Diabetic Cases Pales Flashcards
glyburide
100% excreted by kidney
second gen sulfonylurea
side effect of sulfonylurea
hypoglycemia
meglitinides
short duration of action
close ATP dependent K channels of beta cells
incretin
injectable - GLP1
oral - DPP-IV inhibitor
no hypoglycemia
give after meals
metformin
biguanide
decreased glucose production by liver**
increased insulin receptor sensitivity
weight loss and no hypoglycemia**
lowers LDL and triglycerides
adverse of metformin
lactic acidosis
CI biguanides
renal and liver insufficiency
chronic hypoxia
past hx lactic acidosis
alcoholism
withold if pt getting iodinated contrast
significant weight gain
TZD
CHF
no TZD
SGLT-2 inhibitor
block reuptake of glucose in renal tubules
promote loss of glucose in urine
no hypoglycemia
new drug
yeast infection, dehydration, UTIs
morning hyperglycemia
either dawn phenomenon or samojyi effect
dawn - anti-insulin hormone in AM - tx increase meds
samojyi - night time low glucose - body tries to increase - tx decrease meds
50yo F, allergies and sleepy, N/V anorexia, sleeping and week, given prednisone for allergies
hypotension HR elevated T high resp high lethargic
feet cold and mottled
BUN/Cr elevated glucose very high lactic acid 5.2 ketone negative pH 7.3
hyperosmolar hyperglycemic non-ketotic coma
renal failure
dehydrated
more likely DM II
tx - fluids
hyperosmolar hyperglycemia non-ketotic coma
more in DM II
tx fluids
DKA
more in DM I
tx insulin
prednisone
increases glucose
ACE inhibitor
dilates efferent arterioles
drops pressure in glomeruli - decreases filtration
12yo M to ER with SOB and mental status change
increasing fatigue weight loss thirsty a lot urinates at night breathing deep and fast thrush in mouth
glucose high
pH 7.05
high anion gap
BUN/Cr elevated
diabetic ketoacidosis
path of DKA
insulin deficienct more lipolysis more fatty acid to liver increased ketogenesis acidosis
potassium elevated in DKA**
acidosis - shifts K out of cell
peeing out lots of K
body K low
serum K high
tx of DKA
IV insulin
look at the anion gap
-this tells when you can switch to subQ insulin
DKA age
younger
NKHO age
older
DKA mental status
alert
NKHO coma
comatose confused
renal failure
more common in NKHO
metabolic problem
DKA acidosis
NKHO dehydration
59yo M diabetic
mild burning of feet at times
has not taken glipizide
smokes 1/2ppd
glucose 185
LDL high
left vent hypertrophy
HbA1c 8.3%
done wrong by previous physician?
no metformin (does not cause hypoglycemia)
no follow up
first thing to do with new diabetic patient
HbA1c physical exam get PMH lipid panel assess knowledge of disease give glucometer ask to check blood sugar 4x/daily
HbA1c
marker for control of diabetes
test for peripheral neuropathy
monofilament test
diabetes and HTN
atherosclerosis and renal failure
secondary HTN
initial diabetes tx
metformin and diet/exercise mod
also statin if high lipids
also ACE inhibitor - DOC for diabetes and HTN
ACE inhibitor side effect
cough
when to check HbA1c
3 month later
52yo F with DM II
worried about sugar too low - school bus driver
loses insurance - doesn’t come back for few years
very high glucose - 510
blurry vision, calf pain, urinary frequency, dizzy when stand up
blurry vision - reversible lens swelling
meds to start - insulin** bc very high glucose
meds to avoid hypoglycemia
metformin TZD DDP-IV DLP-1 analog alpha-1 glycosidase
LDL goal for diabetic
70
if not - give statin
what to check with peripheral vascular disease
look for atherosclerosis
do stress test
complications improve with glycemic control
microvascular problems
