DM pales Flashcards
DKA definition
hyperglycemia >250
pH <15
serum ketones
DKA and DMI
usually initial presentation in kids
insulin non-compliance
increase in anti-insulin hormones d/t stress
DKA and DMII
late stages of beta cell failure
during stress or in extremely high BG
signs and symptoms of DKA
onset 1-2 days
weakness
anorexia, nausea, abdominal pain
mental status changes (confusion, lethargy, coma, seizures)
signs of acidosis
confusion
lethargy
kussmal respiration (hyperventilating)
fruity breath odor
signs of dehydration
oral membranes dry
turgor of skin
hypotensive/tachy
finger stick glucose
not accurate if 500
labs of DKA
high glucose low CO2/bicarb/pH high ketones, acetone, ketoacids high BUN and Cr low Na high K
DKA Tx
INSULIN- do not stop insulin until anion gap is corrected, give glucose once glucose is under 200
IV FLUIDS
electrolytes
ventilatory support
hyperosmolar, hyperglycemic, non-ketotic state
aka hyperosmolar coma hyperglycemia >600 serum osmolality >310 (thick blood) no acidosis bicarb >15 normal anion gap
pathology of hyperosmolar hyperglycemic non-ketotic state
hyperglycemia -> osmotic diuresis -> dehydration -> increased osmolality -> decrease in free fluid -> hyperglycemia
ONLY IN DMII, type I would get DKA
causes of hyperosmolar hyperglycemic non-ketotic state
non-compliance with meds acute infection/stress dehydration usually older patients with poor care and/or dementia insidious onset
Tx of hyperosmolar hyperglycemic non-ketotic state
IV FLUIDS!!!
A little IV insulin
electrolyte replacement
ventilatory support
hypoglycemic coma
symptoms at 80 (unless long standing hyperglycemia can become symptomatic at 200 or 150)
coma/passing at 50 (usually only DM or insulinoma)
non-proliferative retinopathy
most common cuase of visual impairment in DMII earlier stage microaneurisms dot hemorrhages retinal edema
proliferative retinopathy
growth of new capillaries and fibrous tissue w/in retina d/t ischemic infarcts (cotton wool spots)
more common in DMI
vitreous hemorrhage and retinal detachment
other eye issues
lens swelling- reversible with correction of BG
diabetic cataracts
Diabetic nephropathy
focal segmental glomerulosclerosis (FSGS)
screen for albuminurea early, later proteinuria
can lead to nephrotic syndrome or end-stage renal disease and dialysis
what CN are often involoved in DM neuropathy
III
IV
VI
diploplia
femoral n neuropathy
diabetic amyotrophy
severe pain on front of thigh and quads
may last for months or even years
charcot foot
deformity dt neuropathy -> collapse of arch loss of sensation initial trauma repetitive traumas (mircrofractures) not a vascular issue
autonomic neuropathy
NO Tx, most frustrating symptoms
- postural hypotension
- diabetic gastroparesis (Dx with GES)
- diarrhea/constipation
- neurogenic bladder (urinary retention, incontinence)
- impotence
- profuse sweating/temp dysregulation
acclerated atherosclerosis in DM dt
hyperglycemia hyperlidemia abnormalities of platelet adhesion HTN oxidative stress inflammation
CV complications
heart disease (2-4x more likely )
Stroke
PVD
derm in DM
pyogenic infections- boils
yeast
necrobiosis lipoidica diabetorum
factors which affect glycoemoglobin
- conditions that shorten erythrocyte life span will falsely decrease hA1C
- diseases with lack of new reticulocytes with falsely raised hA1C (aplastic anemia)
goal for HA1C
7
oral meds
secretagogues (SUs, and nonSUs) incretins metformin TZDs alpha-glycosidase inhibiotors
injectable meds
insulins
pramlintide
incretins
down fall of SUs
tolerance
50% failure in 5 yrs
CIs of SUs
prego/breast feeding
liver or renal insufficiency
sulfa allergies
side effects of SU
GI upset urticaria jaundice SIADH (low Na, high BP) weight gain hypoglycemia
which SU can be used in renal failure
glipizide
glimeperide
only metabolized by liver
meglitinides
-glinide
very short acting so can be taken right before meal
biguandies
metformin
DOC
metformin side effects
GI
lactic acidosis
decrease B12 and folate absorption
CI of metformin
renal and liver insufficiency
chronic hypoxia
past Hx of lactic acidosis
alcoholism
TZDs
-glitazone not great significant weight gain water retention cannot be used with CHF pt liver damage
alpha-glycosidase inhibiots
acarbose miglitol decrease absoroption of CHO GI issues not really used dt side effects
incretins
oral- DPP4 inhibitors (-agliptine) injectible- GLP1 (-tide) significant weight loss early satiety glucose dependent insulin production
pramlintide
analoge of amyloid
supresses glucagon secretion
rarely used
beginning insulin Tx
long acting first to increase baseline
fixed combos should not be used right away
dawn phenomenon
diurnal increase of anti-insulin hormones secretion in am
3 am BG normal or high
no night sweats
insulin dose not high enough
samojyi effect
rebound hyperglycemia after night time lows
3am BG very low
night sweats present
dose of insulin too high
if you think its dawn effect and increase insulin can kill them
