PBL Diabetic Ketoacidosis #7 Flashcards
What do you see on a urine analysis for DKA?
Glucose
Ketones
Proteins
Why is sodium low with DKA?
sodium only lOOKS low due to the massive fluid shift from IC to EC space - the fluid in the EC dilutes where the sodium is.
Why is there high K+ with DKA?
Without insulin, the K+ doesn’t go into the cells. K+ is actually depleted inside the cells, but looks high since it is the EC space.
Why is the patient hypovolemic with DKA?
shift of water from IC to EC space due to the large amount of glucose.
What is the destruction that occurs with type I diabetes
t lymphocytes secrete autoantibodies that destroy beta cells leading to decreased insulin and glucose uptake
What 2 ketones do we see with DKA?
B-hyrodyxbutyrate
Acetoacetate
How should we replace a patient’s volume depletion with DKA?
Give Normal Saline
What is the MOA of insulin?
Binds insulin receptor –> tyrosine phosphoyrlation –> P3 kinase pathway –> glucose uptake into tissue and gene transcription
Anabolic effects!
What are side effects that could occur with insulin replacement?
- cerebral edema
- hypokalemia
- hypoglycemia
- cardiac arrhythmia
HOw long do we infuse insulin?
Until acidosis is corrected.
What promotes K+ into cells?
Insulin
catecholamines
High plasma concentration
metabolic aklalosis
What promotes K+ out of cells?
Exercise
low ph.
hyperglycemia
Rapid Acting Insulin
Types
Onset
Peak
duration
- Aspart, Glulisine, Lispro
- onset = 15 minutes
- peak = 2 hours
- duration = 5 hours
Short Acting Insulin - regular
Names
Onset
Peak
Duration
- Insulin
- onset = 30 minutes
- peak = 3 hours
- duration = 6 hours
INsulin intermediate
Name
Onset
Peak
Duration of Action
- NPH
- Onset = 2 hours
- Time to peak = 6.5 hours
- duration of action = 17 hours
Insulin Long acting
Names
Onset
Peak
Duration of Action
- Glargine, Detemir
- Onset = 1 to 1.5 hours
- Peak = 9 hours
- duration of action = 22 hours
What are signs of diabetes?
- weight loss
- low muscle mass
- polyphagia
- polyuria
- polydipsia
- glycosuria
What are signs of diabetic ketoacidosis?
- Kussmaul respirations
- Dehydration
- Nausea
- Vomiting
- Mental Status Change
- Fruity odor on breath
- Abdominal pain
preventive care for diabetes management
- cardiovascular risk management
- regular labs and physicals
- low carb diet
- weight loss
- exercise
- smoking cessation
- less alcohol
- podiatry exams
Prevalence of type I and type II diabetes.
How much of uS is affected?
What population has higher rates of diabetes?
- Type I = 5-10%
- Type II = 90-95%
- affects 9.3% of US population
- African Americans have 2-4x risk of whites
What is the role of genetics in DKA?
HLA-DR3 and DR4 correlate with autoantibodies for type I diabetes
