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Endocrine II Final > Kirila CIS > Flashcards

Kirila CIS Flashcards

1
Q

What is the dosing of a bolus of insulin is based on?

A

Sliding scale finger stick glucose (FSG)

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2
Q

When someone says “regular” insulin, what do they mean

A

Like the insulin that THEY take, it’s not necessarily the regular kind of insulin

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3
Q

Where should people prick their finger when checking glucose?

A

On the side of their finger… Not as painful and they get to keep their sense of touch

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4
Q

What are we measuring when we measure blood glucose?

A

The glycosylated hemoglobin! HbA1C

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5
Q

What are the possible presentations where we include DM in diff dx?

A
  • mental status changes
  • abdominal pain
  • dehydration
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6
Q

What was bonded in the abdominal pain slide?

A

Diabetic Ketoacidosis

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7
Q

What are the acute complication of diabetes mellitus?

A
  • DKA

- non Ketoacidosis hyperosmolar state (NKHS)

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8
Q

Which type of DM has the DKA?

A

Type 1 usually

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9
Q

Which type has NKHS?

A

Type 2 DM

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10
Q

What is rapid and deep respirations?

A

Kussmal respirations

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11
Q

What breath will people with DKA have?

A

“Fruity”

-she said it’s actually like nail polish

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12
Q

What is something obvious that we need to consider when someone has DKA?

A

Drugs! Cocaine

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13
Q

Initial sx of DKA

A
  • anorexia

- nausea….

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14
Q

Labs for DKA?

A
  • hyperglycemia
  • ketones
  • metabolic acidosis
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15
Q

How is the anion gap in DKA?

A

It is high!!!

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16
Q

What does acidosis cause K to do in respect to cells?

A

-shifts potassium out of cells

17
Q

What was the mneumonic for High anion gap acidosis?

A

-MUDPILES

18
Q

What does MUDPILES mean?

A
  • Methanol
  • uremia
  • diabetic Ketoacidosis
  • Paraldehyde
  • Isolpropyl alcohol, Iron, INH (isoniazid)
  • Lactic acidosis
  • ethylene glycol
  • Salicylates
19
Q

Tx of DKA?

A
  • ICU
  • frequent monitoring of general status, vital signs, glucose, and other labs: acid base status, renal function, potassium and other electrolytes
20
Q

What is the first choice of fluid replacement in DKA?

A

Normal saline for both DKA and NHGS

21
Q

What do we have to keep in mind when replacing K+?

A

-renal function!

22
Q

When do you start intermediate or long-acting insulin?

A
  • when pt is Able to eat as shown by improved mental status, no nausea or vomiting, no abdominal
  • anion gap normalized
  • allow overlap timing of IV with SQ insulin…. Usually by 30-60 minutes
23
Q

NKHS

A

Non Ketotic hyperosmolar state

-our example was the 85 year old guy with decreased mental status

24
Q

What is a big difference between NKHS and DKA?

A
  • the fluid deficit is a lot bigger! 8-10L
  • so give them 2-3 liters NS or first 1-3 hrs
  • when Glc reaches 250 mg/dl, switch to D51/2NS (5% dextrose and 0.45% saline)
25
Q

What is the first treatment of choice for NKHS?

A

Normal saline!

26
Q

Similarities of NKHS and DKA

A 
Insulin deficiency- absolute or relative
Glucagon excess- absolute or relative
Volume depletion
Mental status changes
-both are critical conditions needing intensive monitoring
27
Q

Differences?

A

-fluid deficit is much greater in NKHS… Finish this!

28
Q

What is the major cause of mortality in type 2 DM?

A

-cardiovascular disease

29
Q

What level should the HbA1c be at?

A

-somewhere below 7.0

30
Q

What will we see in the retina exam In an intense type 2 diabetic?

A
  • extensive retinal vascular leak and lipid deposits

- there will be retinal infractions and the patients lose sight

31
Q

Diabetic gastropathy

A

When the stomach doesn’t work as it should

-the timing of the effect of insulin is all screwed up

32
Q

If there’s a guy with t2DM and his sugars seemed much more easily controlled, what’s going on?

A
  • worsening renal function

- they aren’t clearing the medications as fast

33
Q

In diabetic nephropathy, where is the initial insult?

A

At the glomerulus

-remember that the clearance of insulin will decrease

34
Q

How to screen for proteinuria

A
  • spot urine sample
  • protein…
  • standard urine dipstick not sensitive if proteinuria <300 mg/24 hr*
35
Q

What is a 24 hr urine collection used for?

A
  • protein and creatinine clearance

- need to obtain serum creatinine at the same time to determine creatinine clearance

36
Q

What do we need to encourage diabetic people to do?

A

-fucking move!

37
Q

What is the first drug of choice for a type 2 diabetic that has no renal problems?

A
  • metformin!!

- you can’t do this for type 1

Endocrine II Final (4 decks)

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