Endocrinology Flashcards
What is Diabetes Mellitus
A metabolic disease resulting from the breakdown in the ability of the body to produce or utiliza insulin
Pathophysiology of Diabeties Mellitus type 1
- Most commonly seen in adolecent
- Associated with the presence of human leukocyte antigens
- Islet cell antibodies found in approximately 90% of patients within the first year
- Ketone development usually occurs
- Believed to be the result of an infectious or toxic insult to pancreatic B cells
Signs and symptoms of T1DM
- Polyuria
- Polydipsia
- Polyphagia
- Nocturnal enuresis
- Weight loss
- Weakness/Fatigue
Lab/Diagnostivs for T1DM & T2DM
- Fasting glucose greater than 126
- Random plasma glucose greater than 200 with signs of hyperglycemia
- Plasma glucose great that 200 after glucose load
- Hgb A1C greater than 6.5%
Management of T1DM
- Obtain baseline of the following
- Age of onset
- Obesity
- Cardiac risk factors
- Presence of ketomnes
- Diagnostic markers
- Lipid panel
- ECG
- Renel Studies
- Baseline Physical Exam
- Basal Insulin in addition to Mealtime doses and correction factor insulin
What is the somgyi effect?
Nocturnal hypoglycemia stimulates a surge of counter regulatory hormones which raise blood pressue
Treatment: Reduce or omit the at bedtime dose of insulin
What is the Dawn Phenomenon?
Happens when the tissues becomes desentized to insulin.Glucose gradually increases overnight resulting in a high AM blood sugar
Treatment: Add or increase the at bedtime dose of insulin
Pathophysiology of T2DM
- Most common type of diabeties
- Circulating insulin is not enouigh to meet metabolic needs
- Main cause is tissue insensitivity or insulin secretory defect
- Associated with obesity and metabolic syndrome
Signs and symptoms of T2DM
- Insidious onset of hyperglycemia
- Polyuria
- Polydipsia
- Reccurent vaginitis
- Peripheral neuropathy
- Blurred vision
- Chronic skin infections
Management for T2DM
- Obtain baseline data
- Weight control and exercise
- Pharmacotherapy
Pharmacotherapy for diabeties
- Biguanide
- GLP-1
What medication are biguanide?
Metformin
What medication are GLP-1 agonists
- Dulaglutide
- Exanatide
- Liraglutide
- Semaglutide
What is DKA?
Diabetic ketoacidosis is a state of intracellular dehydrationas result of elevated blood glucose levels
Signs and symptoms of DKA
- Polyuria
- Nocturia
- Polydipsia
- Weakness
- Fatigue
- Nausea/Vomiting
- Kussmauls Breathing
- ALOC
- Fruity Breath
- Orthostatic hypotension with tachycardia
- Poor skin turgor
What is HHS?
Hyperosmolar hyperglycemic state is a condition of marked elevated glucose with severe intracellular dehydration without ketone production
Lab/Diagnostics of DKA
- Hyperglycemia
- Ketonemia
- Ketonuria
- Glycosuria
- Metabilic Acidosis
- Elevated Hct
- Elevated BUN/Creat
- Hyperkalemia
- Leukocytosis
- Hyperosmoality
Management of DKA
- Protect the airway
- Administer O2
- At least 1 L of normal saline within the first hour
- Transition to 250-500 mL/h until euvolemic
- When gllucose is less than 250, transition to D51/2NS to prevent hypoglycemia
- Initiate insulin therapy at 0.1u/kg
- Correct acidosis with NACHO3
- Hourly urinary output monitoring
- Supportive care
Hyperosmoality conversion
2[Na(mEq/L) + K (mEq/L)] + glucose (mg per dL/18) + BUN (mg per dL)/2.8
Signs and symptoms of HHS
- Polyuria
- Weakness
- ALOC
- Hypotension
- Tachycardia
- Poor skin turgor
Lab/Diagnositcs of HHS
- Serum glucose greater than 600
- Hyperosmolality
- Elevated BUN and Cr
- Elevated Hgb A1c
- Normal pH
- Normal AG
Management of HHS
- Protect the airway
- Administer O2
- Same fluid protocol as DKA
- Same Insulin protocol as DKA
- Supportive care