Kirila CIS Endocrine Pancreas Flashcards
basal vs bolus insulin
basal is long acing insulin to achieve more steady state of glucose control
bolus insulin can be adjusted at mealtime and based on FSG
different terms for hemoglobin A1c
HbA1c
GHbA1c
glycosylated hemoglobin
how to measure HbA1c
typically on venipuncture sample, also fingerstick machines available
possible presentations to include DM in DD
mental status changes
abdominal pain
dehyrdation
mental status changes
AEIOU TIPS
alcohol epilepsy with seizure activity infection overdose uremia
trauma
insulin (high or low blood sugar)
poisoning/psychosis
stroke
abdominal pain DD
BAD GUT PAINS
bowel obstruction
appendicitis, adenitis
diverticulitis/DKA/dysentary/ diarrhea drug withdrawal
Gatroenteritis/GB disease/stones/obstruction/infection
Urinary tract obstruction or infection
Testicular Torsion
Toxin- lead, black widow spider bite
Pneumonia/pleurisy/pancreatitis/perforated bowel/ulcer/porphyuria
Abdominal aneurysm
IN- infarcted bowel
S splenic rupture/infarction/ sickle cell pain crisis
non-ketotoic hyperosmolar state seen more in
DM 2
etiology of DKA
inadequate insulin administration infection: pneumonia, UTI, gastroenteritis, sepsis infarction- any location surgery drugs (cocaine)
iii suk D
initial symptoms of DKA
VAN TP
vomiting
Anorexia
nausea
thirst
polyuria
DKA hyper or hypotension
tachy or brady cardia
hypotension and tachy
high anion GAP acidosis
MUD PILES
Methanol
Uremia
DKA
Paraldehyde Isopropyl alcohol, iron, INH Lactic Acidosis Ethylene Glycol Salicylates
sodium in DKA
measured sodium is low secondary to hyperglycemia (water pulled into ECF bc hyperosmolar)
for every 100 mg/dL that glucose is over 100mg/dL there will be a 1.6 reduction in sodium
labs DKA potassium TGs lipids and proteins amylase WBC
serum may be normal or somewhat high
-actually total body deficit
hyperTGs
hyperlipoproteinemia
hyperamylasemia
-can suggest acute pancreatitis
leukocytosis
treatment of DKA
frequent monitoing of gen status, vital signs, glucose and
A-B status
renal function
K+ and electrolytes
fluid replacement in DKA
2-3 L NS over first 1-3 hours (5-10 ml/kg/hr)
then 1/2 strength saline at 150 ml/hr
when glucose reaches 250 switch to D51/2 NS at 100-200 ml/hr
fluid deficit is often 3-5 L
initial insulin admin DKA
regular insulin
10-20 units UV or IM (0.15/kg)
then: 5-10 units/hr continous IV or (0.05=.1/kg/hr)
increase if no response in 1-2 hours
DKA eval for underlying causes
cultures EKG CXR drug scren seek additional family history
initial montioring in DKA
BSG hourly
clinical status hourly
-vitals, mental status, fluid I & O
potassium replacement in DKA
consider potassium replacement when serum K is under
5.5 meq/L
when supplemnting potassium keep what in mind
renal function
EKG and cardiac monitoring
verify urinary output and measure hourly
-likely will need indwelling foley catheter initially
glucose goal of DKA (level)
150-250
when do you start intermediate of long acting insulin
when pt is able to eat when
-mental status improved, no nausea/vomiting, no ab pain
anion gap normalized
allow overlap timing of IV with SQ insulin usually by 30-60 mintues
etiology of NKHS
insulin deficiency
inadequate fluid intake
osmotic diuresis induced by hyperglycemia
sepsis MI glucocorticoids phenytoin thiazide diuretics no water access
symptoms of NKHS
polyuria
alterd mental state
thirst
(PAT)
no nausea, vomiting, ab pain, and kussmaul resp
labs in NKHS
lactic acidosis may produce mild increase in anion gap
moderate ketonuria from starvation
Corrected sedrum sodium usually increased
treatment of NKHS
ICU
freq monitoring of gen status, vitals, glucose, acid base , renal fnct, potassium
fluid replacement in NKHS
fluid deficit is often 8-10 L
insulin admin in NKHS
regular insulin
-5-10 units IV or IM bolus
3-7 units continuous infucsion
what may alter the results of Hb A1c
hemoglobinopathies or recent blood transfusions
what level is considered satisfactory control for Hb A1c
under 7
screening for proteinuria
sensitivity
spot urine sample
-protein: standard urine dipstick not senstivie if proteinuria is less than 300 mg/24 hr
screening for proteinuria with microalbumen
use microalbumen/creatinine ratio
random urine sample
this ratio more acurate than measuring microalbumen alone
use 24 hr urine collection
-need to obtain serum creatinine at same time for clearance
what classifies micro vs macroalbumenuria
30-300 mg = micro
over 300 = macro
glucose greater than ____ interferes with neutrophil function
150
long term diabetes monitoring quarterly
Hgb A1C
review self glucose monitoring log
foot inspection for ulcerations
long term diabetes monitoring annual
dilated eye exam
urine protein screening (microalbum/creatinine ratio)
monofilament testing
