Kirila DSA Flashcards
DM type 1- essentials of dx
- 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
DM type 2- essentials of dx
- 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
DM- environmental factors
- 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
Acanthosis nigricans
- nape of neck
- typical dark and velvety appearance
medications that lower glucose levels by their actions on the liver, muscle, and adipose tissue
Metformin!!
- inc hepatic AMP protein kinase activity
- first-line tx for type 2 DM!!
Short-Acting Insulin Preparations- regular insulin
- 30 min after S/C injection
- lasts 5-7 hrs
- IV used for diabetic ketoacidosisi
ocular complications
- cataracts
- retinopathy- nonproliferative and proliferative
- glaucoma
diabetic neuropathy
- distal symmetric polyneuropathy
- isolated peripheral neuropathy
- autonomic neuropathy
autonomic neuropathy
- metoclopramide can help gastroparesis
- erythromycin- improve gastric emptying
- diarrhea– responds to antibiotics
- ED
skin and mucous membrane complications
- 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
surgery
- insulin antagonists are mobilized
- leads to hyperglycemia and even ketoacidosis
type 2 DM- minor surgical procedures
- 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
type 1 DM- minor surgical procedures
- 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
ICU pts with diabetes and new-onset hyperglycemia with blood gluc > 180- tx?
-insulin- aiming for target gluc levels b/w 140-180
diabetic ketoacidosis- fluid replacement
- 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
diabetic ketoacidosis- insulin replacement
- regular insulin given IV in a loading dose of 0.1 unit/kg as a bolus to prime the tissue insulin R’s
- IV doses of insulin are continuously infused
hyperglycemic hyperosmolar state- flud replacement
- start with 0.9% saline (if hypovolemia present- hypotension, oliguria)
- other cases- start with 0.45% saline
- 4-6 L may be required in first 8-10 hrs
- careful monitoring of pt- proper Na and water replacement
- once blood gluc reaches 250- fluid replacement should include 5% dextrose in either water, 0.45% saline solution, or 0.9% saline solution
- maintain glycemic levels of 250-300- reduce risk of cerebral edema
- restore urinary output to 50 mL/h
Lactic Acidosis- essentials of dx
- severe acidosis with hyperventilation
- blood pH < 7.30
- serum bicarbonate < 15
- anion gap > 15
- absent serum ketones
- serum lactate > 5 mmol/L
Lactic Acidosis- sx
- main clinical feature- hyperventilation
- can occur in metformin-treated pts!!! (kidney and liver insuff, HF- contraindicated)
Lactic Acidosis- lab
- plasma bicarbonate and blood pH are low- severe metabolic acidosis
- high anion gap > 15
- dx confirmed- plasma lactic acid conc > 5
Lactic Acidosis- tx
- tx the cause
- alkalinization with IV NA HCO3 to keep the pH > 7.2
