Diabetes PPt-josh Flashcards
Diabetes:
DM is a disease process that is a resut of what 2 things?
- Inadequate supply of insulin
- inadequate tissue response to insulin
Diabetes:
what are the 2 types?
- Type I
- Type II
IDDM and NIDDM are no onger terms reccommended for use
Insulin:
is synthesized by what cells?
Beta cells
Insulin:
is regulated by what 3 ways
- Chemical
- Hormonal
- Neural
Insulin:
facilitates the uptake of what”?
Glucose
Insulin:
is metabolized by what organs
Liver and kidneys
Type I DM:
represents what % of cases?
5-10%
Type I DM:
___ cells mediated autoimmune destruction of beta cells within the pancreatic islets!
T-cells
Type I DM:
what is teh exact cause?
Unk
Type I DM:
what is up with the insulin?
there is minimal to complete absence of circulating Insulin
Type II DM:
makes up what % of cases
90%
Type II DM:
what is up with the insulin
Slow insensitivity and resistance to insulin
Type II DM:
there is a slow exhaustion of what cells?
Beta
Type I vs Type II:
onset sudden?
1
Type I vs Type II:
onset gradual
II
Type I vs Type II:
onset mostly adulthood
II
Type I vs Type II:
onset any age (mostly young)
I
Type I vs Type II:
THIN bodies
I
Type I vs Type II:
chuncky monkies
II
Type I vs Type II:
Ketoacidosis
I-often
II-rare
Type I vs Type II:
has autobodies
I
Type I vs Type II:
endogenous insulin low or absent
I
Type I vs Type II:
endogenous insulin normal, decreased, or increased
II
DM:
cllinical features!
- Polydipsia
- Polyuria
- Polyphagia
- Tired
- Fungal infection
- poor wound healing
- Deterioration of vision
DM:
complications
- DKA
- HHS
- Microvasular
- Macrovascular
- Autonomic neuopathy
DM:
what are the 3 main microvascular comlications
- Nephropathy
- Neuropathy
- Retinopathy
DKA:
most common in what DM
Type I
DKA:
the glucose levels exceed what
Renal excretion
DKA:
what happens to fluids in the body
Diuresis
Hypovolemia
DKA:
give me quick patho
- Glucose levels exceed renal tubular excretion
- Diuresis and hypovolemia ensue
- Increased ketoacidosis
- Substantial deficits of water K+ Na+ and Phosphorus
HHS:
more common in what type
II
HHS:
onset is how long or fast
days weeks
HHS:
the persistent glycosuric diuresis leads to what?
- Polyuria
- polydipsia
- hypovolemia
- hypotension
- tachycardia
- organ hypoperfusion
- mental obdunation
DKA:
treatment
rehydration with normal saline,
insulin drip
electrolyte supplementation
Important to note that you must correct sodium level as you correct hyperglycemia or devastating cerebral edema may result.
HHS:
treatment
- rehydration with normal saline
- insulin drip
- electrolyte supplementation
- (electrolyte disturbances won’t be as severe)
Nephropathy
occurs more with what type
type I
Nephropathy:
causes what complication to kidneys
Glomerulosclerosis
-a scarring and hardening of the glomeruli, tiny blood vessels that are involved in filtering urine. Along with this, glomerular basement membrane thickening and arteriosclerosis and tubulointerstitial disease.
Nephropathy:
Symptoms
- hypertension
- albuminuria
- peripheral edema
- progressive decrease in GFR.
Nephropathy:
When the GFR decreases below __-__ ml/min the body cannot excrete potassium and acids leading to hyperkalemia and metabolic acidosis.
Hypertension, hyperglycemic episodes, high cholesterol, and microalbuminuria decrease the GFR as well
15-20ml/min
Nephropathy:
treatment
tx HTN
ACEi’s
Nephropathy:
what part of the nephron is affected first and most severly?
distal
Neuropathy:
which fibers are affected
- Small- unmyelinated C fibers
- Large myelinated A fibers
Neuropathy:
Complications
- recurrent infection
- foot fractures
- amputations
Neuropathy:
treatments
- tight glucose control
- NSAIDs
- Antidepressants
- Anticonvulsants
Neuropathy:
what is a dangerous end product from hyperglycemia
AGE- advanced glycosylation end product!
AGE:
what does it do? why is it bad?
- forms on collogen cause loss f elasticity, predisposes them to sheering and endothelial injury
- decreasing cell adhesion and allowing leakage
- Increases rate of athrogenesis
Retinopathy:
is a result of what?
result of vessel occlusion, dilation, increased permeability, and microaneurysm.
Retinopathy:
occurs in what 3 stages?
- Stage 1: Nonproliferative retinopathy. Increase in capillary permiability, venous dilation and tortuosity, microaneurysm formation, flame and blot hemmorhages, cotton wool spots and macular edema.
- Stage 2: Preproliferative retinopathy. Progression of retinal ischemia, poor perfusion, culminates in infarcts.
- Stage 3: Proliferative diabetic retinopathy. Neovascularization and fibrous tissue formation in retina and optic disc, can lead to retinal detachment and/ or hemorrhage.
Causes visual impairments from minor color changes to total blindness.
Retinopathy:
S/S
- visual impairment
Retinopathy:
treatment
No specific treatment
DM and CV:
20-30% of the pt’s who present to the Hospital w/ a ___ have DM
MI
DM and CV:
the incidence of ____ is higher in DM pt’s and may be r/t increased amouts of collagen in teh ventricular wall, whch reduces the mechanical compliance of teh heart during filling, inflammatiom and changes in the Ca++ handleing
DM and CV:
most DM pt’s have what presenting sign w/ an MI
NONE usually a silent MI- may have back pain or indigestion pain
Insulin and preop:
insulin pumps should be decreased by ___% the night before sx, then the basal rate the morning of sx
30%
Insulin and preop:
what about long acting insulin
- usual dose at usual time ( continue to monitor BS throughout the day)
Insulin and preop:
short acting insulin
- should be omitted day of sx
- or 1/2’d
Insulin and preop:
70/30 mixed
should be 1/2’d AM of sx
Insulin and preop:
oral hypoglycemic
- stopped 24-48 hrs prior to sx
Why should you avoid LR w/ DM pt’s
- Large volumes will raise BS 12-24 hrs post op BC liver converts Lactate to Glucose
1 ml of D50 will raise a 70kg pt’s BS by how much?
- 2 mg/dl
1 unit of regular insulin will lower BS by how much?
25-30 mg
be aware of possible allergic reaction (death) in pt’s who use ____ and are reversed w/ protamine. you should give a small test dose (1-5mg) over 5-10 min prior to full dose
NPH
what is optimal BGL postop
none
ADA states 140-180
insulin for anyone over 180
It is important to note that __-___ min after the insulin drip is stopped, the patient will be insulin depleted unless they have endogenous insulin, or long acting insulin was delivered. It is recommended not to stop the insulin infusion until subcutaneous insulin has been delivered and is absorbed and taking effect.
10-15 min
Thats is awesome job Diana
your greeeaaaaat
