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Basic Science II > Endocrine (Altose): DMII > Flashcards

Endocrine (Altose): DMII Flashcards

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1
Q

What is normal fasting glucose? What is considered pre-diabetic/diabetic fasting glucose levels?

A

Normal: <100 mg/dL

Impaired/diabetic: >126 mg/dL

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2
Q

What is the etiology of DMI? What is it usually caused by?

A

Autoimmune etiology

Due to destruction of islet cells of the pancreas (functions to synthesize insulin)

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3
Q

How do we prepare our Type I DM patients pre-op?

A

Instruct them not to take short-term insulin.

Instruct them to take 1/3 to 2/3 of their usual intermediate-lasting dose.

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4
Q

Where is insulin produced? At what rate is it made?

How much do we usually secrete a day?

A

Beta islet cells of the pancreas

1 unit/hr at rest

40-50 U/day (Response to food, vagal stimulation, beta stim, alpha block)

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5
Q

What is the effect of insulin on the moieties in our body?

A

Increases cellular uptake of glucose and potassium

Stimulates glycogen formation

Inhibits lipolysis and gluconeogenesis

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6
Q

What does surgical stress do to our insulin levels?

A

It drops our insulin levels.

Release of cortisol, catecholes, and glucagon all lead to hyperglycemia because of this.

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7
Q

Primary difference btwn DM I and DM II is..

How do their onsets differ?

A

DMI - no insulin production at all

DMII - insulin resistant cells or decreased insulin production (or both)

DMI = early onset

DMII = late onset

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8
Q

HgbA1c is a measure of…

A

the average level of blood sugar (glucose) over the previous 3 months.

Correlates well with rate of complications

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9
Q

What specific types of insulins would you withhold pre-op in diabetic patients?

A

Hold metformin (inhibits hepatic gluconeogenesis)

Hold sulfonureas (glyburide, glipizide) bc they increase beta-cell secretion of insulin

If significant interruption of caloric intake is not anticipated, many recommend no change in therapy with DMII patients.

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10
Q

What are some anesthetic considerations about diabetic patients?

A

End-organ diseases

Difficult laryngoscopy due to stiff joints

Autonomic dysfunction

Positioning (more susceptible to ischemia)

Nerve injuries more likely due to poorer perfusion (regional anesthesia)

Increased risk of infection

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11
Q

What is the glucose level threshold at which you would delay surgery? Postpone surgery?

A

>270 mg/dL = delay surgery until you get a better value

>400 mg/dL postpone surgery until you get pt metabolic state under control

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12
Q

What happens at the onset of surgery to our glucose levels?

In diabetic patients, what glucose levels should we strive for intra-operatively?

A

Blood sugar will go up due to decreased insulin secretion from stress hormones

Shoot for 150-200 mg/dL (or <180 mg/dL according to Barash)

Note that blood sugar < 110 mg/dL leads to poorer outcomes.

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13
Q

What is DKA?

A

Diabetic ketoaciosis is a state of exclusive fatty acid breakdown for energy (lipolysis) that leads to ketoacidosis

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14
Q

What subtype of diabetics experience DKA?

A

Type I DM

Type II DM don’t experence DKA because only small amounts of insulin is needed to block lipolyis (and they have it whereas DMI pts dont’ have any)

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15
Q

What are physiological effects of DKA?

A

Dehydration due to osmotic diuresis

Electrolyte imbalances

Anion-gap metabolic acidosis

N/V

Ileus

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16
Q

If a DM pt experiences mental status changes, what is the first thing you should do?

A

Check blood sugar to rule out hypoglycemia.

THEN check ABG to rule out DKA or HNKC.

17
Q

How can we treat DKA intra-op?

A

Treat with fluid, electrolytes, and insulin.

Add some glucose when BG < 250 to prevent precipitous drop in blood glucose (which would cause hypoglycemia, the opposite end of the spectrum)

Electrolytes:

Correct N: add 1.5-2.0 mEq/dL every 100 mg/dL BG over 100

Give K (pt may be hyperkalemic, but total body K will be low)

Maintain UOP

18
Q

In a pt undergoing DKA, what is usually his/her range of blood glucose level?

Does this correlate with the severity of the acidosis?

A

300-500 mg/dL range

NO, Degree of hyperglycemia does NOT correlate with severity of acidosis

19
Q

What is the relationship between glucose and potassium?

A

K follows Glucose

20
Q

What is HNKC?

What is it characterized by?

A

HNKC: Hyperosmolar Non-Ketotic Coma

Characterized by very high BG (>600 mg/dL) with enough insulin to prevent ketosis

21
Q

What subtype of DM pts can get HNKC?

A

DMII patients.

DMI patients will get DKA instead of HNKC due to lack of any insulin.

22
Q

Symptoms of HNKC include…

A

Significant HoTN that leads to lactic acidosis

Cerebral edema –> coma, seizures

Thrombosis secondary to hyovolemia, HoTN, and hyperviscosity of blood (due to extreme dehydration)

23
Q

How do we treat HNKC?

A

Treat with a lot of fluids given at a slow rate as well as insulin infusions.

Correct over 24 hours.

24
Q

What is hypoglycemia?

A

BG of < 40-50 mg/dL

Diabetis may have symptoms at higher levels due to higher threshold for BG levels

25
Q

Symptoms of hypoglycemia include..

A

Seizures

Brady

HoTN

Respiratory failure

**Almost impossible to diagnose in unconscious pt

26
Q

How can we treat hypoglycemia?

A

25g IV dextrose

1 mg IM glucagon

27
Q

Why do renal patients often have high blood glucose levels?

A

Insulin is excreted through your kidneys so renal pts have slow release of insulin into the bloodstream

28
Q

When you are administering insulin through plastic tubing, what do you need to remember?

A

It gets stuck to the plastic! Waste 20 cc’s!

29
Q

What are carcinoids?

A

Slow growing tumors that are often asymptomatic for a long period of time.

30
Q

The majority of all carcinoid tumors are found in the _______ , _______,and _______.

A

bronchus, jejunum, colon

31
Q

Carcinoid syndrome occurs in X% of carcinoid tumors.

A

X = 20

32
Q

What are the signs of Carcinoid Syndrome?

A

Acute onset of:

Flushing

Bronchospasm

Diarrhea

HTN/HoTN

Arrhythmias

33
Q

What is Carcinoid Crisis?

What are the signs of it?

A

A more severe condition of Carcinoid Syndrome that can be fatal if left untreated.

Signs of Carcinoid Syndrome but more severe in addition to:

Tachycardia

Abd pain

34
Q

What causes Carcinoid Syndrome?

A

Carcinoid tumor causes release of serotonin, histamine, bradykinin, epi, NE, kallikrein

35
Q

How can we treat Carconid Synrome/Crisis?

A

Administer somatostatin/octreotide to reduce release of vasoactive products.

36
Q

Drugs to avoid in pts with Carcinoid Syndrome:

A

HA releasing drugs

SCh

Atracurium

Epi

Norepi

Dopamine

Thiopentol

Isoproterenol

Basic Science II (9 decks)

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