DM- Clinical Presentation Flashcards
Hypoglycemia common risk factors
- Longer duration of diabetes
- Older age
- ↓ glycemia with medications
- Erratic timing of meals & missed meals
- History of recent hypoglycemia
- Exercise
- Alcohol ingestion
- Chronic kidney disease
- Malnutrition/glycogen depletion
Characteristics needed to fulfill Whipples triad for hypoglycemia?
Signs and symptoms suggestive of hypoglycemia (neuroglycopenic and/or neurogenic)
Low plasma glucose levels at time of suspected hypoglycemia
Symptom resolution with plasma glucose correction
Hypoglycemic Associated Autonomic Failure in DM I leads to __ Sympathoadrenal response
↓
Hypoglycemia leads to a ___ Epinephrine response
↓
Epinephrine & neurogenic symptoms are attenuated in insulin-deficient - T1DM &
advanced T2DM
Hypoglycemia – Pathogenesis DM I
Failure of physiological & behavioral
defenses
↓
Brain glucose deprivation
↓
Behavioral change, confusion, seizure,
loss of consciousness
Hypoglycemia – Pathogenesis DM II
Failure of physiological & behavioral
defenses
↓
Brain glucose deprivation
↓
Behavioral change, confusion, seizure,
loss of consciousness
Symptoms DM I & II
Palpitations, tremor, sweating,
behavior or mental status changes
First Aid in DM I & II if patient is Conscious
Oral glucose (15-20 gm po)
* Glucose tablets (~4 gm/tablet)
* 4 oz Juice/Soda acceptable
* 1 tbsp of sugar, honey, corn syrup
* Check q15 minutes
* Repeat until corrected
First Aid in DM I & II if patient is unconscious
Adults
* IV dextrose 50% in water (D50)
Adolescents
* 20-50 mL 50% solution
6 mo. – Children
* IV 25% dextrose 2-4 mL/kg IV
bolus then continue IV until able
to eat
Prevention strategies for DM I & II
Rx glucagon for all patients at risk of
severe hypoglycemia & instruct
caregivers/family members on its use
* Review S/S of hypoglycemia &
response
* Instruct pts to carry carbohydrates
* Caution pts about driving risk
* Wear medical alert ID
Hyperglycemia – Early Symptoms
(Insidious Onset)
The 3 “Polys”
1. Polydipsia
2. Polyphagia
3. Polyuria
Others
* Fatigue
* Blurred vision
* Unexplained weight loss (DM I)
Diabetic Ketoacidosis (DKA): Cause = ↓ Insulin secondary to ____
- Inadequate insulin treatment in pts with DM
- New onset DM
- Concurrent infection
- Most Common = Pneumonia or UTI
Diabetic Ketoacidosis common signs and symptoms
- Polydipsia
- Polyuria
- Nausea & vomiting
- Weakness & lethargy
- Dehydration
- Fruity odor on breath
- Kussmaul respirations - deep respirations 2° severe acidosis
- Mental status changes
Normal anion gap =
<12 mEq/L
Causes of anion gap acidosis (unmeasured anions) include:
– Ketoacidosis (diabetic, alcoholic)
– Lactic acidosis (lactate [underperfusion, sepsis])
– Uremia (phosphates, sulfates)
– Poisonings/overdoses (methanol, ethanol, ethylene glycol, aspirin,
paraldehyde)
Initial testing for DKA
- Serum glucose (>250 mg/dL)
- Electrolytes (K+ loss)
- Serum Beta-hydroxybutyrate
(serum ketones) - Not commonly available
- Anion gap (>12 mEq/L)
- good measure of recovery
- Blood gases (↓ pH, ↓ PCO2)
- CBC with differential (infx?)
- Urine dipstick for ketones (↑)
& urinalysis (Acetoacetate,
Acetone) - Urine or blood culture (infx?)
- ECG (possible arrhythmias)
- Renal & liver function tests
- Chest x-ray (clues for infx)
DKA - Management in ICU
- Fluid resuscitation
- Electrolyte replacement (K+, Na+, PO3, Mg, NaHCO3)
- Short acting IV Insulin (hold if K+ is low)
- Extracellular K+ → intracellular from insulin can lead to hypokalemia
Stable Management - Transition from IV to multi-dose SQ insulin
HHS =
Hyperglycemic Hyperosmolar State
DKA vs. HHS
DKA: Absolute (or near-absolute) insulin deficiency, results in:
* Severe hyperglycemia
* Ketone body production
* Systemic acidosis
Develops over hours to 1-2 days
HHS: Severe relative insulin deficiency, results in:
* Profound hyperglycemia & hyperosmolality
(urinary water loss)
* No significant ketone production or acidosis
Develops over days to weeks, higher mortality rate
DKA is most common in ____ diabetes while HHS typically presents in ____ diabetes
Type 1; type 2
