Kirila DSA Flashcards
1
Q
DM type 1- essentials of dx
A
- polyuria, polydipsia, and weight loss assoc with random plasma gluc of 200 or more
- plasma gluc of 126 or more after an overnight fast, on more than 1 occasion
- ketonemia, ketonuria, or both
- islet autoab’s are freq present
2
Q
DM type 2- essentials of dx
A
- many pts > 40 yo and obese
- polyuria and polydipsia. Ketonuria and weight loss generally are uncommon at time of dx. Candidal vaginitis in women may be the initial manifestation. Many pts have few or no sx’s
- plasma glucose 126 after overnight fast on more than 1 occasion. 2 hrs after 75g oral glucose, diagnostic values are 200 or more.
- HbA1c 6.5% or more
- HTN, dyslipidemia, and atherosclerosis often assoc
3
Q
DM- environmental factors
A
- not known
- infections with viruses (mumps, rubella, coxsackie B4), consumption of cow’s milk
- hygiene hypothesis- immune system becomes dysregulated b/c of less childhood infections
4
Q
Acanthosis nigricans
A
- nape of neck
- typical dark and velvety appearance
5
Q
medications that lower glucose levels by their actions on the liver, muscle, and adipose tissue
A
Metformin!!
- inc hepatic AMP protein kinase activity
- first-line tx for type 2 DM!!
6
Q
Short-Acting Insulin Preparations- regular insulin
A
- 30 min after S/C injection
- lasts 5-7 hrs
- IV used for diabetic ketoacidosisi
7
Q
ocular complications
A
- cataracts
- retinopathy- nonproliferative and proliferative
- glaucoma
8
Q
diabetic neuropathy
A
- distal symmetric polyneuropathy
- isolated peripheral neuropathy
- autonomic neuropathy
9
Q
autonomic neuropathy
A
- metoclopramide can help gastroparesis
- erythromycin- improve gastric emptying
- diarrhea– responds to antibiotics
- ED
10
Q
skin and mucous membrane complications
A
- candidal infection
- eruptive cutaneous xanthomas (when triglycerides are high)
- necrobiosis lipoidica diabeticorum- ant surfaces of legs and dorsal surfaces of ankles- plaques with demarcated borders and a glistening yellow surface
- shin spots
11
Q
surgery
A
- insulin antagonists are mobilized
- leads to hyperglycemia and even ketoacidosis
12
Q
type 2 DM- minor surgical procedures
A
- no insulin on day of operation
- start 5% dextrose infusion
- monitor fingerstick blood gluc and give S/C short-acting insulin every 4-6 hrs
- same for major procedure- if not satisfactory, then IV insulin infusion
13
Q
type 1 DM- minor surgical procedures
A
- D/C the pump the evening b/f the procedure and given 24-hr basal insulin
- on day of procedure, start 5% dextrose
- monitor blood gluc and give S/C short-acting insulin every 4-6 hrs
14
Q
ICU pts with diabetes and new-onset hyperglycemia with blood gluc > 180- tx?
A
-insulin- aiming for target gluc levels b/w 140-180
15
Q
diabetic ketoacidosis- fluid replacement
A
- usually fluid deficit is 4-5 L
- 0.9% saline solution first- 1 L/h over first 1-2 hrs, then rate of 300 mL/h
- use 0.9% saline unless serum Na > 150 (then use -.45% saline)
- when blood glucose falls to 250- fluids changed to a 5% gluc-containing solution- maintain serum gluc at 250-300
