Diabtetes

Question 1

What does FSG, BSG, HGM, GSM,and SBGM mean?

Answer 1

Finger stick glucose
Bedside stick glucose
Home glucose monitoring
Glucose self monitoring 
Self blood glucose monitoring

Question 2

What is the difference between basal and bolus insulin?

Answer 2

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.

Question 3

What represents an average 3-4 months glucose level?

Answer 3

Hemoglobin A1c

Question 4

3 possible presentations she wants us to know to have DM as a differential?

Answer 4

Mental status changes
Abdominal pain
Dehydration

Question 5

What is the mnemonic and what does each letter stand for in out differential diagnosis for mental status changes?

Answer 5

AEIOUTIPS

Alcohol, epilepsy, infection, overdose, uremia, trauma, insulin, poisoning, stroke

Question 6

What is the mnemonic for abdominal pain and what does each letter stand for?

Answer 6

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

Question 7

5 big time reasons for DKA?

Answer 7

1. Not controlling sugars, usually through inadequate insulin
2. Infection: pneumonia, UTI, gastroenteritis, and sepsis
3. Infarction: anywhere
4. Surgery
5. Drugs like cocaine

Question 8

Signs of DKA? N/V
Tachycardia
Hypotension
Fruity smell to breath
Kussmaul respiration’s 
Ab pain
Fever

Answer 8

N/V
Tachycardia
Hypotension
Fruity smell to breath
Kussmaul respiration’s 
Ab pain
Fever

Question 9

3 lab signs of DKA?

Answer 9

Hyperglycemic, ketones in blood and urine, and metabolic acidosis (high potassium)

Question 10

How to calculate high anion gap?

Differential diagnosis for high anion gap?

Answer 10

Sodium - (cl + bicarb)

Methanol, uremia, DKA, Paraldehyde, Isopropyl alcohol Iron Idoniazid, Lactic Acidosis, Ethylene Glycol, Salicylates

Question 11

What is low secondary to the high glucose in DKA?

Answer 11

The measured sodium

Question 12

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?

Answer 12

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

Question 13

How do we typically administer the insulin to a DKA patient?

Answer 13

IV

Question 14

At what potassium level do we start to consider replacement and what 3 things do we need to consider when giving potassium?

Answer 14

Less than 5.5
Renal function
Baseline EKG
Ins and outs

Question 15

3 DKA Treatment goals?

Answer 15

Increase glucose utilization by insulin dependent tissues
Correct the acidosis and ketones
Fluid and electrolyte replacement

Question 16

When can we start intermediate or long acting insulin on patient being treated for DKA, 2 things?

Answer 16

1. When they can eat, shown by improved mental status changes, no ab pain, no N/V
2. Anion gap normalized

Question 17

3 big time causes of NKHS?

Answer 17

Insulin deficiency
Inadequate fluid intake
Hyperglycemia

Question 18

6 precipitating factors to NKHS?

Answer 18

Sepsis
MI
Glucos
Phenytoin
Thiazides
Impaired access to water

Question 19

What are 3 symptoms of NKHS and what is typically absent that is seen in DKA?

Answer 19

Piss a lot, thirsty, altered mental state

N/V, ab pain, and kussmaul respiration’s are absent

Question 20

What is the anion gap in NKHS and why is there ketouria in NKHS?

Answer 20

Mildly elevated

From starvation

Question 21

What is the fluid deficit in NKHS?

Answer 21

8-10 liters

Question 22

5 similarities between DKA and NKHS?

Answer 22

Insulin deficiency, glucagon excess, volume depletion, mental status changes, and ICU

Question 23

3 main differences between NKHS and DKA?

Answer 23

Fluid deficit much bigger in NKHS, drugs can cause NKHS, and N/V ab pain and kussmaul respiration’s

Question 24

Explain the problem with diabetic gastropathy?

Answer 24

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

Question 25

What is going on if a patient with all of the sudden has controlled sugars at a lower insulin dose and why?

Answer 25

Impaired renal function because insulin is cleared by the kidneys.

Question 26

What does a spot urine sample screen for?

Answer 26

If protein in urine is 300 mg or above

Question 27

What do we need to do if we want to check for micro protein?

Answer 27

Microalbumin/creatinine ratio

30-300 mg

Question 28

What do we do a 24 urine collection for?

Answer 28

To actually quantify the protein, get a specific number

Question 29

2 things as to why diabetics are immunocompromised?

Answer 29

1. When glucose is greater than 150, it interferes with neutrophil function
2. Multiple co morbidities

Question 30

5 lifestyle modifications for diabetes treatment?

Answer 30

Physical activity, dietary modifications, weight loss, counseling, diabetic education

Question 31

What should be done quarterly with diabetic patient?

Answer 31

Hgb A1c
Review self glucose monitoring log
Foot inspection

Question 32

What should be done annually with diabetic patient?

Answer 32

Dilated eye exam
Urine protein screening
Monofilament testing

Question 33

What 2 infections can be triggers for type 1 diabetes?

Answer 33

Cocksackie virus

Enterovirus