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endoII exam2 > Pales DM CIS part I > Flashcards

Pales DM CIS part I Flashcards

1
Q

What is diabetic ketoacidosis

A

glucose >250
acidosis with blood pH <15
serum + ketones

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2
Q

When does DKA present in DM II

A

late stages beta cell failure

during stress

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3
Q

signs DKA

A

weakness, decreased appetite, nausea, vague abdominal pain

mental status changes: confusion, lethargy, coma

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4
Q

signs of acidosis

A

confusion, lethargy, kussmal respration

fruity breath

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5
Q

signs of dehydration

A

oral membranes
turgor of skin
hypotension/tachycardia

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6
Q

DKA labs

A 
high blood glucose
low CO2/bicarb/pH
high ketones/acetone/ketoacids
high BUN Cr
high serum K with decrease total body K
low Na
high PO4
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7
Q

how to correct Na for high glucose

A

for every 100 over add 1 to Na

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8
Q

Tx DKA

A

IV insulin to correct acidosis!!!

give glucose too to buffer the insulin because need enough insulin to correct acidosis

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9
Q

labs for hyperosmolar hyperglycemic non-ketotic state

A 
high glucose
serum osmolality>310
no acidosis (pH>7.3)
serum bicarb>15
normal anion gap <14
low K
Na can be low (correct for glucose and then hgih)
elevated BUN/Cr
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10
Q

what causes hyperosmolar hyperglycemic non ketotic state

A

hyperglycemia causes osmotic diuresis causing dehydration increaseing osmolality, decrease free fluid and resulting in hyperglycemia

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11
Q

what can hyperosmolar hyperglycemic nonketotic state lead to

A

hypovolemic shock

end organ damage: coma, renal failure

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12
Q

what DM can have hyperosmolar hyperglycemic non ketotic state

A

DM II

non compliance to medications

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13
Q

Tx hyperosmolar hyperglycemic non-ketotic state

A

IV fluids
a little IV insulin
electrolyte replacement
ventilatory support at times

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14
Q

when can hypoglycemic coma happen

A

blood glucose <50

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15
Q

2 conditions when can have diabetic coma

A

DM

or those with metabolic disturbance

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16
Q

hypoglycemia Sx

A 
HA
sweat
shaky
hungry
confused
grumpy
dizzy
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17
Q

Tx hypoglycemic coma

A

sugar orraly

glucagon SQ

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18
Q

microvascular complicaitons DM

A

neuropathy: peripheral sensory and motor. also autonomic
nephropathy: chronic kidney disease
retinopathy: blindness

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19
Q

macrovascular complications D

A 
atherosclerosis of big arteries
coronary- MI
cerebral/carotid-stroke
LE- LE amputation
Renal-HTN- MI/stroke
mesenteric-bowel ischemia
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20
Q

leading cause blindness in US

A

diabetic retinopathy

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21
Q

2 types retinopathy

A
  • nonproliferative “background”

- proliferative

22
Q

what is most common retinopathy

A

non proliferative from microaneurysms, dot hemorrhages, retinal edema

23
Q

cause of proliferative retinopaty

A

new capillaries and fibrous tissue in retina from ischemic retinal infarcts (wool spots)

24
Q

other ocular complications (not retinopathy) form DM

A 
lens swelling (reversible)
cataracts
25
Q

what causes the diabetic nephropathy

A

from the increased pressure. focal segmental diabetic nephropathy

26
Q

how to screen for diabetic nephropathy

A

microalbuminuria screen

27
Q

stocking glove pattern

A

diabetic neuropathy

28
Q

what are the + and - signts peripheral neuropathy

A

burning pain, paresthesias

hyposthesia, decrease temp and vibratory sensation, loss of achilles reflexes

29
Q

what is mononeuropathy

A

isolated nerve, likely ischemic
cranial nn
femoral nerve- diabetic amyotrophy, severe pain on front of thigh and quad weakness

30
Q

charcot foot

A

diabetic neuropathy

31
Q

4 conditions of charcot foot formation

A

loss of sensation, initial trauma, repetitive traumas

good blood flow to feet

32
Q

signs diabetic gastroparesis

A

nausea/vomiting
abdominal pain
weight loss.malnutrition
diagnosed by gastric empyting study

33
Q

what is neurogenic bladder

A

urinary retention
incontinence
frequency

34
Q

cholesterol levels in DM

A

high LDL
high TG
low HDL

35
Q

red lesions on shins with DM

A

necrobiosis lipidoica diabetorum

36
Q

best indicator for increased risk complications in DM

A

HbA1c

37
Q

what can decrease HbA1c

A

if patient has shortened RBC life span

like hemolytic anemia, frequent transfusions or bleeding

38
Q

glucose control prevents what complications of DM

A

microvascular

39
Q

oral medications used in DM

A

secretogogues, insuline sensitizers, glucourics inhibitors (increase glucose loss in urine)

40
Q

MOA sulfonulure

A

block K channel on beta cells so increase insulin secretion

41
Q

contraindications sulfonylureas

A

pregnancy, liver or renal insufficiency

42
Q

what DM med can cause hypoglycemia

A

sulfonylurea

43
Q

side effects sulfonylurea

A

GI upset, urticaria, weight gain
jaundice
SIADH
hypoglycemia

44
Q

rule for meglitinides

A

skip a meal skip the pill

45
Q

how does incretin/GLP-1 or DDP-4 inhbiitors work

A

increase insulin, meal dependent

does not cause hypoglycemia

46
Q

what drugs are insulin sensitizers

A

biguanides (metformin)

47
Q

results metformin

A

weith loss
does not cause hypoglycemia
improves cholesterol

48
Q

side effects metformin

A

lactic acidosis, GI upset, dec B12/folate absorption

49
Q

Contraindications metformin

A

renal or liver insufficiency, chronic hypoxia

alcholism

50
Q

TZDs MOA

A

increase sensitivity to insulin

decrease hepatic gluconeogensis

51
Q

side effects TZDs

A 
significant weigh gain
water retention (CHF contraindication)

endoII exam2 (18 decks)

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