Pales DM CIS part I Flashcards
What is diabetic ketoacidosis
glucose >250
acidosis with blood pH <15
serum + ketones
When does DKA present in DM II
late stages beta cell failure
during stress
signs DKA
weakness, decreased appetite, nausea, vague abdominal pain
mental status changes: confusion, lethargy, coma
signs of acidosis
confusion, lethargy, kussmal respration
fruity breath
signs of dehydration
oral membranes
turgor of skin
hypotension/tachycardia
DKA labs
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
how to correct Na for high glucose
for every 100 over add 1 to Na
Tx DKA
IV insulin to correct acidosis!!!
give glucose too to buffer the insulin because need enough insulin to correct acidosis
labs for hyperosmolar hyperglycemic non-ketotic state
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
what causes hyperosmolar hyperglycemic non ketotic state
hyperglycemia causes osmotic diuresis causing dehydration increaseing osmolality, decrease free fluid and resulting in hyperglycemia
what can hyperosmolar hyperglycemic nonketotic state lead to
hypovolemic shock
end organ damage: coma, renal failure
what DM can have hyperosmolar hyperglycemic non ketotic state
DM II
non compliance to medications
Tx hyperosmolar hyperglycemic non-ketotic state
IV fluids
a little IV insulin
electrolyte replacement
ventilatory support at times
when can hypoglycemic coma happen
blood glucose <50
2 conditions when can have diabetic coma
DM
or those with metabolic disturbance
hypoglycemia Sx
HA sweat shaky hungry confused grumpy dizzy
Tx hypoglycemic coma
sugar orraly
glucagon SQ
microvascular complicaitons DM
neuropathy: peripheral sensory and motor. also autonomic
nephropathy: chronic kidney disease
retinopathy: blindness
macrovascular complications D
atherosclerosis of big arteries coronary- MI cerebral/carotid-stroke LE- LE amputation Renal-HTN- MI/stroke mesenteric-bowel ischemia
leading cause blindness in US
diabetic retinopathy
2 types retinopathy
- nonproliferative “background”
- proliferative
what is most common retinopathy
non proliferative from microaneurysms, dot hemorrhages, retinal edema
cause of proliferative retinopaty
new capillaries and fibrous tissue in retina from ischemic retinal infarcts (wool spots)
other ocular complications (not retinopathy) form DM
lens swelling (reversible) cataracts
what causes the diabetic nephropathy
from the increased pressure. focal segmental diabetic nephropathy
how to screen for diabetic nephropathy
microalbuminuria screen
stocking glove pattern
diabetic neuropathy
what are the + and - signts peripheral neuropathy
burning pain, paresthesias
hyposthesia, decrease temp and vibratory sensation, loss of achilles reflexes
what is mononeuropathy
isolated nerve, likely ischemic
cranial nn
femoral nerve- diabetic amyotrophy, severe pain on front of thigh and quad weakness
charcot foot
diabetic neuropathy
4 conditions of charcot foot formation
loss of sensation, initial trauma, repetitive traumas
good blood flow to feet
signs diabetic gastroparesis
nausea/vomiting
abdominal pain
weight loss.malnutrition
diagnosed by gastric empyting study
what is neurogenic bladder
urinary retention
incontinence
frequency
cholesterol levels in DM
high LDL
high TG
low HDL
red lesions on shins with DM
necrobiosis lipidoica diabetorum
best indicator for increased risk complications in DM
HbA1c
what can decrease HbA1c
if patient has shortened RBC life span
like hemolytic anemia, frequent transfusions or bleeding
glucose control prevents what complications of DM
microvascular
oral medications used in DM
secretogogues, insuline sensitizers, glucourics inhibitors (increase glucose loss in urine)
MOA sulfonulure
block K channel on beta cells so increase insulin secretion
contraindications sulfonylureas
pregnancy, liver or renal insufficiency
what DM med can cause hypoglycemia
sulfonylurea
side effects sulfonylurea
GI upset, urticaria, weight gain
jaundice
SIADH
hypoglycemia
rule for meglitinides
skip a meal skip the pill
how does incretin/GLP-1 or DDP-4 inhbiitors work
increase insulin, meal dependent
does not cause hypoglycemia
what drugs are insulin sensitizers
biguanides (metformin)
results metformin
weith loss
does not cause hypoglycemia
improves cholesterol
side effects metformin
lactic acidosis, GI upset, dec B12/folate absorption
Contraindications metformin
renal or liver insufficiency, chronic hypoxia
alcholism
TZDs MOA
increase sensitivity to insulin
decrease hepatic gluconeogensis
side effects TZDs
significant weigh gain water retention (CHF contraindication)
