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DIT Endocrine > End 9 - DKA And Diabetes Treatment > Flashcards

End 9 - DKA And Diabetes Treatment Flashcards

1
Q

What is Diabetic Ketoacidosis?

A

State of profound lack of insulin causing cells to think that the body is starving so they release a lot of glycagon and therefore ketone bodies are released to be used as fuel. This causes acidosis. The most important finding is the level of acidosis, not the level of glycemia.

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2
Q

What are common causes of DKA?

A

Stress: Almost always related to a state of excess glucagon, catecholamines or corticosteroids. Infection (pneumonia, gastroenteritis, UTI), diabetic medication reduction or omission, severe medial illness (MI, CVA, trauma), Undiagnosed DM, Dehydration, Alcohol or drug abuse (especially stimulants), Corticosteroids (exogenous).

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3
Q

What is Hyperosmolar Hyperglycemic State (HHS)?

A

An emergency seen mostly in DM II patients. There is some insulin (therefore no lipolysis, therefore no beta-oxydation, and no ketones So no Kussmal breathing). Hyperglycemia (more than 800). High serum osmolarity (higher than 340). Causes mental confusion, delirium, coma, severe dehydration, N/V.

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4
Q

What are the differences of DKA vs HHS?

A

DKA: Ketosis, No serum hyperosmolarity, hyperglycemia of 300 or higher. HHS: No ketosis, Serum hyperosmolarity, extreme hyperglycemia of 800 or higher.

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5
Q

What is Ketosis-Prone Type 2 diabetes?

A

Particular defect in DM II, very hereditary. The hyperglycemia exerts a very toxic effect on the pancreas, shutting down insulin production, which can cause DKA. With appropriate tx, the pancreas can recover somewhat.

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6
Q

What is the tx for DKA?

A

ICU. IV Fluids. Insulin (IV insulin infusion) not just for the hyperglycemia but to put a stop to lypolysis and the production of ketones). Monitor anion gap (until it closes; this might mean giving insulin drip with glucose). Give K+.

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7
Q

What is the tx for HHS?

A

IV fluids. Insulin. K+. There is no anion gap.

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8
Q

What are the 6 types of diabetes drugs?

A

Biguanides. Sulfonylureas. Thiazolidinediones. DPP-4 inhibitors. GLP-1 Agonists. Others.

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9
Q

Which particular Biguanides is used in diabetes? What are the positives of this drug and the mechanism of action?

A

Metformin. It is effective, low risk for hypoglycemia, No weight gain, low cost, few side effects (GI upset and lactic acidosis). It decreases gluconeogenesis in the liver. Can also lower LDL and tryglycerides.

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10
Q

What are the three Sulfonylureas in the market in the US? What is the requirement to use this drugs?

A

Glimepiride. Glipizide. Glyburide. You need a functioning pancreas to use this drugs.

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11
Q

What is the mechanism of action of Sulfonylureas?

A

They work by closing the potassium channel in the beta cells. This causes the cell to depolarize, which increases Ca2+ influx, leading to increase of exocytosis of insulin vesicles; they are insulin secretagogues.

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12
Q

What are the side effects of sulfonylureas?

A

Hypoglycemia and Weight gain.

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13
Q

What are the 2 most used Thiazolidinediones (TZDs)?

A

Pioglitazone. Rosiglitazone.

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14
Q

What is the mechanism of action of Thiazolidinediones (TZDs)?

A

Causes increased sensitivity to insulin in the peripheral tissue. It binds to PPAR-gamma receptor (which regulate fatty acid storage and glucose metabolism).

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15
Q

What are the side effects of Thizaolidinediones (TZDs)?

A

Increased fluid retention. Worsen CHF. Weight gain. Increased risk of MI (Rosiglitazone). Increased risk of bladder cancer (Pioglitazone). Increased risk of osteoporosis (Pioglitazone).

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16
Q

What the four DPP4-inhibitors used in DM?

A

Sitagliptin. Alogliptin. Saxagliptin. Linagliptin.

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17
Q

What is the incretin effect?

A

The difference of insulin release when glucose ingested orally vs glucose given IV. More insulin is released by oral ingestion due to several gut hormones that potentiates insulin release. The most important incretin is GLP-1.

18
Q

What is the mechanism of action of Sitagliptin, Saxagliptin and Linagliptin?

A

They inhibit dipeptidyl peptidase IV (DPP-IV), which affects glucagon-like peptide (GLP-1) among other hormones. This prolongs incretin actions, which decreases glucagon secretion and increaases insulin secretion and delays gastric emptying.

19
Q

What are the two GLP-1 analogues used in DM?

A

Exenatide and Liraglutide.

20
Q

What is the mechanism of action of Exenatide and Liraglutide?

A

Exanatide is an analog of exedin (a hormone derived from Gila monster saliva) w/ actions similar to GLP-1. Liraglutide is a synthetic analog of human GLP-1. They both mimic the actions of incretins, which decrease glucagon secretion and increase insulin secretion, and delay gastric emptying.

21
Q

What is the requisite of using Exenatide or Liraglutide? What are the side effects?

A

You must not be on insulin therapy. Possible increase of acute pancreatitis.

22
Q

What is the mechanism of action of Pramlintide? What is the requisite?

A

It is an amylin analog, normally secreted w/ insulin, decreased glucagon secretion and gastric emptying. Used only in patients taking insulin, but in either DM I or DM II.

23
Q

What is the mechanism of action of Acarbose and Miglitol?

A

They are alpha-glucosidase inhibitors (the enzyme breaks down disaccharides). They prevent sugar and starch digestion, which decreases postprandial hyperglycemia.

24
Q

Which of the oral agents used in the control of DM II has the following characteristic: Lactic acidosis is a rare but worrisome side effect?

A

Metformin.

25
Q

Which type of diabetes mellitus fits the following description: Most common side effect is hypoglycemia.

A

Sulfonylureas.

26
Q

Which type of diabetes mellitus fits the following description: Recommended first-line tx for most patients.

A

Metformin.

27
Q

Which type of diabetes mellitus fits the following description: Not sage in settings of hepatic dysfunction or CHF.

A

TZDs.

28
Q

Which type of diabetes mellitus fits the following description: Should not be used in patients w/ elevated serum creatinine.

A

Metformin.

29
Q

Which type of diabetes mellitus fits the following description: should not be used in patients w/ cirrhosis or inflammatory bowel disease.

A

Alpha-glucosidase inhibitors.

30
Q

Which type of diabetes mellitus fits the following description: Not associated w/ weight gain.

A

Metformin. DPP4-inhibitors. GLP-1 analogs.

31
Q

Which type of diabetes mellitus fits the following description: Metabolized by liver; excellent choice in patients w/ renal disease.

A

TZDs.

32
Q

Which type of diabetes mellitus fits the following description: Mech of Action: closes K+ channel on beta cells causing depolarization which causes increase of Ca2+ influx, causing insulin release.

A

Sulfonylureas.

33
Q

Which type of diabetes mellitus fits the following description: Mech of Action: inihibits alpha-glucosidase at intestinal brush border.

A

Alpha-glucosidase inhibitors.

34
Q

Which type of diabetes mellitus fits the following description: Mech of Action: Agonist at PPAR gamma receptors causing improved target cell response to insulin.

A

TZDs.

35
Q

Which type of diabetes mellitus fits the following description: Mech of Action: decreases hepatic gluconeogenesis.

A

Metformin.

36
Q

Which type of diabetes mellitus fits the following description: good for weight loss.

A

GLP-1 agonist.

37
Q

Which type of diabetes mellitus fits the following description: avoid in hypoglycemia.

A

Sulfonylureas.

38
Q

Which type of diabetes mellitus fits the following description: best tx for anyone w/ organ failures (renal, liver, heart).

A

Insulin.

39
Q

A 40 y.o man comes to the emergency room for the tx of DKA. Hist type 1 diabetes is normally well controlled, and he doesn’t know why his DKA developed this time. What is the differential diagnosis for the development of his DKA?

A

Infection. Dehydration. Nonadherence to insulin tx. Severe medical illness (MI, trauma). Steroids. Alcohol or drug abuse.

40
Q

RFF: Standard tx for DKA.

A

IV fluids, IV insulin, K+ replacement.

41
Q

RFF: Standard tx for DM I.

A

Insulin.

42
Q

RFF: Standard tx for DM II.

A

Low carb diet, weight loss, oral hypoglycemic drugs, insulin.

DIT Endocrine (12 decks)

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