General Info Flashcards
Na+ Normal Lab Value
135-145
K+ Normal Lab Value
3.5-5
BUN Normal Lab Value
7-18
Creatinine Normal Lab Value
0.6-1.2
WBC Normal Lab Value
5,000-10,000
Hemoglobin Normal Lab Value
male 14-18
female 12-16
Hematocrit Normal Lab Value
male 40-52%
female 37-47%
Exceeding the renal threshold
blood glucose of 180-200mg/dL
Diagnostic criteria for diabetes
Hemoglobin A1c > 6.5%
Fasting blood glucose >/= 126 mg/dL on two occasions
Random blood glucose >/= 200 mg/dL with symptoms
Pre-diabetes criteria
Fasting blood glucose of 100 to 125 mg/dL
Hemoglobin A1c greater than 5.7% (to 6.4%)
Rapid-acting insulins
Lispro (Humalog)
Aspart (Novolog)
Human (Afrezza) inhaled
Short-acting insulins
Regular (Humulin-R and Novolin-R)
Intermediate-acting insulins
NPH (Humulin-N and Novolin-N)
Long-acting insulins
Glargine (Lantus)
Detemir (Levemir)
Rapid-acting: Onset, Peak, Duration
Onset: 10-15 min
Peak: 1 hour
Duration: 3-5 hours
Short-acting: Onset, Peak, Duration
Onset: 10-60 min
Peak: 2-3 hours
Duration: 4-6 hours
Intermediate-acting: Onset, Peak, Duration
Onset: 2-4 hours
Peak: 6-8 hours
Duration: 12-16 hours
Long-acting: Onset, Peak, Duration
Onset: 2 hours
Peak: none
Duration: 24 hours
Dawn phenomenon
Relatively normal blood glucose level until approximately 3am, when blood glucose levels begin to rise. (Thought to result from nocturnal surges in growth hormone secretions, which create a greater need for insulin in the early morning hours in patients with type 1 diabetes.)
Somogyi effect
Normal or elevated blood glucose at bedtime, a decrease at 2 to 3am to hypoglycemic levels, and a subsequent increase caused by the production of counter regulatory hormones.
Oral diabetic medications
Bigaunides: Metformin
Sulfonylureas:
2nd- Glipizide, Gluburide, Glimepiride
1st- Chlorpropamide, Tolazamide, Tolbutamide (not used)
Nonsulfonylurea Insulin Secretagogues: Repaglinide, Neteglide
Thiazolidinediones (TZDs): Pioglitazone, Rosiglitazone
Alpha-Glucosidase Inhibitors: Acarbose, Miglitol
Dopamine Agonists: Brocriptine
SGLT2 Inhibitors: Camagliflozin, Dapagliflozin
DDP4 Inhibitors/Incretin Enhancers: Sitagliptin, Saxaglipton, Exenatide
Biguanides
no hypoglycemia
Action: Does NOT stimulate insulin release- decreases liver glucose release and cellular insulin resistance, which makes blood sugar go down.
Contraindication: renal/liver disease, alcoholism, severe CHF, over 80, with contrast dye or anesthesia
AE: muscle cramps (lactic acidosis), N/V, diarrhea.
Sulfonylureas
yes hypoglycemia
Action: Directly stimulates beta cells of pancreas to secrete insulin and improve insulin action at the cellular level
Contraindication: alcohol (causes severe N/V), sulfa allergy
AE: hypoglycemia, nausea, heartburn, weight gain
Thiazolidinediones (TZDs)
no hypoglycemia
Action: Enhances insulin action and glucose utilization in peripheral tissues
Contraindication: Liver failure (monitor before starting and periodically)
AE: impair liver function, reduce effectiveness of contraceptives, cause MI/HF (hyperlipidemia), anemia, impaired platelet function, weight gain, edema
Alpha-Glucosidase Inhibitors
no hypoglycemia
Action: delay the absorption of glucose in the intestines- slow entry of glucose into systemic circulation, do not increase insulin secretion. Must be taken with first bite of food.
Contraindication: GI or renal dysfunction, cirrhosis
AE: abdominal discomfort/ distension, diarrhea, flatulence
Nonsulfonylureas Insulin Secretagogues
yes hypoglycemia
Action: Stimulate rapid onset and short duration of insulin secretion from the pancreas. Take about 15 minutes before meals
Contraindication: renal/ liver dysfunction and alcohol
AE: hypoglycemia, weight gain (less likely than sulfonylureas)
SGLT2 Inhibitors
no hypoglycemia
Action: Blocks re-uptake of glucose in the kidneys (force the kidneys to release more glucose into the urine)
Contraindications: renal dysfunction
AE: dehydration, kidney failure, slightly more prone to UTIs
DDP4 Inhibitors
yes hypoglycemia
Action: Enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying
AE: hypoglycemia, nausea, diarrhea, acute pancreatitis, weight loss
Hypoglycemia
diaphoresis, trembling, dizziness, irritability, headache, confusion, drowsiness/fatigue, slurred speech –> seizure, coma death
Cold and clammy need some candy
Hypoglycemia treatment
15grams of carbohydrate
25 to 50 mL D50W
1mg Glucagon IM or subQ
Hyperglycemia
increased thirst, dry mouth, headaches, difficulty concentrating, blurred vision, frequent urination, fatigue (weak or tired), irritability –> DKA/HHNKS
Hot and dry sugar high
Diabetic Ketoacidosis
Relative or absolute lack of insulin which leads to hyperglycemia, ketosis (fat is metabolized to produce ketones in the blood and urine), acidosis, BUN and Creatinine increase, Kussmaul respirations, osmotoic diuresis/dehydration, electrolyte loss, weakness/hypotension, N/V, abdominal pain, lethargy/coma/death
DKA diagnostic findings
GLucose > 250, serum pH 6.8-7.3, low serum bicarb, serum and urine ketones, glucose in the urine (renal threshold 180-200), abnormal electrolytes, fruity (acetone) breath
Treatment of DKA
Fluid replacement, insulin IV infusion, restore electrolytes (insulin carries potassium into cells), reverse acidosis (change IV fluids to D5W when glucose hits 250), monitor urine output
Hyperglycemic Hyperosmolar Non Ketotic Syndrome
Very high blood sugars: >600-800, absence of ketosis (still some insulin available), high blood osmolarity >350, dehydration and electrolyte loss
HHNS treatment
Fluid loss could be 10L or more, replace 1/2 of estimated loss in the first 12 hours, IV insulin, monitor electrolytes
Features of hyperthyroidism
fast, wet, and restless
increased sympathetic nervous system, increased HR, hypertension, palpitations, dysrhythmias, increased metabolism, weight loss, heat intolerance, diaphoresis, thinning hair, rapid shallow breathing, muscle weakness and wasting, weakness/tremors, fatigue/ sleep disturbance, goiter, exopthalmos, lid lag, photophobia, irritability and restlessness, emotional lability, amenorrhea
Hyperthyroidism drug therapy
Anti thyroid agents: Propylthiouracil (PTU), Methimazole (Tapazole), Carbimazole, Lithium
Iodine preparations: Strong iodine (Lugol’s solution), Saturated solution of potassium iodide (SSKI), Potassium iodide tablets, solution or syrup
Propylthiouracil
Blocks synthesis of hormones (conversion of T3 to T4)
AE: rash, N/V, agranulocytosis, lupus syndrome, hypothyroidism, increased risk for infection and delayed healing
Methimazole
Blocks synthesis of thyroid hormone
AE: more toxic than PTU, watch for rash, N/V, agranulocytosis, hypothyroidism, etc.
Potassium iodide
Suppresses release of thyroid hormone.
AE: Discontinue for rash, can produce iodinism: lacrimation, salivation, stuffy nose, acne
Features of hypothyroidism
thick, slow, and swollen
weakness, lethargy, fatigue, dry skin/ coarse hair brittle nails, thick tongue/hoarse voice, cold intolerance, constipation/weight gain, mental impairment, muscle cramps/slow muscle movements, depression/blank expression, bradycardia/dysrhythmias/cardiomyopathy
edema of eyelids, face, legs, hearing loss, menorrhagia, slowing of return phase of reflexes, goiter
Myxedema coma
life threatening emergency!
coma, respiratory failure, hypotension, hypothermia, hyponatremia, hypoglycemia, shock, organ failure and death
Features of hyperparathyroidism
“Moans, groans, stones, and bones”
Gastrointestinal: peptic ulcers, N/V, pancreatitis, constipation, anorexia
Renal: kidney stones
Skeletal: bone pain, osteoporosis, spontaneous fracture, weakness
Mental: depression, anxiety, sleep disturbances, psychosis, coma
High levels of PTH along with hypercalcemia and hypophosphatemia
Features of hypoparathyroidism
Symptoms related to hypocalcemia: tingling, muscle cramps, tetany and convulsions
Positive Chvostek’s and Trousseau’s signs
Features of Anterior Hypopituitarism
Depend on the cause and hormone affected, but general fatigue, weakness, sensitivity to cold, decreased appetite, weight loss, abdominal pain, low BP, HA, visual disturbances, loss of armpit/pubic hair, cessation of periods, infertility, failure to lactate, decreased libido, loss of body/facial hair
