Lecture 7 Diabetes

Question 1

hypoglycemia symptoms

Answer 1

shaky, dizzy, nervous, sweating
hungry
pale
clumsy
headache
confusion, inattention
tingling
fainting

Question 2

hyperglycemia symptoms

Answer 2

dehydration - thirsty
polyphagia, polydipsia, polyuria
tired and weak
blurry vision

Question 3

hypoglycemia

Answer 3

blood glucose <70 mg/dL

Question 4

severe hypoglycemia

Answer 4

blood glucose <40 mg/dL

Question 5

causes of hypoglycemia

Answer 5

too much insulin or oral anti diabetic meds
too little food
excessive physical activity

Question 6

treating hypoglycemia

Answer 6

15 g carbs orally if able to swallow
recheck blood glucose in 15 minutes
15 g carbs again if glucose <70

glucagon injection or D50 IV

Question 7

hyperglycemia

Answer 7

blood glucose >250 mg/dL

Question 8

causes of hyperglycemia

Answer 8

insufficient insulin
missed doses of insulin
physical or emotional stress
illness or infection

Question 9

complications from hyperglycemia

Answer 9

ketone production
rapid weight loss
impaired circulation
increased risk for infection

Question 10

main clinical features of DKA

Answer 10

hyperglycemia
dehydration
acidosis

Question 11

signs and symptoms of DKA

Answer 11

same as hyperglycemia
hypotension
dry skin, dry mucous membranes, flat neck veins
acetone breath
GI disturbances
kussmaul respirations

Question 12

DKA blood glucose value

Answer 12

300 - 800 mg/dL

Question 13

DKA serum pH

Answer 13

6.8-7.3

Question 14

DKA serum bicarb

Answer 14

0-15 mEq/L

Question 15

Where are ketones found?

Answer 15

serum and urine

Question 16

DKA anion gap

Answer 16

positive anion gap

more positively charged ions (Na, K, Ca, Mg) than negatively charged ions (bicarb)

Question 17

DKA treatment

Answer 17

IV insulin continuous
rehydration - NS
monitor VS and I/Os, signs of fluid overload
monitor potassium (insulin brings it into cells)

Question 18

diabetes management when sick

Answer 18

• take meds as usual
• test BG and ketones every 3-4 hours
• report BG >300 or urine ketones
• substitute soft foods if unable to eat normal foods
• 1/2 cup of fluids every 30 minutes - 1 hour

Question 19

Hyperglycemic Hyperosmolar Nonketotic Syndrome

Answer 19

life-threatening
> 340 mOsm/L
> 600 mg/dL blood glucose
ketosis absent or minimal
alterations in LOC

Question 20

when is HHNS more common?

Answer 20

for patients with type 2 diabetes

Question 21

causes of HHNS

Answer 21

infection, surgery, dialysis, illness

Question 22

signs and symptoms of HHNS

Answer 22

hypotension
dehydration
tachycardia
neuro signs

Question 23

treating HHNS

Answer 23

fluid replacement
correct electrolyte imbalances
IV insulin

Question 24

what complication is more common with type 1 diabetes?

Answer 24

renal (microvascular) complication

Question 25

what complication if more common with type 2 diabetes?

Answer 25

cardiovascular (macrovascular) complications

Question 26

what are macrovascular diseases?

Answer 26

atherosclerosis of medium and large blood vessels
coronary artery disease
cerebrovascular disease

Question 27

why can MI be “silent” with diabetes

Answer 27

lack of ischemic symptoms secondary to autonomic neuropathy

Question 28

managing macrovascular disease

Answer 28

manage HTN, start on ACE or ARB if BP goal not met in 3 months.
statin for hyperlipidemia
81 mg aspirin

Question 29

what is microvascular disease

Answer 29

thickening of the capillary basement membrane in the retina, kidneys, gums, and peripheral extremities

Question 30

what happens from microvascular disease in the gums?

Answer 30

increased susceptibility to peridontal disease and cavities

Question 31

what is the leading cause of blindness in the US before age 74?

Answer 31

diabetic retinopathy

Question 32

what happens from vessel changes in diabetic retinopathy?

Answer 32

microaneurysms
intraretinal hemorrhage
hard exudate

Question 33

signs and symptoms of diabetic retinopathy

Answer 33

blurry visionn
floaters
cobwebs
hazy vision
vision loss

Question 34

how common is diabetic nephropathy?

Answer 34

occurs in 20-40% of patients with diabetes

leading cause of end stage renal disease

Question 35

signs and symptoms of diabetic nephropathy

Answer 35

hypoglycemia
albumin in the urine
HTN

Question 36

how prevalent is peripheral vascular disease?

Answer 36

2-3 times more common in diabetic patients compared to non-diabetic patients

Question 37

signs and symptoms of peripheral vascular disease

Answer 37

diminished peripheral pulses
intermittent claudication

Question 38

what happens with severe arterial occlusive peripheral vascular disease?

Answer 38

higher incidence of gangrene and amputation for people with diabetes

Question 39

diabetic neuropathy

Answer 39

affects peripheral sensorimotor nerves AND autonomic nerves

Question 40

signs and symptoms of peripheral neuropathy

Answer 40

aching or burning
numbness and tingling
decreased awareness of body and position
decreased sensation of light, pain, temperature

Question 41

foot care for diabetic neuropathy

Answer 41

wear shoes and socks always
inspect feet every day
wash feet every day
protect feet from extreme temperatures
check with PCP right away with any concerns