DIABETES PART 2

Question 1

main treatment for hypoglycemia?

Answer 1

juice
glucose tablets
glucagon emergency kit
nasal glucagon

Question 2

how much D50W should be administered?

Answer 2

25 grams intravenously

Question 3

name this type of hyperglycemia:

growth hormone antagonizes action of insulin

increased GH from 12-2 AM

• reduces sensitivity to insulin in early morning hours
• raises BG levels
• 3 am BG will be high

Answer 3

AM hyperglycemia

Dawn phenomenon

Question 4

name this type of hyperglycemia:

nocturnal hypoglycemia

• surge of counterregulatory hormones
• high AM BG

3 am BG will be low

Answer 4

AM hyperglycemia

Somogyi effect

Question 5

name this presentation?

kussmaul respirations
fruity odor
abdominal pain
-present in 30%
elevated amylase level
-presen tin 90%

polyuria, polydipsia, weight loss
evolves rapidly
abdominal pain and hyperventilation
neurologic changes only in severe acidosis
serum glucose 350-800
high AG MAC bicarbonate level <15 mEq/L
plasma osmolality lower
larger ketone bodies

Answer 5

DKA

Question 6

name this presentation?

insulin is still being produced
polyuria, polydipsia
dry mucous membranes
mental status changes
-weakness, malaise, lethargy
-focal neurologic defects, disturbance in visual acuity, delirium, coma

polyuria, polydipsia, weight loss
more gradual
abdominal pain unusual
lethargy, focal signs, obtundation from greater degree of hyperosmolality
serum glucose 600-1000 mg/dL
minimal acidosis
bicarbonate level >15 mEq/L
plasma osmolality 320-380 mosm/kg
small ketone bodies

Answer 6

HHS

Question 7

insulin will push K into the cells in DKA causing, hypo or hyper- kalemia?

Answer 7

hypokalemia

Question 8

how is DKA and HHS managed?

Answer 8

correction of fluid and electrolyte abnormalities

administration of insulin

infusion of isotonic saline

add K to the fluid if K is 3.3-5.3 mEq/L

insulin bolus followed by an insulin infusion

potassium repletion if K<3.3 meq/L

change to dextrose containing fluid

• DKA200 mg/dL
• HHS 250-300 mg/dL

Question 9

emphasis:

don’t start insulin until the K is supplemented
add glucose when the BG drops, but don’t stop the insulin
stop the insulin when the ketosis is cleared

Answer 9

remember

Question 10

when is bicarbonate therapy indicated?

Answer 10

pH<6.9, not if pH>7; consider if severe hyperkalemia >6.4 mEq/L to push K into cells

Question 11

when is DKA resolved? HHS?

what to do once acidosis is resolved?

Answer 11

keto acidosis is resolved, anion gap <12 mEq/L and normalization of beta hydroxybutyrate levels

mentally alert, plasma osmolality <315 mOsml/kg

basal and bolus insulin