Kirila CIS Flashcards

1
Q

capillary glucose monitoring- terms

A
  • FSG- fingerstick glucose
  • BSG- bedside glucose
  • accucheck
  • HGM- home glucose monitoring
  • GSM- glucose self-monitoring
  • SBGM- self blood glucose monitoring
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2
Q

basal and bolus insulin

A
  • basal- long acting insulin- steady state of glucose control
  • bolus- adjusted at mealtime and based on FSG (sliding scale) +/- carbohydrate count anticipated
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3
Q

average 3 month glucose- all terms mean the same test

A
  • Hemoglobin A1c
  • HbA1c
  • GHbA1c
  • glycosylated hemoglobin
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4
Q

presentations when DM should be included in diff dx

A
  • mental status changes
  • abd pain
  • dehydration
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5
Q

Mental status changes- diff dx

A

AEIOUTIPS

  • alcohol
  • epilepsy with seizure activity
  • infection
  • overdose
  • uremia
  • trauma
  • Insulin (high or low blood sugar)
  • poisoning/psychosis
  • stroke
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6
Q

Abd pain- diff dx

A

BAD GUT.. PAINS

  • bowel obstruction
  • appendicitis, adenitis
  • diverticulitis, DIABETIC KETOACIDOSIS, dysentery/diarrhea, drug withdrawal
  • gastroenteritis, gall bladder dz
  • UTI or obstruction
  • testicular torsion, toxin (lead, black widow bite)
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7
Q

Abd pain- diff dx- 2

A

PAINS

  • pneumonia, pleurisy, pancreatitis, perforated bowel, ulcer, porphyria
  • abdominal aneurysm
  • INfarcted bowel, MI, incarcerated hernia, IBD
  • splenic rupture, infarction, sickle cell pain crisis
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8
Q

Acute complications of DM

A
  • DKA- seen in Type 1!!
  • NKHS (non-ketotic hyperosmolar state)- aka hyperosmolar non-ketotic coma (HNKC); Hyperglycemic hyperosmolar state (HHS)- seen in type 2!!!
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9
Q

DKA- etiology

A
  • inadequate insulin admin
  • infection- pneumonia, UTI, gastroenteritis, sepsis
  • infarction- coronary, cerebral, mesenteric, peripheral
  • surgery
  • drugs (Cocaine)
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10
Q

DKA- initial sx’s

A
  • anorexia
  • N/V
  • polyuria
  • thirst
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11
Q

DKA- progression of sx’s

A
  • abd pain
  • altered mental fxn
  • coma
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12
Q

DKA- signs

A
  • kussmaul respirations- rapid/deep
  • acetone (Fruity) breath odor (or like nail polish remover)
  • dry mucous membranes
  • poor skin turgor
  • tachycardia
  • hypotension
  • fever
  • abd tenderness
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13
Q

DKA- lab

A

-hyperglycemia
-ketosis
-metabolic acidosis:
Anion gap inc
pH 0.1 dec = K 0.6 inc- since acidosis causes K to shift out of cells

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14
Q

DKA- lab 2

A
  • measured Na is low secondary to hyperglycemia- for every 100 mg/dL that glucose is over 100, there will be a 1.6 meq dec in Na
  • K- serum may be normal or somewhat high- actually total body deficit!!!
  • hypertriglyceridemia
  • hyperlipoproteinemia
  • hyperamylasemia- can suggest pancreatitis
  • leukocytosis
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15
Q

High anion gap acidosis- diff dx

A

MUDPILES

  • methanol
  • uremia
  • diabetic ketoacidosis
  • paraldehyde
  • isopropyl alcohol, iron, INH
  • lactic acidosis
  • ethylene glycol
  • salicylates
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16
Q

DKA- tx

A
-ICU:
frequent monitoring of general status, vital signs, glucose, and other labs
-acid base status
-renal fxn
-K and other electrolytes
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17
Q

DKA- fluid replacement

A

1-2-3 rule

  • 2-3 L NS (0.9%) over first 1-3 hrs (5-10 ml/kg/hr)
  • then 0.45% saline at 150 ml/hr
  • when glucose reaches 250 mg/dl, switch to 5% dextrose and 0.45% saline at 100-200 ml/hr
  • fluid deficit is often 2-5 L
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18
Q

DKA- initial insulin administration

A

regular insulin

  • 10-20 units IV or IM
  • then 5-10 units/hr continuous IV
  • Inc if no response in 1-2 hrs
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19
Q

DKA- eval for underlying causes

A
  • cultures
  • EKG
  • CXR
  • drug screen
  • history from family or pt
20
Q

DKA- initial monitoring

A
  • blood work- BSG at least hourly; electrolytes q 2-4 hrs +/- ABG’s
  • clinical status hourly- vital signs, mental status, fluid I and O
21
Q

DKA- K replacement

A
  • consider when serum K < 5.5 mEq/L
  • when supplementing K, keep in mind:
  • renal fxn
  • baseline EKG and continuous cardiac monitoring
  • verify urinary output and measure hourly
22
Q

DKA- tx goals

A
  • inc the rate of glucose utilization in insulin dep tissues- glucose goal of 150-250 meq/dL
  • reverse ketonemia and acidosis
  • correct depletion of water and electrolytes
23
Q

start intermediate or long-acting insulin- when?

A
  • when pt is able to eat- mental status improved, no N/V, no abd pain
  • anion gap normalized
  • allow overlap timing of IV with SQ insulin- 30-60 min
24
Q

NKHS (non-ketotic hyperosmolar state)- etiology

A
  • insulin def
  • inadequate fluid intake
  • osmotic diuresis induced by hyperglycemia
25
Q

NKHS- precipitating factors

A
  • sepsis
  • MI
  • glucocorticoids
  • phenytoin
  • thiazide diuretics
  • impaired access to water
26
Q

NKHS- sx’s

A
  • polyuria
  • thirst
  • altered mental status
  • ABSENT- N/V, abd pain, kussmaul respirations (seen in DKA)
27
Q

NKHS- lab

A
  • lactic acidosis may produce a MILD inc in anion gap
  • moderate ketonuria from starvation
  • CORRECTED serum Na usually inc
28
Q

NKHS- tx

A

ICU

  • frequent monitoring of general status, vital signs, glucose, other labs
  • acid base status
  • renal fxn
  • K and other electrolytes
29
Q

NKHS- fluid replacement

A
  • 2-3 L NS over first 1-3 hrs
  • fluid deficit is usually 8-10 L- reverse over next 24-48 hrs using 0.45% saline
  • when glucose reaches 250 mg/dl, switch to 5% dextrose and 0.45% saline at 100-200 ml/hr
30
Q

NKHS- insulin admin

A
regular insulin
-5-10 units IV bolus
-3-7 units continuous infusion
-transition when eating as with DKA
monitor, replace K, investigate and address underlying causes
31
Q

NKHS, DKA- differences

A
  • fluid deficit is much greater in NKHS
  • some drugs can contribute to NKHS
  • N/V, abd pain, ketoacidosis, kussmaul respirations- absent in NKHS!
32
Q

major

A

..

33
Q

long term complications of DM

A
  • retinopathy
  • neuropathy
  • HD
  • nephropathy
34
Q

major cause of mortality in type 2 DM

A

-CV dz

35
Q

HbA1c

A
  • 3-4 month “avg” of blood sugars- based on glucose binding to red cells- hemoglobinopathies or recent blood transfusions may alter results
  • < 7.0 = satisfactory control
36
Q

diabetic gastropathy

A
  • delayed gastric emptying

- caused by autonomic neuropathy

37
Q

insulin is cleared by?

A

kidney

38
Q

what happens when declining kidney fxn?

A

-declining insulin requirement!!

insulin cleared by kidney

39
Q

screening for proteinuria

A

spot (random) urine sample

  • protein- standard urine dipstick not sensitive if proteinuria < 300 mg/24 hr
  • most common type of protein in albumin
40
Q

screening for proteinuria- 2

A

microalbumin/creatinine ratio

  • random urine sample
  • ratio to microalbumin to creatinine is more accurate than measuring microalbumin alone- ratio corrects for variations due to urine conc
  • MICROalbuminuria- 30 - 300 mg (over 300 = macro or albuminuria)
41
Q

24 hour urine collection

A

For protein and creatinine clearance

  • used to quantify large amts of protein in urine
  • can be done on the same specimen
  • need to obtain serum creatinine at the same time to determine creatinine clearance
  • problematic- diff to remember to save ALL urine, dexterity required to get it into container, leak in container
42
Q

immune compromise

A
  • gluc > 150 interferes with neutrophil fxn
  • general debilitation
  • mult co-morbidities
43
Q

foot care

A

daily inspection!- can use plastic mirror, family assistance (can be diff for pt with dexterity and visual problems)

  • never go barefoot
  • moisturize- but NOT in b/w or under toes
  • prescription shoes
  • podiatry
44
Q

diabetes- tx

A
  • lifestyle modification- physical activity!!, diet, weight loss, psychosocial, education
  • medications
45
Q

diabetes- monitoring

A
Quarterly
-HgbA1C
-review SGM (self gluc monitoring) log
-foot inspection
Annual
-dilated eye exam
-urine protein screening (microalbumin/creatinine)
-monofilament testing
46
Q

type 1 DM

A
  • < 1% of children dx in 1st yr of life

- <2% are under 3 yo