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Foundations III- Endocrine > Type 1 DM, hypoglycemia, HHS & DKA > Flashcards

Type 1 DM, hypoglycemia, HHS & DKA Flashcards

1
Q

what is the patho of T1DM?

A

Beta-cell destruction

pancreas failure to produce insulin

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2
Q

what is T2DM?

A

progressive insulin secretory defect

or decreased sensitivity of insulin receptors

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3
Q

what are the different classifications of diabetes?

A

prediabetes
T1DM
T2DM
gestational DM

other: monogenic diabetes syndromes, dz’s of the exocrine pancrease (CF), drug or chemical induced

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4
Q

what do beta cells produce?

what do alpha cells produce

A

insulin and amylin

glucagon

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5
Q

what pt’s is T1DM most common in the US?

A

non-white hispanic white children

increased risk if fam hx

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6
Q

what are modifiable risk factors of T2DM?

A

physical inactivity, high body fat or body wt., high BP, high cholesterol

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7
Q

Causes of T1DM

A

immune-mediated (type 1A)

Idiopathic T1DM (type 1B)

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8
Q

What factor is present in first-degree relatives of pt’s w/ T1DM?

A

persistent presence of 2 r more autoantibodies which is a predictor of clinical hyperglycemia and DM

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9
Q

what are circulating antibodies present at the time of dx in T1DM?

A 
islet cells
glutamic acid decarboxylase 65 (GAD65)
insulin
ICA-512
zinc transporter 8 (ZNT8)
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10
Q

what are some tests to dx T1DM?

A 
C-peptide
gada or anti-GAD
Insulin Autoantibodies 
insulinoma-assoc.-2 autoantibodies
ICA
ZnT8Ab
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11
Q

what is the C-peptide test and when can it be checked?

A

Low levels of C-peptide and insulin usually point to T1DM in presence of exogenous insulin

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12
Q

antibody levels ____ w/increasing duration of dz.

A

decrease

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13
Q

T1DM: ___ levels of anti-insulin antibodies develop in almost all patients once they are
treated w/____

A

low

insulin

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14
Q

The A1C test measures the average blood glucose for the past ____.

A

2-3 months

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15
Q

diabetes is dx’d at an A1C of greater than or equal to….

A

6.5%

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16
Q

what test rather than A1C should be used to dx type 1

diabetes in symptomatic individuals?

A

blood glucose

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17
Q

in what situations is screening for T1DM w/an antibody panel recommended?

A

ONLY in setting of a clinical research study or in

a first-degree family member of a proband with type 1 diabetes

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18
Q

The ADA recommends children under the age of 19 dx’d with T1DM strive to maintain an A1C level

A

7.5%

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19
Q

what are lab levels consistent w/prediabetes?

A 
FPG 100-125 
or
2h plasma glucose 140-199
or 
A1C 5.7-6.4%
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20
Q

what are some essentials of dx for T1DM?

A

polyuria, polydipsia, and wt. loss assoc. w/ RBG of 200mg/dL or more

FBG of 126 or more on more than one occasion

Ketonemia, ketonuria, or both

Islet autoantibodies are frequently
present.

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21
Q

what are some essentials of dx for T2DM?

A

often >40 y/o and obese

Polyuria and polydipsia

Candidal vaginitis may be 1st sxs

FBG of 126 or more; 2 hr after 75g PO glucose, BG 200mg/dL or more

HbA1c >6.5%

assoc. w/HTN, dyslipidemia, and atherosclerosis

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22
Q

s/s of T1DM

A

hyperosmolality and
hyperketonemia, increased urination and thirst, diuresis -> loss of glucose, blurred vision d/t lens exposure to hyperosmolar fluids

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23
Q

Common sxs of T1DM

A

lethargy, stupor, Kussmaul breathing, N/V, abd pain, smell of acetone

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24
Q

insulin resistance is characteristic of T1 or T2?

A

Type 2

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25
Q

____ of pt’s do not meet targets for A1C, BP, or lipids

A

33-49%

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26
Q

what specialty should a PCP refer to if pt has T1DM?

A

endocrinologist

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27
Q

what is the tx for T1DM?

A

insulin

acetylsalicylic acid

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28
Q

when should you prescribe acetylsalicylic acid for DM pt’s?

A

pts w/incr CVD risk for primary prevention

females over 50y/o, males over 60y/o, or 1+: HTN, HLD, smoking, family history of premature disease, or
albumineria

29
Q

what are transplantation options for DM pt’s?

A

Pancreas transplantation with or without kidney transplantation

Islet cell transplant

30
Q

which pt’s cannot receive pancreatic islet auto-transplantation?

A

pt’s w/ T1DM

31
Q

what is the MC T1DM complication?

A

peripheral neuropathy

32
Q

T1DM complications lipoprotein abnormalities assoc. w/

A

slight elevation of
LDL cholesterol and serum
triglycerides

33
Q

T2DM complications lipoprotein abnormalities assoc. w/

A

distinct “diabetic dyslipidemia” is
characteristic of the insulin resistance
syndrome

High serum triglyceride level >300

low HDL cholesterol

34
Q

what are 2 major DM neuro/vascular complications?

A

diabetic foot ulcers

gangrene of the feet

35
Q

what is 1 major DM ocular complication?

A

diabetic retinopathy

36
Q

what are 4 major DM heart dz complications?

A

Coronary atherosclerosis
Myocardial infarction
Peripheral vascular disease
Stroke

37
Q

what is the glycemic criteria for hypoglycemia?

A

70mg/dL or less

38
Q

causes of hypoglycemia?

A

behavioral: too much insulin or alcohol, post exercise

regulatory issues: loss of glucagon response, sympatho-adrenal responses

DM complications: gastroparesis, ESRD

Meds

Others: hypopituitarism, GI surg, insulinoma, etc.

39
Q

sxs of hypoglycemia

A

shaky, diizzy, anxious, hungry, tachy, sweaty, HA, weak/tired, blurry vision

40
Q

Medications assoc. w/hypoglycemia?

A 
BB's
sulfonylureas
Gatifloxacin & levofloxacin
ACE inhibitors
Salicylates
Quinine
Pentamidine (used for?)
41
Q

how can you prevent/tx hypoglycemia?

A

Glucose tablets or juice

Carbohydrates, 15 grams

Parenteral glucagon emergency kit (1 mg)

50 mL of 50% glucose solution by rapid intravenous infusion

42
Q

what emergent tx can be used for hypoglycemia?

A

glucagon injection

43
Q

what is the somogyi effect?

A

Nocturnal hypoglycemia leads to a surge of counter-regulatory hormones to produce high blood glucose levels by 7 am (prebreakfast hyperglycemia)

44
Q

how can you tx somogyi effect?

A

eliminating the dose of intermediate insulin at dinnertime and giving it at a lower dosage at bedtime

or by increasing food
intake at bedtime

45
Q

what are the 2 worst side effects of DM T1 or T2?

A

hyperglycemic hyperosmolar state and DKA

46
Q

what is the calculation of serum osmolality?

A

= (2 x [Na+]) + (glucose/18) + (BUN/2.8)

47
Q

hypertonic hyponatremia is caused by?

A

hyperglycemia

48
Q

what can cause hyperosomolality in DM pt’s?

A

advanced renal failure (urea), alcohols

49
Q

what are the classic findings in HHS?

A 
MC in T2DM
hyperglycemia >600mg/dL
serum osmolality >310
blood pH >7.3
serum bicab >15
normal anion gap
minimal 
*ketonuria/ketonemia
50
Q

s/s of HHS

A

Profound dehydration - dx/tx are delayed until fluid deficit has
reached levels of 6–10 L

Non-ketotic, polydipsia, polyuria, possible neuro changes from nystagmus to coma

51
Q

lab results consistent w/HHS?

A

BG: 800 - 2400 mg/dL

Serum urea nitrogen elevations >100
mg/dL typical

52
Q

tx for HHS

A

Fluids!!!

restore UOP

hypovolemic sxs –> .9% NS

insulin (can be delayed)

K+ and Phosp

53
Q

what do you want to reduce the risk of in HHS by maintaining glycemic levels?

A

cerebral edema

54
Q

what is DKA?

A

a severe insulin deficiency

55
Q

DKA is marked by elevations of…

A

elevations of glucagon, cortisol, growth hormone, epinephrine, and norepinephrine concentrations

56
Q

DKA may be the 1st manifestation of what type of DM?

A

T1DM

57
Q

DKA MCly occurs in…

A

pts already dx’d w/T1DM

58
Q

how is DKA preventable?

A

by self-monitoring of blood glucose and blood

or urine ketone levels

59
Q

what are the MC precipitating factors in DKA?

A

MC = infection (UTI’s and pneumonia’s)

Insulin deficiency
Iatrogenic (glucocorticoids)
Inflammation (pancreatitis)
Ischemia (MI, CVA)
Intoxication (etoh, drugs)
60
Q

S/s of DKA

A

signs of hypovolemia (tachycardia, orthostasis),

N/V, abd, polydipsia, polyuria, enuresis, “fruity” acetone breath, Kussmaul breathing, AMS, coma

61
Q

initial studies for DKA eval

A

ABC’s, mentation, volume status

CBC (leukocytosis)
BMP
EKG
U/A +dipstick urine ketones?
plasma osmo
serum ketones
ABG if bicarb is low
amylase
62
Q

production of ketoacids w/minor lactic acid and free fatty acid contributions causes…

A

metabolic acidosis

63
Q

therapeutic goals

A

restore plasma volume and tissue perfusion, decr BG and somolality towards normal, correct acidosis, replenish, electrolyte losses, identify and tx precipitating factors

64
Q

early sxs of DKA

A

N/V/abd pain and hyperventilation

65
Q

As DKA worsens so does…

A

mental status

66
Q

Is onset of DKA gradual or rapid?

A

rapid

67
Q

Tx for DKA

A

ABC’s
Large IV’s
Fluids, fluids, fluids
frequent monitoring, esp. K+

68
Q

when do you give insulin for DKA?

A

after addressing K+

Foundations III- Endocrine (5 decks)

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