DM day 2

Question 1

what is critical about a DM physical exam?

Answer 1

look at their feet

they may not look at their feet

Question 2

what kind of pain do DM pts feel with ulceration?

Answer 2

none

Question 3

what is the primary goal of working with DM pts and peripheral neuropathy?

Answer 3

prevention of ulcers, infections/early txment
patient education
examination of feet regularly
proper foot wear

Question 4

what 6 things are involved in the foot exam?

Answer 4

1. inspect the skin (temp, infections, ulcers, nails)
2. foot architecture
3. palpate PT and DP pulses
4. check ankle reflexes
5. check fine touch
6. check vibration sense

Question 5

what are txment choices for peripheral neuropathy?

Answer 5

1st line Tricyclics (amitriptyline, nortriptyline)-start low, go slow, PM dosing b/c sedation-25mg
gabapentin-neurontin
pregabalin-lyrica
duloxetine-cymbalta

Question 6

which type of neuropathy is hard to treat?

Answer 6

autonomic neuropathy

Question 7

what are common autonomic complaints?

Answer 7

gastroparesis
constipation
neurogenic bladder (lacks full sensation or motor capacity to go)
erectile dysfunction
orthostatic hypotension
resting tachycardia

Question 8

what is orthostatic hypotension?

Answer 8

bodies ability to adjust constriction of blood vessels when going from sitting to standing position

Question 9

when would you be suspicious of resting tachycardia?

Answer 9

pt who is resting and has a high-normal heart rate

Question 10

what is cardiac denervation?

Answer 10

inability to feel chest pain or palpitations

Question 11

what is esophageal dysfunction?

Answer 11

bolus is not moved through the esophagus correctly

Question 12

what is symmetrical anhidrosis?

Answer 12

inability to sweat (causes inability to disapate heat)

Question 13

what is gustatory sweating?

Answer 13

sweating while you eat

Question 14

what is a pupillary autonomic neuropathy?

Answer 14

decreased diameter of dark adapted pupil

argyll-robertson type pupil

Question 15

what is the most common cause of death in the US and the most common cause of death in ppl with DM?

Answer 15

cardiovascular dz

Question 16

why are small, dense LDL’s the bad ones?

Answer 16

they combine with the macrophages and become foam cells

Question 17

what is a stimulus for atherogenesis?

Answer 17

inflammation

Question 18

what is the trifecta of DM CV dz?

Answer 18

atherosclerosis PLUS no ability to feel CP

Question 19

RED FLAG?

Answer 19

Type 2 DM
active
“feeling wierd”?

Question 20

what happens with a plaque ruptures?

Answer 20

platelet plug forms
blockage
BOOM
heart attach

Question 21

what are the 5 steps to manage cardiac risks of a cardiac pts?

Answer 21

1. ASA QD
2. control BP
3. control lipids
4. weight reduction
5. STOP SMOKING

Question 22

what is the most common cause of renal failure in the US?

Answer 22

diabetic nephropathy

Question 23

what are the two key ways to prevent nephropathy?

Answer 23

1. glycemic control

2. BP control

Question 24

what is considered normal albuminuria?

Answer 24

<30mcg/mg

Question 25

what is considered microalbuminuria?

Answer 25

30-300mcg/mg

Question 26

what is considered macroalbuminuria?

Answer 26

> 300mcg/mg

Question 27

what is a screening test for nephropathy?

Answer 27

morning spot urine

Question 28

what lab values are dx of nephropathy?

Answer 28

2-3 elevated readings over 2-3 months

Question 29

what is a late finding of renal dz (40% of kidney damage)?

Answer 29

elevated creatinine

Question 30

what are management options for DM nephropathy?

Answer 30

ACE inhibitors (normotensive w/microalbuminuria)
low protein diet (in macroalbuminuria)
aggressive BP management in HTN pts

Question 31

what is the most common cause of DKA?

Answer 31

infection

Question 32

what is the most important electrolyte abn of DKA?

Answer 32

hypokalemia

Question 33

why does ETOH become a problem with diabetes?

Answer 33

missing insulin
mixing drinks (high sugar)

Question 34

what should you consider when you have a pt in DKA?

Answer 34

psychiatric concerns (less common,but should be considered)

Question 35

what are dx lab features of DKA?

Answer 35

high blood glucose
low pH
high ketonuria
low bicarb (getting bound while trying to compensate)
dehydration (high BUN and creatinine)
hypokalemia (total body stores)
high anion gap

Question 36

how do you correct serum sodium?

Answer 36

serum value + 1.6 (glucose-100)

Question 37

why is someone in DKA hypokalemic?

Answer 37

K+ is switching places with H+ to try to compensate for the acidosis
then you pee out a lot of potassium

Question 38

what are the 3 types of ketone bodies?

Answer 38

1. acetone
2. acetoacetate
3. beta hydroxybuterate

Question 39

which ketone bodies to test strips detect?

Answer 39

acetone

acetoacetate

Question 40

why should you not check serial ketones?

Answer 40

the ketones will move backwards in the enzymatic process and it will look like they are getting worse

Question 41

why do you have to be careful when treating DKA and the glucose gets down to 250?

Answer 41

too low too quickly causes major fluid shifts and can cause cerebral edema and death

Question 42

what are clinical features of hyperosmolar hyperglycemic state (HHS)?

Answer 42

hyperglycemic
dehydration
hx of type 2 diabetes

Question 43

what are lab features of HHS?

Answer 43

marked hyperglycemia
high serum osmolaltiy
high dehydration
no acidosis
no ketosis
AMS (common in elderly pts)
\+/- K level (massive diuresis)

Question 44

what is the definition of hypoglycemia?

Answer 44

BS <60 mg/dl

Question 45

what are neuroglycopenic sxs?

Answer 45

nonsense
acting silly
unable to concentrate

Question 46

what is autonomic hyperactivity?

Answer 46

sweaty
clammy
impending doom