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6030 Primary Care Test 2 Complete ☑️ > Module 3 (c) > Flashcards

Module 3 (c) Flashcards

1
Q

Complications of Diabetes Care

-Hypoglycemia Definition

A
  • Hypoglycemia is defined as a blood glucose level <70 mg/dl

- Caused by imbalance of food, exercise, and insulin

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2
Q

Complications of Diabetes Care

-Risk Factors for Hypoglycemia

A
  1. Elderly
  2. Tight glucose control
  3. Renal insufficiency or ESRD
  4. Multiple DM medications
  5. T1DM and Insulin-dependent T2DM
  6. Previous Hypoglycemia

-Beta Blockers can CAUSE or exacerbate HYPOGLYCEMIA in some individuals.
—Monitor BS closely

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3
Q

Complications of Diabetes Care

-Symptoms of Hypoglycemia **

A

Mild Symptoms Include: (No Mental status change in Mild symptoms) (SELF-MANAGE)

  1. Headache
  2. Sweating
  3. Increased HR and feeling anxious and irritable
  4. Trembling
  5. Weakness or tiredness

Moderate Symptoms: (Decrease Thinking, Mental Fog.. Mental status changes)
-Individuals with Mild or MODERATE Hypoglycemia can SELF MANAGE

Severe Hypoglycemia (COMA, UNABLE TO SELF MANAGE)****
-Need assistance
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4
Q

Hypoglycemia Treatment

-15-15 rule

A

Preferred treatment:

  • 15 G of GLUCOSE for the conscious individual
  • 15 G rapid-acting carbohydrate
  • Check BS level in 15 minutes

If BG is still <70, repeat 15 G of carbohydrate
-If normal, eat a meal or snack to prevent recurrence

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5
Q

Hypoglycemia Treatment

-Examples of 15 G of Glucose?

A
  1. 4 ounces of regular soda or juice, glucose gel, glucose tablets
  2. 1 tablespoon of sugar, honey, or corn syrup
  3. Hard candies, jellybeans, or gumdrops
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6
Q

Hypoglycemia Treatment

-Severe Treatment?

A

If Patient can swallow, give 45 g of simple carbohydrates

If patient is unconscious
-GLUCAGON IM injection <54 mg/dL

Call 911 if glucagon is unavailable
-Do not force food or drink

D50 1/2 ampule can be given IV for patients in severe hypoglycemia per paramedics or ER.

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7
Q

Hypoglycemia S/S

-Patient Education

A

Educate patient and family

  • Recognition of signs and symptoms of hypoglycemia
  • appropriate treatment
  • Wear medical ID bracelet

DOCUMENT EDUCATION GIVEN in clinic

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8
Q

Complications of Diabetes Care

-DKA characteristics?

A
  1. Hyperglycemia
  2. Hyperketonemia
  3. Metabolic Acidosis

Caused by inadequate insulin treatment or non-adherence to therapy

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9
Q

Complications of Diabetes Care

-DKA Dx Criteria

A
  1. BS greater than 250
  2. PH <7.3
  3. Bicarb level 18 meq/L or less
  • Elevated serum ketones
  • Dehydration
  • Insulin deficiency (precipitating factor)
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10
Q

Complications of Diabetes Care

-DKA Causes

A
  1. New onset type 1 diabetes
  2. Non-adherence to insulin
  3. Infection, Illness, major surgery
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11
Q

Complications of Diabetes Care

-DKA symptoms

A
  1. Rapid development of abdominal pain, nausea & vomiting
  2. Kussmaul respirations
  3. Dehydration, excessive thirst, and frequent urination
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12
Q

Complications of Diabetes Care

-DKA Physical Exam

A
  1. Fruity odor (Acetone breath)
  2. Tachycardia
  3. Hypotension
  4. Changes in consciousness
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13
Q

Complications of Diabetes Care

-DKA Lab Assessments

A
  1. ABG’s
  2. Electrolytes
  3. Glucose
  4. Anion Gap
  5. Beta-hydroxybutyrate (serum ketones)

ER Inpatient Management

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14
Q

Complications of Diabetes Care

-Management of DKA

A
  1. Fluid resuscitation
  2. IV insulin Administration
  3. Electrolyte monitoring and replacement
  4. Treatment of underlying illness
  5. Usually managed in the ICU
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15
Q

Complications of Diabetes

-Microvascular Complications

A
  1. Diabetic Retinopathy
  2. Diabetic Nephropathy
  3. Diabetic Neuropathy

Occurs when DM is untreated or poorly managed

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16
Q

Complications of Diabetes (Microvascular Complications

-Diabetic Retinopathy

A
  1. Affects MOST patients with T1DM; and 21% of patients with T2DM
  2. LEADING cause of NEW-ONSET BLINDNESS
  3. Loss of vision if untreated
  4. Need annual ophthalmology screening
17
Q

Complications of Diabetes (Microvascular Complications)

-Diabetic Retinopathy Screening?

A
  1. Annual screening by an ophthalmologist
    - At Dx of T2DM
    - 5 years after Dx of T1DM (Due to earlier onset)
18
Q

Complications of Diabetes (Microvascular Complications)

-Diabetic Nephropathy

A
  1. Most common cause of ESRD
  2. Second leading cause of death
  3. 60% of patients require dialysis or transplantation
  4. MICROALBUMINURIA earliest indication
19
Q

Complications of Diabetes (Microvascular Complications)

-Diabetic Nephropathy Characteristics

A
  1. Proteinuria
  2. Hypertension
  3. Edema
  4. Renal Insufficiency
20
Q

Complications of Diabetes (Microvascular Complications)

-Earliest Indicator of Diabetic Nephropathy?

A
  1. Microalbuminuria
21
Q

Complications of Diabetes (Microvascular Complications)

-Testing for Microalbuminuria?

A
  1. Test annually at diagnosis of T2DM

2. Test 5 years after diagnosis of T1DM

22
Q

Complications of Diabetes (Microvascular Complications)

-When Nephrology Consult is needed for Diabetic Nephropathy

A
  1. Microalbuminuria (30-300 mg/24hrs)
  2. Overt albuminuria >2mg/dl or
  3. Decreased GFR (<50ml/min)
23
Q

Complications of Diabetes (Microvascular Complications)

-Diabetic Nephropathy Treatment?

A

Treat with:
1. ACE inhibitor (One side effect is cough)
OR
2. ARB
Not both, due to similar class of medication

These medications are shown to delay dz progression to proteinuria

24
Q

Complications of Diabetes (Microvascular Complications)

-Diabetic Neuropathy

A
  1. Affects 60-70% of patients
  2. Peripheral neuropathy is most common neuropathic complication
  3. Starts in feet and legs and is characterized by burning, tingling, prickling
  4. Worse at night
  5. Muscle weakness and gait affected.
25
Q

Complications of Diabetes (Microvascular Complications)

-Peripheral Neuropathy - Clinical Exam

A
  1. Loss of sensation detected by 10g Semmes-Weinstein Monofilament
  2. Pain is present
  3. Disruption of cartilage in foot architecture
    - Hammertoes, Charcot joint
26
Q

Diabetic Foot Monofilament test

A
  1. Tests areas of the foot in 10 places. If any of the areas are abnormal REFER to a podiatrist for EARLY INTERVENTION
27
Q

Complications of Diabetes (Microvascular Complications)

-Neuropathy Pain Pharmacological Treatment?

A
  1. Topical Agents
    - Capsaicin cream or Lidocaine patch
  2. Anticonvulsants
    - Gabapentin (300 - 1200 mg 3 times daily)
  3. Tricyclic Antidepressants
  4. SSRI’s or SNRI’s
  5. DELAY opioids for as long as possible. Not a first choice
28
Q

Complications of Diabetes (Microvascular Complications)

-Non-Pharmacologic management Neuropathy?

A

NO THERAPY is proven to reverse neuropathy once established

  1. Regular food inspection
  2. Supportive shoes and foot protection w/ padded socks
  3. Strength, Gait and balance training.
29
Q

Complications of Diabetes (Macrovascular Complications)

-3 Types

A
  1. Coronary Artery Disease
  2. Cerebrovascular Disease
  3. Peripheral Vascular Disease
30
Q

Complications of Diabetes (Macrovascular Complications)

-Coronary Artery Disease (CAD)

A
  1. Atherosclerotic narrowing of the blood vessels to the heart
    - 2-4x increase risk in diabetes
  2. Occurs earlier and more extensively in diabetes
  3. MI may occur w/out typical angina***
31
Q

Complications of Diabetes (Macrovascular Complications)

-MI and CAD

A

MI may occur w/out typical angina if pt has CAD

32
Q

Complications of Diabetes (Macrovascular Complications)

-Cerebrovascular Disease

A
  1. Atherosclerotic narrowing of arteries to the brain
    - 2-5x increase in diabetes
  2. Stroke-related mortality, repeated stroke, and dementia after stroke are also increased.
33
Q

Complications of Diabetes (Macrovascular Complications)

-Peripheral Vascular Disease

A
  1. Peripheral vascular disease is atherosclerotic narrowing of the arteries to the extremities.
    - 2-4x more common in diabetes
  2. Diabetes is the LEADING CAUSE of non-traumatic amputation
34
Q

Complications of Diabetes (Macrovascular Complications)

-PVD Manifestations

A
  1. Claudication

2. Absent pedal pulses, femoral bruits

35
Q

Complications of Diabetes (Macrovascular Complications)

-Pharmacologic Prevention?

A
  1. STATINS are recommended for all patients with diabetes
    - Start slow and increase dosage due to tolerance and side effects
    - Myalgia’s can be common s/e w/ higher doses.

Optimal Mgmt of Co-morbidity ex

  • HTN (ACE inhibitor or ARB)
  • Dyslipidemia
36
Q

Complications of Diabetes (Macrovascular Complications)

-Non-Pharmacological Management

A
  1. Lifestyle Modification
    - Weight loss
    - Tobacco cessation
    - Physical activity
    - Moderate alcohol
37
Q

Diabetes

-Indications for Referral or Hospitalization

A
  1. New Dx of Type1DM
  2. Poorly controlled T2DM (Sooner than later)
  3. Complications like DKA
  4. After hospitalization
  5. Initiation of insulin pump
  6. Pregnancy
  7. If Pt requests to see a specialist ***
38
Q

Diabetes

-Collaborative Care

A

Diabetes is a progressive disease that requires collaborative treatment from many specialists to PREVENT, Identify, or SLOW the progression of end-stage organ complications

Collaborative Specialties:

  1. Endocrinologist
  2. Ophthalmologist
  3. Podiatrist
  4. Cardiologist
  5. Vascular Surgeons
  6. Nephrologist
  7. OB
39
Q

ADA Recommendations for Diabetic Hospitalization?

A
  1. DKA
  2. Hiperosmolar nonketotic state
  3. Hypoglycemia w/ neuroglycopenia
  4. Uncontrolled diabetes

6030 Primary Care Test 2 Complete ☑️ (8 decks)

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