MDT S/S, Treatment Flashcards
Essentials of diagnosis for what issue?
(1) Polyuria / Polydipsia
(2) Weight loss
(3) Plasma glucose of 126 mg/dL or higher after an overnight fast, documented on more than one occasion.
(4) Ketonemia / ketonuria - inadequate insulin leads to inadequate glucose within muscle cells which promotes fat metabolism (the source of ketones).
Diabetes
signs and symptoms of what issue
May include polyuria, polydipsia, fatigue, polyphagia, unexplained weight loss, poor wound healing, blurred vision, and a higher prevalence of certain infections, especially candidal vaginitis and balanitis, recurrent/severe urinary tract infections, recurrent skin infections, and malignant otitis externa.
Classic diabetes
Insulin is indicated for type 1 diabetes as well as for type 2 diabetes with what issues?
hyperglycemia not adequately controlled with diet alone or combined with other medications
Short Term Therapy Type 1
1) Treatment of type 1 DM requires a multidisciplinary approach by the
healthcare team (Physician, Nurse, and Dietitian).
2) Patients diagnosed with new-onset of type 1 DM require ________ therapy.
3) Immediate short term goal is to what?
2) lifelong insulin
3) control hyperglycemia, maintain serum electrolytes and hydration to avoid DKA episodes.
Essentials of diagnosis for what issue?
(a) Insulin resistance due to inadequate activity of insulin receptors.
(b) Most patients are over 40 years of age and obese through is becoming more common in adolescence.
(c) Polyuria and polydipsia. Ketonurea and weight loss generally are uncommon at time of diagnosis. Candidal vaginitis in women may be an initial manifestation. Many patients have few or no symptoms.
(d) Plasma glucose of 126 mg/dL or higher after an overnight fast on more than one occasion.
(e) Random glucose of 200mg/dL or higher.
(f) Hemoglobin A1C of 6.5% or higher.
(g) Hypertension, dyslipidemia, and atherosclerosis are often associated.
Type 2 Diabetes
Treatment type 2 diabetes
Stage 1
diet modification and weight reduction.
a) Diet (Recording food eaten)
b) Exercise (Incorporating regular exercise)
Treatment type 2 diabetes
-stage 2
includes various oral antidiabetic medications.
a) Biguanides (Metformin/Glucophage) ***First line medication
b) Sulfonylurea’s
c) Meglitinide analogs
d) Dipeptidyl Peptidase derivative
e) Thiazolidinediones
f) α-Glucosidase Inhibitors
g) Glucagon-Like Peptide Receptors Agonist
h) Sodium-glucose cotransporter-2 (SGLT2 Inhibitor)
Treatment: type 2 diabetes
Stage 3
insulin requirement
-due to inability to achieve adequate glucose control with oral medications
Signs and symptoms of what issue?
Patients with this may have a wide array of symptoms and signs.
(2) The clinical manifestations are divided into two broad categories: neuroglycopenic and sympathomimetic.
(a) Neuroglycopenic
–1) As glucose is the main energy source for CNS function, most episodes of symptomatic hypoglycemia include neurologic dysfunction.
–2) With a decline in serum sugar, the brain quickly exhausts its reserve supply of carbohydrate fuel, resulting in CNS dysfunction.
–3) This manifests most commonly by alterations in consciousness, lethargy, confusion, combativeness, agitation, and unresponsiveness.
–4) Other neuroglycopenic manifestations include seizures and focal neurologic deficit
(b) Sympathomimetic
–1) A rapid fall in blood glucose levels or the hypothalamic sensing of
neuroglycopenia causes the release of the counter-regulatory hormones, primarily the catecholamines epinephrine and norepinephrine.
—-a) Typical symptoms include anxiety, nervousness, irritability, nausea, vomiting, palpitations, and tremor
hypoglycemia
Treatment for Hypoglycemia if able to tolerate PO
drink juices, sucrose water, or glucose solutions; eat candy or other foods; or chew on glucose tablets when symptoms occur.
Immediate treatment of hypoglycemia involves provision of _____
Glucose
Treatment for hypoglycemia
Adults unable to eat or drink can be given what?
-glucagon 0.5 or 1 mg SC/IM
or
-50% dextrose 50 to 100 mL IV bolus
with or without
a continuous infusion of 5 to 10% dextrose solution sufficient to resolve symptoms
DISPOSITION HYPOGLYCEMIA
Either continued or recurrent mental status alteration, recurrent hypoglycemia, or a downward trend in serial glucose values during observation despite adequate replacement therapy demands….
admission to the hospital MEDEVAC
What is the disposition of this patient HYPOGLYCEMIA
A responsible adult who will monitor the patient’s mental status frequently, coupled with a motivated patient who will perform serum glucose determinations frequently and who can maintain oral feeding.
outpatient observation
What are the clinical signs of hypoglycemia
confusion, irritability, fatigue, anxiety, sweating, irregular heart rhythm, perioral paresthesia
Essentials of diagnosis for what issue?
(1) Hyperglycemia > 250 mg/dL
(2) Acidosis with blood pH < 7.3
(3) Serum bicarbonate < 15 mEq/L
(4) Serum positive for ketones
Diabetic Ketoacidosis
Clinical Findings for what issue?
(1) May begin with a day or more of polyuria, polydipsia, marked fatigue, nausea and vomiting and, finally, mental stupor that can progress to coma.
(2) Dehydration, possible stupor.
(3) Rapid deep breathing and a “fruity” breath odor of acetone.
(4) Hypotension with tachycardia indicates profound fluid and electrolyte depletion.
(5) Mild hypothermia usually present; elevated or even a normal temperature may suggest infection.
(6) Abdominal pain and tenderness in the absence of abdominal disease; conversely, cholecystitis or pancreatitis may occur with minimal symptoms and signs.
Diabetic KETO
What is the mainstay of tx for DKA
Initially Insulin plus fluid and electrolyte replacement
-Consult Medical Officer prior to Insulin Administration
Insulin TX for DKA
1. Begin with loading dose of ____ unit/kg as IV bolus, followed by ____ unit/kg/h, continuously infused or given hourly as an IM injection
2. Recheck _______ before repeat insulin injection(s).
3. ________ insulin into the fluid line so the rate of fluid replacement can be changed without altering the insulin delivery rate
4. If plasma glucose level fails to fall at least ___% in the first hour, give repeat loading dose
- 0.15 unit/kg IV followed by 0.1 unit/kg/h IM
- blood glucose
- “Piggy-back”
- 10%
Disposition of DKA
MEDIVAC
Essentials of diagnosis for what issue?
(1) Weakness, cold intolerance, constipation, depression, menorrhagia, hoarseness, dry skin, bradycardia
(2) Delayed return of deep tendon reflexes
(3) Serum free tetraiodothyronine aka thyroxine (T4) low
(4) Thyroid-stimulating hormone (TSH) elevated in primary hypothyroidism
Hypothyroidism
Treatment for hypothyroidism
-levothyroxine is started at 25 – 75 mcg/day administered
orally
-Thyroid function tests should be repeated every 4 to 6 weeks for medication titration until TSH is at goal.
