q

DM II

A

more macrovascular

30
Q

diabetic cataracts

A

more quickly than non-DM

31
Q

lens swelling

A

ocular complication of DM

high BG draws fluid into lens - blurry vision

32
Q

diabetic nephropathy

A

focal, segmental, glomerulosclerosis

lots of fluid to kidney (osmotic diuresis) - infiltration - increased pressure and scarring

screen for albumin**

33
Q

peripheral neuropathy

A

often first complication of DM

stocking-glove pattern

positive and negative signs

motor neuropathy - in advanced cases

34
Q

severe pain on front of thigh and quad weakness

A

femoral nerve

-diabetic neuropathy

35
Q

monofilament test

A

one sharp sensation in multi spots

test for diabetic neuropathy

36
Q

charcot foot

A

collapse of midfoot

diabetic neuropathic atrophy

37
Q

4 conditions of charcot foot formation

A

1 loss of sensation
2 initial trauma
3 repetitive trauma
4 good blood flow to foot

38
Q

postural hypotension

A

autonomic neuropathy
-complication of diabetes

no tx

39
Q

diabetic gastroparesis

A

weight loss, malnutrition, N/V

complication of diabetes

40
Q

diagnosis of diabetic gastroparesis

A

gastric emptying study

41
Q

neurogenic bladder, impotence, sweating, temp dysregulation

A

complication of diabetes

-autonomic neuropathies

42
Q

heart disease and stroke

A

2-4x more likely to have heart disease with diabetes

4x more likely to have stroke

43
Q

metabolic complications of diabetes

A

dyslipidemia

high LDL
high triglycerides
low HDL

44
Q

dermatologic complications of diabetes

A

chronic pyogenic infections

frequent boils from immune dysregulation

yeast infections

45
Q

necrobiosis lipoidica diabetorum

A

derm complication of diabetes

can be treated with steroids - mistaken for cellulitis

46
Q

blood sugar finger stick

A

just gives a snapshot of particular time

but several throughout day can give trend

47
Q

measure of HbA1c

A

measure of blood sugar over last 8-12 weeks

goal is 7%

48
Q

correlates with risk of complications

A

HgA1c

49
Q

conditions that shorten RBC life span**

A

will falsely decrease HbA1c

hemolytic anemia
hypersplenism
frequent transfusions

50
Q

aplastic anemia

A

RBC live longer

-gives false rise in HbA1c

51
Q

continuous glucose monitoring

A

gives you a graphy over about 3 days of monitoring

52
Q

study conclusion

A

intensive control of DM - positive effect on decreasing microvascular complications

modest positive effect on rate of macrovascular complications

goal of HbA1c = 7**

53
Q

sulfonylurea

A

increase insulin secretion - block K channels of beta cells in pancreas

glyburide - 2nd generation -
-excreted by kidney - renal disease - get hypoglycemia

54
Q

adverse effect sulfonylurea

A

hypoglycemia

55
Q

chronic renal failure

A

use 1st gen sulfonylurea

-glipizide/glimepride

56
Q

meglitinides

A

close ATP dependent K channels on beta cells

take with meals - skip meal/skip dose

very short acting***

57
Q

biguanides

A

metformin - DOC

decresed glucose production by liver**

increased insulin sensitivity of receptors

promote weight loss and no hypoglycemia

58
Q

averse of biguanides

A

lactic acidosis

59
Q

TZD

A

increased insulin sensitivity**

decreased hepatic gluconeogenesis

may cause weight gain

60
Q

lots of weight gain

A

with TZDs

61
Q

alpha glycosidase inhibitor

A

decreased absorption at brush border

CI - GI disorder

62
Q

tx approach to DM

A

diet and lifestyle mods
plus metformin

if fail oral hypoglycemics - insulin

63
Q

insulin therapy

A

longer effect with renal insufficiency

64
Q

sabojyi effect

A

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

65
Q

dawn phenomenon

A

morning - spike of hormones that work against insulin - high blood glucose

tx - increase meds

Endo II Exam 2 (16 decks)

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