Ketoacidosis

Question 1

Rapid acting insulin

Answer 1

Lispro
Onset = 15-30 minutes
Peak = 30-90 minutes
Duration = 3-5 hrs

Question 2

Long acting insulin

Answer 2

Glargine
Onset = 1-1.5 hrs
Duration = 24 hrs
NO PEAKS

Question 3

Short acting

Answer 3

Regular
Onset = 30-60 min
Peak = 2-5 hrs
Duration = 5-8 hrs

Question 4

Intermediate

Answer 4

NPH
Onset = 1-2 hrs
Peak = 4-12 hrs
Duration = 18-24 hrs

Question 5

How does insulin effect menstrual cycle

Answer 5

Insulin stimulates gonadotropin hormone

- so, low insulin –> low gonadotropin hormone –> less FSH and LH –> dysregulation of menstrual period

Question 6

Type 1 diabetes genetics

Answer 6

HLA-DR3 and DR4 –> 90% of Caucasians with diabetes have those haplotypes
Type IV hypersensitivity –> T cell destruction of pancreatic beta cells –> low insulin –> hyperglycemia

Question 7

Mechanism of Insulin

Answer 7

Insulin binds to its receptor (tyrosine kinase) → tyrosine phosphorylation of receptor → glycogen, lipid, and protein synthesis as well as increased expression of GLUT-4 receptor for glucose uptake into cells (adipose tissue and skeletal muscle)

Question 8

K+ Homeostasis

Answer 8

High K+ –> increased ROMK and BK channels in Principal Cells, increased Na/K ATPase activity in all cells
Low K+ –> decreased ROMK and BK channels in Principal Cells, increased K/H ATPase in alpha-intercalated cells

Question 9

Causes of moving K into cells

Answer 9

Hyperinsulinemia
Increased catecholamines
Metabolic alkalosis

Question 10

Causes of moving K out of cells

Answer 10

Insulin deficiency

Metabolic acidosis

Question 11

Tm of glucose

Answer 11

Tm is the maximum amount of glucose the kidney can reabsorb. Once the kidney reaches its maximum, glucose can’t be reabsorbed any further because the channels are saturated –> glucosuria

Question 12

Respiratory compensation of metabolic acidosis

Answer 12

Kussmaul respirations

rapid shallow breathing –> blow off CO2 –> shift equation toward CO2 and away from H+

Question 13

Respiratory compensation of metabolic alkalosis

Answer 13

Hypoventilation

- decrease in breathing –> increase CO2 –> shift equation toward H+ and away from CO2

Question 14

Most common precipitating factor of DKA

Answer 14

Not taking insulin

Question 15

Stressors effects on precipitating DKA

Answer 15

Stressors cause release of Epi –> blocks insulin action and stimulates glucagon –> decrease utilization of glucose in periphery and increased gluconeogenesis –> severe hyperglycemia –> osmotic diuresis and dehydration

Question 16

Clinical presentation of DKA

Answer 16

fatigue, N/V, abdominal pain, fruity odor breath, Kussmaul breathing –> all can lead to decrease cerebral perfusion and coma

Question 17

2nd major effect of insulin deficiency

Answer 17

increased ketogenic machinery
- stimulate lipoprotein lipase –> increased fatty acid beta oxidation –> lots of ketone bodies –> too many for kidney (ketonemia, ketonuria) –> metabolic ketoacidosis