Diabetic Complications & Hypoglycemia Flashcards
what diabetic complication leads to end stage renal disease?
nephropathy
kidney functioning at 10-15% of normal capacity
end stage renal disease (ESRD)
which type of DM is nephropathy more common in?
type 1 DM
how does nephropathy initially present?
proteinuria (increased albuminuria)
what should the ratio of albumin to creatinine be in the first morning void urine to be considered normal?
< 30 albumin mcg : 1 mg creatinine
what is a good predictor of future chronic renal disease?
ratio of albumin to creatinine in first morning void urine
how many abnormal readings of ratio of albumin to creatinine, and how often, to diagnose a patient with neuropathy d/t DM?
two abnormal readings
over 3-6 months
what 5 other conditions can cause albuminuria?
short term hypoglycemia
exercise
UTI
heart failure
fever
why is it important to identify diabetic nephropathy early?
to prevent progression to end stage renal disease
how can we prevent progression of nephropathy to end stage renal disease? (3)
glycemic control
low protein diet
ACE inhibitor or ARB
why is an ACE inhibitor or ARB used for nephropathy?
lowers intraglomerular pressure
what do the combination of atherosclerosis and dyslipidemia caused by DM, lead to?
3-5x increased risk of MI
what can peripheral vascular disease lead to, due to DM? (2)
ischemia of lower extremities
gangrene of feet
diseased blood vessels cannot supply blood to nerves - nerves shrivel up and lead to decreased sensation in extremities
peripheral neuropathy
what is the prevalence of peripheral neuropathy?
50% of older patients with type 2 DM
what kind of pattern is seen in peripheral neuropathy?
stocking and glove pattern
(distal symmetric polyneuropathy)
what is gone first in peripheral neuropathy? how does the patient present? (3)
sensory
decreased pain
decreased vibratory
decreased temp
what exam can we use to determine if a patient has peripheral neuropathy?
Semmes Weinstein filament
dot hemorrhages, exudates, and retinal edema present in 60% of diabetes after 16 years
non-proliferative retinopathy
what occurs in non-proliferative retinopathy? what does it lead to?
retinal capillary leaks proteins and lipids into retina/macula
visual impairment
what is the most common cause of visual impairment?
non-proliferative retinopathy
neovascularization in the retina and vitreous chamber due to capillary being totally closed off and not providing any nutrients to retina
proliferative retinopathy
what does proliferative retinopathy lead to? (leading cause in the US)
blindness
what can severe hypertriglyceridemia lead to?
cutaneous xanthomas
brown, painless spots that don’t require treatment
shin spots
what kind of infection can DM cause below the breasts, axillas, between the fingers, and vulvovaginitis?
candidal infection
if a patient presents with shin spots, when do they say the onset was?
1-2 weeks ago
hyperpigmented, velvety plaques located in the axillae, groin, and posterior neck
acanthosis nigricans
how is acanthosis nigricans described?
hyperkeratosis (increased production of skin)
in which DM type is hyperpigmentation/ acanthosis nigricans common in?
type 2 DM
in patients with DM, what should be done at every annual appointment? (6)
foot exam
optometry with dilation
U/A
serum creatinine
lipid panel
LFT
what are we looking for in a U/A for DM patients? (2)
albumin
glucose
what vaccines should we encourage at appointments for DM patients?
flu vaccine annually
pneumococcal q 5 yrs
how often should Hgb be checked?
at least q 6 months
what is our goal for BP and LDL in patients with DM? (2)
BP 120-130/90
lower LDL by 30-50%
at what glucose level is endogenous insulin inhibited?
glucose < 80
at what glucose level does glucagon get released into the blood?
glucose < 70
what is released into the blood when glucose is below 65? (3)
epinephrine
GH
cortisol
what occurs when glucose is below 50?
decreased alertness
a patient presents with diaphoresis, palpitations, hunger and anxiety. what is their approximate glucose level?
less than 65
what causes the sweating, palpitations, nausea, hunger, anxiety and tremor in hypoglycemia?
adrenergic surge (cortisol and epi)
what causes the blurred vision, decreased fine motor skills, poor concentration, and dizziness in hypoglycemia?
decreased cognitive function
what 3 components are required to diagnose hypoglycemia? what is the name for it?
hx of hypoglycemic symptoms
fasting BG < 45
immediate recovery after getting glucose
Whipple’s Triad
what are 4 causes of hypoglycemia?
fasting
excess insulin
postprandial (reactive)
alcohol
in which patients is postprandial (reactive) hypoglycemia seen?
after gastric bypass
what is the treatment for a patient that is asymptomatic/mildly symptomatic with glucose equal to or less than 70?
give 15-20 grams of oral glucose
