Clinical Approach to Diabetes and Hypoglycemia Flashcards Preview

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Flashcards in Clinical Approach to Diabetes and Hypoglycemia Deck (48)
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31

What are the 2 endocrine emergencies?

1. DKA= hyperglycemia, acidosis, and ketosis
2. hyperosmolar nonketoitic coma

32

What causes the mortality in DKA?

- acidosis and dehydration

33

How do you treat DKA?

- fluids (normal saline) and insulin

34

How do you treat hyperosmolar nonketotic coma?

- fluids

35

What is hypoglycemia?

- neuroglycopenic and/or neurogenic symptoms
- low plasma glucose (less than 70 mg/dL
- symptom relief after administration of carbohydrates

36

What are the symptoms of hypoglycemia?

- neurogenic (autonomic)= trembling, palpitations, sweating, anxiety, hunger, nausea, tingling.
- neurglycopenic= confusion, weakness, drowsiness, vision changes, difficulty speaking, headache, dizziness.

37

Who is at risk to develop hypoglycemia?

those with:
- autonomic neuropathy
- DM with a beta blocker
- deficiencies in counter-regulatory hormones

38

What is reactive hypoglycemia?

- post-prandial symptoms, which are usually ADRENERGIC responses.

39

How do we treat reactive hypoglycemia?

- frequent small meals
- propantheline bromide or calcium channel blockers
- acarbose (delays carbohydrate absorption)

40

What is alimentary hypoglycemia?

- occurs following GI surgery or vagotomy.
- a short-circuited GI tract results in increased carbohydrate absorption.

41

How do you resolve alimentary hypoglycemia quickly?

- feeding

42

What is fasting hypoglycemia?

- wake up with a glucose less than 70.
- neuroglycopenic symptoms including stroke may occur.
*more serious implications than reactive hypoglycemia.

43

Are most islet cell tumors malignant or benign?

- benign

44

What is factitious hypoglycemia?

- hypoglycemia that doesn't make sense. Typically in patients with access to insulin or sulfonylureas, making themselves hypoglycemic.
*will see low c-peptide levels, bc it is being taken exogenously.

45

What is the most common cause of drug induced hypoglycemia?

- alcohol= reduces gluconeogenesis acutely.

46

Can renal disease cause hypoglycemia?

- YES bc the kidneys are necessary for insulin clearance.

47

What does the workup involve for hypoglycemia?

- exclude drug induced
- pre-existing hepatic or renal disease
- pituitary or adrenal disease
- retroperitoneal tumor
- carbohydrate or meal induced

48

How do you treat hypoglycemia?

- glucose
- glucagon
- terbutaline (B2 agonist)
- somatostain analogue= reduces insulin.