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F3 E4 Shea > DM 1 (two) > Flashcards

DM 1 (two) Flashcards

1
Q

What tx for DM1?

  • Used for primary prevention
  • Pts w/ incr. risk of CVD
    • F: >50
    • M: >60
    • and 1 RF: HTN, HLD, smoking, fam hx of premature dz, albumineria
A

Acetylsalicylic acid

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2
Q

Pts w/ Type 1 DM can get what 2 transplants?

Which one can they NOT get?

A
  • Pancreas transplantation with or without kidney transplantation
  • Islet cell transplant
  • NOT: pancreatic islet auto-transplantation
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3
Q

Type 1 or 2 DM?

  • Moderately deficient control of hyperglycemia
  • SLIGHT elevation of LDL cholesterol
  • Slight elevation of serum triglycerides
  • Little/if any change to HDL
  • Once hyperglycemia is corrected, –> lipoprotein levels are normal
A

Type 1

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4
Q

Type 1 or 2 DM?

  • “Diabetic Dyslipidemia” is characteristic of insulin resistance syndrome
  • HIGH serum triglyceride level >300
  • LOW HDL cholesterol <30
  • Qualitative change in LDL particles, smaller/dense LDL particles are more susceptible to oxidation, renders them more atherogenic.
A

Type 2

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5
Q

What are the 2 neuro/vascular dz complications of diabetes?

A
  • Diabetic foot ulcers
  • Gangrene of feet
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6
Q

What are the 4 heart disease complications?

A
  • Coronary atherosclerosis
  • Myocardial infarction
  • Peripheral vascular disease
  • Stroke
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7
Q

What are the 3 causes of Hypoglycemia?

A
  • Behavioral
  • Regulatory issues
  • Diabetic complications
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8
Q

What are the 3 behavioral causes of Hypoglycemia?

A
  • Too much insulin
  • Too much ETOH
  • Post-exercise
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9
Q

What are the 2 causes of regulatory issues leading to Hypoglycemia?

A
  • Loss of glucagon response
  • Sympatho-adrenal responses
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10
Q

What are the 2 diabetic complications leading to Hypoglycemia?

A
  • Gastroparesis
  • End-stage kidney disease
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11
Q

Sxs of what?

  • Shaky
  • Tachy
  • Diaphoretic
  • Dizzy
  • Anxious
  • Hungry
  • Blurred vision
  • Weak/tired
  • HA
  • Nervous/upset
A

Hypoglycemia

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12
Q

What meds can induce Hypoglycemia?

A

◦Sulfonylureas

◦Gatifloxacin & levofloxacin

◦ACE inhibitors

◦Salicylates

◦β-adrenergic blocking agents

◦Quinine

Pentamidine

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13
Q

What can these lead to?

  • Hypopituitarism
  • Addison disease, or myxedema
  • Disorders related to liver malfunction, such as acute alcoholism (glycogen depletion) or liver failure
  • Gastrointestinal surgery
  • Insulinoma
A

Hypoglycemia

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14
Q

What are the 4 ways to prevent/tx hypoglycemia?

A
  • Glucose tablets or Juice
  • 15 g of carbs
  • Parenteral glucagon emergency kit (1 mg)
  • 50 mL of 50% glucose solution by rapid IV infusion
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15
Q

What is this effect called?

  • Nocturnal hypoglycemia –> leads to surge of counter-regulatory hormones to produce high blood glucose by 7 AM (pre-breakfast hyperglycemia)
  • How is it treated?
A
  • Somogyi Effect
  • Tx:
    • Eliminating dose of intermediate insulin at dinner time
    • Giving intermiediate insulin at a lower dose at bedtime
    • Increase food intake at bed time
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16
Q
  • Glucose >600
  • Osmolarity >320 (normal is 280-295)
    • Due to ETOH, antifreeze
  • No ion gap (normal)
A

HHS

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17
Q
  • 1st symptom that pt has Type 1 DM
  • Glucose >300
  • Low bicarb
  • Ketones / Ketouria
  • Acidic pH <7.3
A

DKA

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18
Q

What is the pre-dominating factor in estimating osmolality?

A

Na

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19
Q

If hyperosmolality is not due to high Na, what other 4 things causes it?

A

Ineffective osmoles (permeable)

  • Advanced renal failure (urea)
  • Alcohols
    • Mannitol, ethanol, glycerol, isopropanol
  • Hypertonic Hyponatremia
  • Hyperglycemia

(HA HA)

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20
Q

Hyperglycemic Hyperosmolar State

  • Occurs more commonly in DM1 or DM2?
  • Hyperglycemia > ___ mg/dL
  • Serum osmolality > ____
  • Blood pH of what?
A
  • type 2
  • Hyperglycemia: >600
  • Osmolality: >310
  • pH: >7.3 (no acidosis)
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21
Q

What is this?

  • Hyperglycemia without ketones
  • minimal ketonuria/ketonemia
  • NORMAL anion gap (<14)
  • Serum bicarb >15
A

Hyperglycemic Hyperosmolar State

22
Q

Clinical findings of what?

  • Profound dehydration (dx/tx delayed until fluid deficit reaches 6-10 L)
  • Non-ketotic
  • Polydipsia / Polyuria
  • Neuro changes (ranging from nystagmus - coma)
A

HHS

(hyperglycemic hyperosmolar syndrome)

23
Q

Lab results of what condition?

  • Plasma glucose: 800 - 2400 mg/dL
  • Serum urea nitrogen elevations >100 mg/dL typical
A

HHS

( hyperglycemic hyperosmolar syndrome)

24
Q

HHS treatment

  • FLuids to restore UOP to ___ mL/h or greater
  • Hypovolemic sxs (hypotension/oliguria) are treated w/ what?
  • 0.45% saline may be utilized for maintenance as body fluids are markedly HYPERosmolar
A
  • 50
  • 0.9% normal saline
25
Q

HHS treatment

  • Once blood glucose reaches ____ mg/dL, fluid replacement should include 5% dextrose in either water, 0.45% NS, or 0.9% NS
  • Maintain glycemia levels of 250-300 mg/dL in order to reduce the risk of what??
A
  • 250
  • cerebral edema
26
Q

HHS treatment

  • Treatment w/ what can be delayed??
  • FLuid replacement ALONE can decrease hyperglycemia by correcting the hypovolemia, which can then increase both glomerular filtration & renal excretion of glucose.
A

Insulin can be delayed

27
Q

HHS tx

  • If there is ____, start insulin rate at 0.05 units/kg/h (bolus not needed) & titrate to lower blood glucose levels by 50-70 mg/dL /hour
A

Ketonemia

28
Q

HHS tx

  • If the pt had ketonemia and you started insulin and they are now stabilized (blood glucose fell to around 250), then insulin can be given via what route?
A

Subcutaneously

29
Q

HHS tx

  • Potassium should be monitored closely
  • Potassium chloride replacement should proceed liberally, unless what 2 conditions are present???
A
  • CKD
  • Oliguria
30
Q

HHS tx

  • Severe hypophosphatemia (<1 mg/dL) during insulin therapy, what is the tx?
A

Phosphate replacement for ketoacidotic pts

31
Q

What is this?

  • SEVERE insulin deficiency
  • Marked elevations of glucagon, cortisol, GH, epinephrine, norepinephrine
A

Diabetic Ketoacidosis (DKA)

32
Q

Most cases of DKA occur in which type of DM?

A

Type 1 DM

  • already diagnosed pts or may be 1st manifestation of type 1 DM
33
Q

DKA is usually preventable by self monitoring what 2 things?

A
  • Blood glucose
  • Blood/Urine Ketone levels
34
Q

DKA

  • What is the most common precipitating factor??
  • Other causes: insulin omission, pancreatitis, MI, stroke, and drug use
A

Infection

35
Q

Causes of what?

Which one is MC cause?

  • Insulin deficiency (failure to take enough)
  • Iatrogenic (glucocorticoids)
  • Infection
  • Inflammation (pancreatitis, cholecystitis)
  • Ischemia/infarction (myocardial, cerebral, gut)
  • Intoxication (EtOH, drugs)
A

DKA

(INFECTION is MC cause)

36
Q

Sxs of what?

  • N/V
  • Abd pain
  • Polydipsia / Polyuria
  • Enuresis
  • “fruity” acetone breath
A

DKA

37
Q

Sxs of what?

  • Kussmaul breathing
  • 2 signs of hypovolemia?? __ & ___
  • AMS
  • ____ is rare & indicated prolonged period of this condition
A

DKA

  • Hypovolemia: hypotension & tachycardia
  • Coma is rare
38
Q

Acronym for DKA

  • KUSSMAL
A
  • K: ketones
  • U: uremia
  • S: sepsis
  • S: salicylates
  • M: methanol
  • A: aldehydes
  • L: lactic acidosis
39
Q

Initial eval of DKA (4)

A
  • ABCs
  • Mentation
  • Precipitating factors
  • Volume status
40
Q

What will a BMP show in pt w/ DKA?

A
  • Glucose, Anion gap***, bicarb
  • potassium (up or down)
  • Na (low) - hyponatremia

(We want to close the gap!!)

41
Q

What test should be ordered if HCO3 is low in pt w/ DKA?

A

ABG

42
Q

What lab value may be elevated in pt w/o pancreatitis who is in DKA?

A

Amylase

43
Q

DKA or HHS?

  • GLucose >250
  • pH <7.3
  • HCO3 <18
  • MODERATE ketonuria or ketonemia
A

DKA

44
Q

DKA or HHS?

  • Glucose >600
  • pH >7.3
  • HCO3 >15
  • MINIMAL ketonuria & ketonemia
A

HHS

45
Q

______ (increased anion gap) is principally caused by increased production of ketoacids w/ minor contributions from lactic acid / free fatty acids

A

Metabolic Acidosis

46
Q

Describe the levels of K, phosphate, and Mg

A

Initially, serum K & phosphate are normal or high, but invariably there is total body depletion of K, phosphate, and Mg.

47
Q

If plasma glucose levels are <250 = “euglycemic ketoacidosis) caused by what 3 things?

A
  • Fasting/Starvation
  • ETOH
  • Pregnancy
48
Q

It is important to prevent the development of hypoglycemia to reduce the likelihood of _____, which could result from too rapid decline of blood glucose…

A

Cerebral Edema**

49
Q

DKA tx

  • Usually require large volume resuscitation!!
  • IV insulin drip continued till GAP is closed!
  • Pts may require what type of IVF prior to gap closing?
  • What 4 levels can be deceiving while BS remains high??
A
  • Dextrose containing IVF
  • K, phosphorus, Sodium, Mg
50
Q
  • DKA patients should be admitted to what hospital department?
  • What 2 “special” things might they need for management?
A
  • ICU
  • PICC & ABG
51
Q

DKA summary:

  • DKA usually evolves gradually or rapidly?
  • What are the early sxs? (4)
  • As DKA worsens, what symptom worsens?
  • ABCs
  • Large IVs (FLUIDS, FLUIDS, FLUIDS)!!
A
  • Rapidly
  • N/V/ abd pain, hyperventilation
  • mental status worsens as DKA worsens
52
Q

DKA tx

  • Monitoring of what levels is most important?
A

Electrolytes (K+)

F3 E4 Shea (12 decks)

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