Kirila CIS Flashcards
What is the dosing of a bolus of insulin is based on?
Sliding scale finger stick glucose (FSG)
When someone says “regular” insulin, what do they mean
Like the insulin that THEY take, it’s not necessarily the regular kind of insulin
Where should people prick their finger when checking glucose?
On the side of their finger… Not as painful and they get to keep their sense of touch
What are we measuring when we measure blood glucose?
The glycosylated hemoglobin! HbA1C
What are the possible presentations where we include DM in diff dx?
- mental status changes
- abdominal pain
- dehydration
What was bonded in the abdominal pain slide?
Diabetic Ketoacidosis
What are the acute complication of diabetes mellitus?
- DKA
- non Ketoacidosis hyperosmolar state (NKHS)
Which type of DM has the DKA?
Type 1 usually
Which type has NKHS?
Type 2 DM
What is rapid and deep respirations?
Kussmal respirations
What breath will people with DKA have?
“Fruity”
-she said it’s actually like nail polish
What is something obvious that we need to consider when someone has DKA?
Drugs! Cocaine
Initial sx of DKA
- anorexia
- nausea….
Labs for DKA?
- hyperglycemia
- ketones
- metabolic acidosis
How is the anion gap in DKA?
It is high!!!
What does acidosis cause K to do in respect to cells?
-shifts potassium out of cells
What was the mneumonic for High anion gap acidosis?
-MUDPILES
What does MUDPILES mean?
- Methanol
- uremia
- diabetic Ketoacidosis
- Paraldehyde
- Isolpropyl alcohol, Iron, INH (isoniazid)
- Lactic acidosis
- ethylene glycol
- Salicylates
Tx of DKA?
- ICU
- frequent monitoring of general status, vital signs, glucose, and other labs: acid base status, renal function, potassium and other electrolytes
What is the first choice of fluid replacement in DKA?
Normal saline for both DKA and NHGS
What do we have to keep in mind when replacing K+?
-renal function!
When do you start intermediate or long-acting insulin?
- 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
NKHS
Non Ketotic hyperosmolar state
-our example was the 85 year old guy with decreased mental status
What is a big difference between NKHS and DKA?
- 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)
What is the first treatment of choice for NKHS?
Normal saline!
Similarities of NKHS and DKA
Insulin deficiency- absolute or relative Glucagon excess- absolute or relative Volume depletion Mental status changes -both are critical conditions needing intensive monitoring
Differences?
-fluid deficit is much greater in NKHS… Finish this!
What is the major cause of mortality in type 2 DM?
-cardiovascular disease
What level should the HbA1c be at?
-somewhere below 7.0
What will we see in the retina exam In an intense type 2 diabetic?
- extensive retinal vascular leak and lipid deposits
- there will be retinal infractions and the patients lose sight
Diabetic gastropathy
When the stomach doesn’t work as it should
-the timing of the effect of insulin is all screwed up
If there’s a guy with t2DM and his sugars seemed much more easily controlled, what’s going on?
- worsening renal function
- they aren’t clearing the medications as fast
In diabetic nephropathy, where is the initial insult?
At the glomerulus
-remember that the clearance of insulin will decrease
How to screen for proteinuria
- spot urine sample
- protein…
- standard urine dipstick not sensitive if proteinuria <300 mg/24 hr*
What is a 24 hr urine collection used for?
- protein and creatinine clearance
- need to obtain serum creatinine at the same time to determine creatinine clearance
What do we need to encourage diabetic people to do?
-fucking move!
What is the first drug of choice for a type 2 diabetic that has no renal problems?
- metformin!!
- you can’t do this for type 1
