Endo

Question 1

When should dextrose be added to the fluid in a patient being treated for DKA

Answer 1

When the blood glucose is between 250-300 or the BG is dropping > 100 mg/dl/hr

Question 2

What type of bolus should be avoided in a patient with DKA unless they are severely acidic ( pH

Answer 2

Sodium Bicarb- increases risk for cerebral edema

Question 3

The most common lab values in DKA

Answer 3

pH 200..

Child can be a new onset type 1 DM, or pt with type 1 DM who is sick, had trauma, not taking care of self. Also can be seen in Type 11 DM, but rare- control is very poor!

Question 4

What should we begin the insulin drip at for a pt with DKA

Answer 4

0.05-1 U/kg/hr

Check DS hourly

Question 5

What are the labs for a newly dx type I diabetic

Answer 5

insulin auto antibodies, insulin levels, hypothyroid function, islet cell autoantiboies, c-peptide

Question 6

What is the mgmt for DKA?

Answer 6

Correct dehydration and lytes/acidosis/blood sugar SLOWLY

• Mgmt: NS bolus 20 ml/kg ( Harriet says run over 1 hr), insulin drip, add glucose when serum glucose is about 250-300 or BG is dropping fater than 100/hr, replace phos and K. ( per Napnap)

Per Cheryl:
Fluid resuscitation: with NS to correct severe dehydration ( NS bolus over 1 hour)
Replace fluid volume deficit over 48 hours: 4L m/2 over 48 hours of an isotonic fluid: NS ( can do the 2 bag method to control dextrose amt)
Insulin gtt: NO bolus - consider adding K to the fluids when starting isulin) ( K phos/ K acetate)
Sodium bicard for severe acidosis only

• frequent ABGs or VBGs, hourly DS, and BMP.

Question 7

What are the treatment goals for DKA

Answer 7

SLOW: correction of fluid and lytes. 
Correct metabolic acidosis, 
Provide insulin to treat and prevent ketosis and lower serum glucose ( ** pH is an indicator of insulin deficiency) 
PREVENT NEURO complications 
Treat underlying disorder: ie: URI

Question 8

When should you add K to your fluids ( pt w DKA)

Answer 8

If K is > 6: NO K, if K is between 4-6: 20 meq/L

OR in the beginning as soon as your start insulin ( don’t want to bottom K out as insulin will help move K into cells)

Question 9

What type of K should we add

Answer 9

K acetate or K phos

Question 10

What are signs of insulin resistance

Answer 10

acanthosis nigricans, obesity, hypertension, high lipids, PCOS, family hx and race.

Question 11

Labs to dx type 1 DM

Answer 11

Polyuria, polydipsia or wt loss
Random BG > 200 
Fasting BG greater than or equal to 126
ALC > 6.5 
OGTT greater than or equal too 200

Question 12

Total daily dose of insulin

Answer 12

0.5-1 u/kg/day

Question 13

Basal dose of insulin ( glargine or Detemir)

Answer 13

1/2 the daily total

Question 14

1 U covers 15 grams of carbs

Answer 14

pearl

Question 15

Rapid acting insulin

Answer 15

Humalog ( lispro), Novolog ( asprat)

Onset: 5-15 mins
peak 30-9- mins
effective duration 5 hr

Question 16

Short acting

Answer 16

Regular U100 or Regular U500

onset: 30-60 min
peak: 2-3 hour
effective duration: 5-8 hour

Question 17

intermediate

Answer 17

NPH

onset: 2-4 hours
peak 4-10 hour
duration: 10-16

Question 18

Long acting

Answer 18

Lantus ( glargine)
Levemir ( Determir)

can NEVER mix

onset: 2-4 hour ( slow)
no peak
duration 20-24 hours

Question 19

How often should you check a hbA1c

Answer 19

q 3 months

Question 20

Signs of DKA

Answer 20

abd pain, vomiting, polyuria, hyperglycemia, ketonuria, lethargy, MS changes,

PE findings: tachycardia, signs of dehydration and Kussmaul respiration

Question 21

Typical findings of DKA

Answer 21

increased glucose, low PH, HCO3

Question 22

When do you see ketones in urine

Answer 22

BS > 240..can be sooner

Question 23

When do you spill glucose into your urine ( glucosuria)

Answer 23

BS > 180

Question 24

Biggest complication of DKA

Answer 24

Cerebral edema

Question 25

DKA

Answer 25

insulin deficiency in which a starvation state triggers a cascade of metabolic responses including hyperglycemia and ketone body formation with lactic acidosis from decreased tissues perfusion resulting in metabolic acidosis.

** Typical findings: increased glucose, loe pH, HCO3

Question 26

When is a pt with DKA converted to subq insulin

Answer 26

when pH and HCO3 are normalized..

Give good, give sub q injection, stop gtt 30-60 mins after