Diabtetes Flashcards
What does FSG, BSG, HGM, GSM,and SBGM mean?
Finger stick glucose Bedside stick glucose Home glucose monitoring Glucose self monitoring Self blood glucose monitoring
What is the difference between basal and bolus insulin?
Basal is the long acting insulin to make sure the individual has steady normal levels.
Bolus is when you take an injection because you are going to eat and you did a test for your glucose level and you now need more insulin.
What represents an average 3-4 months glucose level?
Hemoglobin A1c
3 possible presentations she wants us to know to have DM as a differential?
Mental status changes
Abdominal pain
Dehydration
What is the mnemonic and what does each letter stand for in out differential diagnosis for mental status changes?
AEIOUTIPS
Alcohol, epilepsy, infection, overdose, uremia, trauma, insulin, poisoning, stroke
What is the mnemonic for abdominal pain and what does each letter stand for?
BAD GUT PAINS Bowel obstruction Appendicitis Diverticulitis, DKA Gastroenteritis, Gall bladder problems UTI Testicular torsion,Toxin Pneumonia, pancreatitis, peptic ulcer Abdominal aneurysm Infarction, bowel or heart, IBD Splenic rupture/infarction
5 big time reasons for DKA?
- Not controlling sugars, usually through inadequate insulin
- Infection: pneumonia, UTI, gastroenteritis, and sepsis
- Infarction: anywhere
- Surgery
- Drugs like cocaine
Signs of DKA? N/V Tachycardia Hypotension Fruity smell to breath Kussmaul respiration’s Ab pain Fever
N/V Tachycardia Hypotension Fruity smell to breath Kussmaul respiration’s Ab pain Fever
3 lab signs of DKA?
Hyperglycemic, ketones in blood and urine, and metabolic acidosis (high potassium)
How to calculate high anion gap?
Differential diagnosis for high anion gap?
Sodium - (cl + bicarb)
Methanol, uremia, DKA, Paraldehyde, Isopropyl alcohol Iron Idoniazid, Lactic Acidosis, Ethylene Glycol, Salicylates
What is low secondary to the high glucose in DKA?
The measured sodium
What is the method of fluid replacement she explained to us that we can use for DKA? How much fluid are we typically trying to replace in DKA?
123 method. Give 2-3 liters of NS at first Then switch to 1/2 normal saline Then when glucose hits 250, switch to D5 1/2 NS 3-5 liters
How do we typically administer the insulin to a DKA patient?
IV
At what potassium level do we start to consider replacement and what 3 things do we need to consider when giving potassium?
Less than 5.5
Renal function
Baseline EKG
Ins and outs
3 DKA Treatment goals?
Increase glucose utilization by insulin dependent tissues
Correct the acidosis and ketones
Fluid and electrolyte replacement
When can we start intermediate or long acting insulin on patient being treated for DKA, 2 things?
- When they can eat, shown by improved mental status changes, no ab pain, no N/V
- Anion gap normalized
3 big time causes of NKHS?
Insulin deficiency
Inadequate fluid intake
Hyperglycemia
6 precipitating factors to NKHS?
Sepsis MI Glucos Phenytoin Thiazides Impaired access to water
What are 3 symptoms of NKHS and what is typically absent that is seen in DKA?
Piss a lot, thirsty, altered mental state
N/V, ab pain, and kussmaul respiration’s are absent
What is the anion gap in NKHS and why is there ketouria in NKHS?
Mildly elevated
From starvation
What is the fluid deficit in NKHS?
8-10 liters
5 similarities between DKA and NKHS?
Insulin deficiency, glucagon excess, volume depletion, mental status changes, and ICU
3 main differences between NKHS and DKA?
Fluid deficit much bigger in NKHS, drugs can cause NKHS, and N/V ab pain and kussmaul respiration’s
Explain the problem with diabetic gastropathy?
If a patient takes insulin at meal time and there is delayed emptying due to gatropathy, then the insulin working window will be missed, and when the stomach finally empties, there will be hyperglycemia
What is going on if a patient with all of the sudden has controlled sugars at a lower insulin dose and why?
Impaired renal function because insulin is cleared by the kidneys.
What does a spot urine sample screen for?
If protein in urine is 300 mg or above
What do we need to do if we want to check for micro protein?
Microalbumin/creatinine ratio
30-300 mg
What do we do a 24 urine collection for?
To actually quantify the protein, get a specific number
2 things as to why diabetics are immunocompromised?
- When glucose is greater than 150, it interferes with neutrophil function
- Multiple co morbidities
5 lifestyle modifications for diabetes treatment?
Physical activity, dietary modifications, weight loss, counseling, diabetic education
What should be done quarterly with diabetic patient?
Hgb A1c
Review self glucose monitoring log
Foot inspection
What should be done annually with diabetic patient?
Dilated eye exam
Urine protein screening
Monofilament testing
What 2 infections can be triggers for type 1 diabetes?
Cocksackie virus
Enterovirus
