Mod 8: dka and HHS

Question 1

DKA results from __deficiency and release of counter regulatory hormones: ___, ___, ___

Answer 1

insulin deficiency

catecholamines, glucagon, cortisol

Question 2

DKA Predisposing factors

Answer 2

illness, infection, trauma, surgery, MI, noncompliant

Question 3

DKA risk factors

Answer 3

DM1, poor glycemic control, young/old, minority, insurance, low BMI, infection, delayed treatment

Question 4

DKA lack of insulin causes 
^\_\_\_glucose production 
v\_\_\_glucose utilization 
initiation of \_\_\_\_
formation of \_\_\_\_ and \_\_\_\_\_\_\_

Answer 4

^hepatic glucose production
vPeripheral glucose utlization
initiation of gluconeogenesis
formation of ketone bodies and metabolic acidosis

Question 5

DKA diagnostic criteria 
glucose >
serum bicarb <
PH
\_\_anion gap
presence of urine or serum \_\_\_\_
fluid volume \_\_\_
\_\_\_imbalance

Answer 5

glucose >250
serum bicarb <18
ph <7.30
elevated anion gap
urine or serum ketones
fluid volume deficit
electrolyte imbalance

Question 6

DKA usually triggered by precipitating event such as ___,___,____

Answer 6

infection, acs, insulin noncompliance

Question 7

HHS is an uncommon complication of DM type __

common in the ___ and triggered by ___,__,___

Answer 7

type 2
elderly
triggered by infection, renal/cv disease

Question 8

HHS increased glucose = ^____pressure and _______

=severe ___, ___ blood volume, __perfusion

Answer 8

^serum osmotic pressure and osmotic diuresis

severe dehydration, low Blood volume, poor perfusion

Question 9

HHS diagnostic criteria 
glucose >\_\_\_
\_\_serum bicarb
serum osmolality of >\_\_\_
\_\_\_/\_\_ketones

Answer 9

glucose >600
normal serum bicarb
serum osmolality >320
absent/low ketones

Question 10

Macroangiopathy d/t atherosclerosis can cause

Answer 10

PVD, TIA/stroke, CAD/MI

Question 11

Microangiopathy causes
thickening of _____
____hyperplasia and ____
alll which ___perfusion

Answer 11

thickening of capillary membranes
endothelial cell hyperplasia and thrombosis
====vPerfusion

Question 12

How does Microvascular damage =
blindness- damaged \_\_\_\_\_
ckd, microalbuminuria- damaged \_\_\_\_\_
(first sign of diabetic kidney disease)
poor wound healing- damage in \_\_\_\_

Answer 12

damaged retinal arterioles =retinopathy/blind
damaged kidney capillaries =ckd, microalbuminuria (w/in5-10yrs)
damage in skin vessels= poor wound healing

Question 13

Angiopathic ischemia and oxidative stress cause

3

Answer 13

peripheral neuropathy- burning numbness
autonomic neuropathy- gastroparesis, bladder probs, silent MI
decreased phagocytic activity= ^infections