Diabetes Mellitus Flashcards

Question

At diagnosis if A1C is less than 9% then consider...

Answer 1

monotherapy | lifestyle changes + metformin

Answer 2

dual therapy (lifestyle changes + metformin + additional agent) Additional agent is determined based on if the patient has ASCVD or not

Answer 3

triple therapy | lifestyle management, metformin, and two additional agents

Answer 4

combination injectable therapies.

Answer 5

Acts on liver- decrease glucose production, muscle, and adipose- increased uptake

Answer 6

Cr > 1.4 in women or 1.5 in men hepatic failure alcoholism

Answer 7

500-2000 mg daily

Answer 8

GI upset lactic acidosis B-12 deficiency AKI

Answer 9

Perform A1C 2x annually in patients that meet treatment goals Perform A1C quarterly in patients whose therapy has changed or who are not meeting their treatment goals.

Answer 10

``` Nutrition therapy limit alcohol intake sodium restriction 150 min/week of physical activity Stop tobacco products psychosocial care metformin therapy for prevention of diabetes in those with pre diabetes. ```

Answer 11

glimepiride glipizide glyburide

Answer 12

Stimulate voltage gated calcium channels act on pancreatic B cells to promote insulin release. Metabolized in liver excreted in kidneys

Answer 13

severe renal impairment hepatic failure caution with CV disease and elderly

Answer 14

Hypoglycemia

Answer 15

Only difference from sulfonylureas is that they don't stimulate voltage gated calcium channels, still block Potassium channels Excreted in bile Pulses of insulin from pancreatic B cells

Answer 16

Repaglinide

Answer 17

Use with caution with other CYP450 medications

Answer 18

Hypoglycemia

Answer 19

Give 15 minutes before meals, can combine with metformin appropriate for renal impairment and elderly Can be used as an initial therapy for those with contraindications to metformin

Answer 20

Nateglinide

Answer 21

Binds to sulfonylurea receptors absorbed in intestines metabolized by liver results in rapid pulses of insulin

Answer 22

Appropriate for patients with renal impairment and elderly given pre meal may be combined with metformin

Answer 23

Pioglitazone (actos) | Rosiglitazone (Amanda)

Answer 24

sensitizes peripheral tissue to insulin | metabolized by the liver

Answer 25

Cardiovascular disease

Answer 26

``` Angina, AMI (avandia) Edema Fractures (decreases bone density) Anemia Weight gain (sodium reabsorption) ```

Answer 27

May be combined with sulfonylureas or metformin

Answer 28

Acarbose | Miglitol

Answer 29

Slow absorption of carbohydrates in the upper GI tract | Reduces postprandial glucose surge

Answer 30

Avoid in CKD

Answer 31

flatulence risk of hypoglycemia with sulfonylureas elevated LFTs

Answer 32

Give with the first bite of food

Answer 33

Byetta- weekly Victoza Trulicity-weekly

Answer 34

"Incretins" Enhance glucose stimulated insulin secretion Suppress glucagon production Delay gastric emptying May lead to weight loss and appetite suppression

Answer 35

Medullary thyroid cancer | Multiple endocrine neoplasia

Answer 36

N/V/D | Increased risk for thyroid cancer

Answer 37

Injectable | May be combined with metformin, sulfonylureas or TZDs

Answer 38

Onglyza Januvia Tradjenta

Answer 39

"incretins" Do not combine with GLP-1 Inhibit the degradation of GLP-1 Increased effect on post-prandial glucose

Answer 40

Hypersensitivity reactions Stevens-Johnson syndrome Possible pancreatic effects Joint pain

Answer 41

Reduce in patients with renal impairment Can be combined with Metformin, sulfonylureas and TZDs Can decrease albuminuria Steer clear with CHF patients

Answer 42

Invokana (ASCVD) Farxiga Jardiance (ASCVD- decreases mortality)

Answer 43

Increases urinary glucose excretion by preventing reabsorption in the kidneys

Answer 44

Moderate renal insufficiency

Answer 45

UTI Vaginitis Dehydration

Answer 46

Farxiga- reduce dosing with hepatic impairment

Answer 47

10 u/day or 0.1-0.2 u/kg/day Increase by 10-15% or 2-4 unites once or twice weekly until you reach FBG target For hypoglycemia: determine & address cause, if no clear cause then decrease by 4 units or 10-20%.

Answer 48

Treated with multiple daily injections of prandial insulin and basal insulin OR a continuous subcutaneous insulin infusion

Answer 49

Pramlintide

Answer 50

Starts to work in 15-30 minutes Peak 1-2 hours Duration 3-6 hours Maximum duration 4-6 hours

Answer 51

Starts to work in 30 min-1 hour Peak action- 2-4 hours Duration- 3-6 hours Max duration 6-8 hours

Answer 52

Starts to work in 2-4 hours Peak 8-10 hours Duration 10-18 hours Max duration 14-20 hours

Answer 53

Starts to work in 1-2 hours No peak Duration 19-24 hours Max 24 hours

Answer 54

Starts to work in 1-2 hours No peak Duration 19-20 hours Max- 20 hours

Answer 55

0.5 u/kg/day 2/3 AM 1/3 PM

Answer 56

Basal long acting (1/3) + pre meal bolus (2/3)

Answer 57

AM: NPH (2/3) + Regular (1/3) PM: NPH (1/2) + Regular (1/2) Prandial- insulin analog based on CHO intake

Answer 58

Hourly basal rate (1/2) + Prandial bolus (1/2)

Answer 59

Nocturnal hypoglycemia then hyperglycemia by 0700 | Treatment: Bedtime snack

Answer 60

Nocturnal decrease in insulin sensitivity leading to hyperglycemia by 0700 Treatment: increase evening insulin dose

Answer 61

Hypoglycemia Financial burdens QOL demands behavioral changes

Answer 62

``` All patients with DM should have CV risk factors assessed annually Dyslipidemia HTN Smoking Family Hx Assess urine for albuminuria ```

Answer 63

Cardiovascular complications

Answer 64

Patients over the age of 50 who have at least one additional risk factor Or if they are < 50 but with multiple other risk factors clinical judgement required aspirin therapy 75-162 mg/day

Answer 65

<130 systolic (<140 ADA) <80 diastolic (<90 ADA) They should be treated with lifestyle and pharmacologic therapy ACE or ARB is first line therapy May use Thiazides and dihydropyridine CCBs

Answer 66

At diagnosis At initial medical evaluation Every 5 years or more if indicated

Answer 67

``` If asymptomatic, routine screening is not recommended. Consider investigations with... Atypical symptoms s/s of associated vascular disease EKG abnormalities ```

Answer 68

use ASA and statin therapy and consider ACE | With prior MI continue BB for at least 2 years

Answer 69

at least once a year by assessing urinary albumin and eGFR All patients with T1DM > 5 years All patients with T2DM All patient with comorbid HTN

Answer 70

BG control BP control ACE/ARB not recommended for primary prevention in patients with normal BP eGFR < 30- consult for evaluation for RRT

Answer 71

Dilated and comprehensive eye exam: T1DM within 5 years of onset T2DM at time of diagnosis ``` Manifestations of diabetic retinopathy include: hard exudates Fovea Microaneurysms Hemorrhages Cotton wool spots ```

Answer 72

T1DM 5 years T2DM at diagnosis ``` Should include 10g monofilament testing vibration sensation temperature pinprick ```

Answer 73

BG control Treat for pain with pregabalin, Neurontin, duloxetine

Answer 74

Comprehensive foot evaluation annually Feet inspected every visit Examine skin, foot deformities, neurologic assessment, vascular assessment

Answer 75

perform hbA1c on all patients Insulin therapy initiated for BG > 180 Sole use of SS insulin in inpatient is strongly discouraged Tailor discharge plan to patient Have a hypoglycemia management protocol in place

Answer 76

Hypothalamus secretes thyroid releasing hormone (TRH) which acts on the anterior pituitary which then releases thyroid secreting hormone (TSH) which stimulates the release of hormones T3, T4 from he thyroid. T3, T4 have a negative response on the pituitary and hypothalamus to stop releasing their hormones if there is enough.

Answer 77

TRH, TSH (both high) Hypothyroid

Answer 78

TRH, TSH (both low) Hyperthyroid

Answer 79

``` Fatigue, weakness cold intolerance dyspnea on exertion weight gain cognitive dysfunction constipation decreased hearing depression myalgia menorrhagia arthralgia dry skin hoarseness edema bradycardia slow movement/speech ```

Answer 80

``` All patients with clinical s/s Presence of a goiter History of autoimmune disease Head/neck irradiation Family history Meds that could interfere HLD Hyponatremia Anemia Pericardial/pleural effusions Pituitary pathology ```

Answer 81

TSH "gold standard"- elevated with primary hypothyroidism Free T4 ``` Additional testing: Lipid Blood glucose Sodium CBC (normocytic or microcytic anemia) Antithyroglobulin Ab Antithyroperoxidase Ab CT/MRI neck for goiter ```

Answer 82

TSH 0.5-4 | Free T4- 4.6-12

Answer 83

Levothyroxine 25-75 mpg/day (young adults) 50 mpg/day (older adults) repeat TSH in 8 weeks titrate dosage to clinical s/sx and repeated labs careful not to induce hyperthyroid increase at 25 mcg increments Then repeat blood work annually when on a set dose

Answer 84

``` Rare AMS Hypothermia Decreased cardiac output Increase vascular permeability increase water retention ```

Answer 85

Passive rewarming Cardiac monitoring Intubation for respiratory failure IV levothyroxine- 500 mpg loading dose then 50-100 msg daily after Alternative medication IV liothyronine 10-20 mcg loading dose 10 mpg Q 4-6 hours x 48 hours risk for arrhythmias ``` D5W infusion Monitor Na Avoid fluid overload For adrenal insufficiency IV hydrocortisone 100mg loading then 25-50 mg Q8 after May need vasopressors ```

Answer 86

Autoimmune, thyroidectomy, RAI

Answer 87

Medication induced, pituitary adenoma, adrenal insufficiency

Answer 88

Graves' disease (60-80% have one of these first three) Toxic multi nodular goiter Toxic adenoma

Answer 89

``` Nervousness Heat intolerance Anxiety Irritability Weight loss Frequent BMs Palpitations Fever Resting tremor hyperreflexia tachycardia/afib exophthalmos ```

Answer 90

``` TSH decreased T4 normal or increased T3 increased Increased thyroid resin uptake elevated ESR, CRP Anemia Leukocytosis Hypercalcemia ```

Answer 91

Beta blockers for symptoms -Propranolol most common Thioureas: -Methimazole (preferred)- block T3, T4 production -Propylthiouracil -Often used in conjunction with Iodine 131 therapy Repeat thyroid function in 6-8 weeks Titration is based on FT4 levels Recurrence with discontinuance of medication Ineffective with thyroiditis Risk for agranulocytosis/pancytopenia- monitor CBC

Answer 92

Thyroidectomy- typical treatment for graves disease | Need to be euthyroid prep using medication

Answer 93

Can cause hypo from decrease T3 production But more commonly hyper direct toxic effect on the thyroid follicular cells which results in destructive thyroiditis. Enhanced thyroid production Must be monitored closely

Answer 94

Propranolol I-131 Have cardiologist involved

Answer 95

Marked delirium Fever SVT

Answer 96

Methimazole- give at higher doses with sodium iodide 1 hour after Propranolol Hydrocortisone ``` Supportive measures antipyretics avoid stimulation cardiac monitoring fluid repletion avoid ASA ```

Answer 97

Radioiodine uptake scanning (Hcg first) Thyroid US Orbital CT/MRI

Answer 98

Progressive destruction of thyroid cells until they are euthyroid Used in conjunction with propranolol and methimazole Check Hcg Smoking cessation is essential I-131 is used

Answer 99

Graves opthalmopathy.

Answer 100

hyperparathyroidism

Answer 101

TSH, FT4, Ca levels

Answer 102

Recurrent laryngeal nerve damage- vocal cord paralysis | Hypoparathyroid

Answer 103

Hypothalamic-Pituitary Adrenal Axis

Answer 104

Occurs secondary to an excess of circulating cortisol, either endogenous or exogenous from glucocorticoid. ACTH hyper secretion (endogenous) Benign pituitary adenoma Exogenous glucocorticoid production More prevalent in females

Answer 105

Due to gluconeogenesis and glycolysis ``` Weight gain Glucose intolerance Moon face buffalo hump hirsutism depression Diastolic hypertension ``` Fatigue Slow wound healing Hypercoagulable state Hypokalemia Hypernatremia

Answer 106

``` Impaired glucose tolerance Hyperglycemia Glycosuria Leukocytosis Hypokalemia Hypernatremia ```

Answer 107

Get 1 mg of dexamethasone at 11 PM | Colect serum cortisol level at 8 AM the next morning because that is when cortisol levels should peak

Answer 108

For screening for Cushings syndrome or Hypercortisolism

Answer 109

"negative predictive"- these findings exclude cushings syndrome Under 2 mpg/dL HPLC assay this is diagnostic that they DO NOT have cushings

Answer 110

This is used as a confirmatory test Abnormally high 24 hour urine free cortisol level and creatinine confirms Hypercortisolism Typically 3 x upper limit of normal for lab

Answer 111

Once the DEX suppression, 24 hour urine and ACTH testing is complete Then you can get Pituitary MRI, Adrenal CT, or Chest/Abd/Pelvis CT- these are used if tumor is suspected

Answer 112

Primary treatment intervention for tumor related cushing syndrome -Trans-sphenoidal resection is the gold standard ``` Post-op: Glucocorticoid replacement Glucose management DVT prophylaxis Monitor for adrenal insufficiency ```

Answer 113

When the body experiences stress or the circadian rhythm, neurotransmitters work to produce cortisol. The hypothalamus triggers the release of corticotropin releasing hormone which then acts on the anterior pituitary and leads to the ACTH release from the anterior pituitary which works on the adrenal gland to release cortisol. Also any synthetic glucocorticoids that the patient is receiving will also stimulate this cortisol production and release. If inflammation in the body occurs, this provides negative feedback to the neurotransmitters to the hypothalamus to produce less cortisol.

Answer 114

Anti seizure medications Estrogen therapy pseudo-bushings state (CRF, Alcoholism)

Answer 115

These are utilized by patients who are awaiting surgical intervention or it is contraindicated Spironolactone- manage hypokalemia Dihydrop CCB- manage HTN Ketoconazole/metyrapone- adrenal enzyme inhibitors so they inhibit synthesis or cortisol in the adrenal cortex- monitor LFTs Cabergoline- dopamine agonist- targets pituitary- monitor free cortisol Monitor K, Cr, NA, CBC Assess for DM, Osteoporosis wean and DC glucocorticoids

Answer 116

Cardinal gazes 3rd cranial nerve palsy

Answer 117

Osmoreceptor located in the hypothalamus which are very sensitive to the concentration of sodium and osmolarity. Can be stimulatory or inhibitory to increase or decrease ADH production. Stretch receptors in the carotid sinus, atria and large veins. They can be stimulatory for ADH secretion with decreased volume and afferent activity. Inhibitory for increased volume and afferent activity. Once the stretch or osmo receptors are stimulated the posterior pituitary will secrete ADH by acting on the synthesis. Once ADH is secreted it will result in increased water reabsorption. Water reabsorption is passive by increasing permeability of the renal collecting ducts.

Answer 118

DI you have decreased ADH secretion which leads to large volume of dilute urine SIADH you have increased ADH secretion which leads to decreased urine volume and very concentrated urine

Answer 119

Neurogenic (destruction of posterior pituitary) | Nephrogenic (Renal tubular defect leading to decreased ADH sensitivity)

Answer 120

Central: Tumors Surgery Trauma Renal: Renal diseases (genetics) Lithium ADH unresponsive kidney

Answer 121

``` may be asymptomatic Or Extreme thirst Polydipsia (2-20 L) Polyuria (2-20L/24hour) Urinary frequency Nocturia Somnolence s/s dehydration- hypotension, tachycardia, poor skin turgor ```

Answer 122

``` 24 hour urine: Volume osmolarity < 300 Ur Creatinine Specific gravity < 1.010 ``` ``` Hyperuricemia Hypernatremia Hypokalemia Hypercalcemia Serum Osmo > 290 ```

Answer 123

MRI of hypothalamus and pituitary to look for neurologic abnormalities

Answer 124

Administration of DDAVP intranasal or IV/SubQ Urine volume/Osmo measured 12 h before and 12 h after administration Assess serum Na (don't want to reduce too quickly)

Answer 125

Central DI: Rapid decrease in thirst and polyuria symptoms after administration and you will have a normalizing serum Na Nephrogenic DI: clinically unchanged For marginal improvement: double the dose and reassess

Answer 126

DDAVP for the goal of reducing UOP Can be given intranasal, PO, SubQ, IV PO has less efficacy so requires larger dose Assess Serum Na!!!

Answer 127

Chlorpropamide- second line choice. Enhances renal response to ADH Thiazide in combo with low sodium diet- more common with nephrogenic DI

Answer 128

Monitor serum Na frequently initially to prevent sodium decreasing too quickly

Answer 129

Thiazide diuretics and NSAIDs (HCTZ + Indomethacin) Induce a mild hypovolemia. increase proximal sodium and reabsorption which leads to decreased H2O delivery to collecting ducts

Answer 130

Amiloride (midamor) (blocks lithium via the sodium channels in the kidneys) Monitor for hyperkalemia and lithium levels frequently

Answer 131

``` Glucose BUN/Cr K+ Na Ca Plasma and urine osmolarity ```

Answer 132

-If patient unable to take in PO then IVF is indicated. -For hypovolemic shock give saline until perfusion is restored -0.45% Na or D5W with half the FWD given in the first 12-24 h. Monitor serum Na reduction, should not exceed 1-2 mEq/L/h

Answer 133

FWD= 0.4 x body weight (kg) x [(serum Na/140)-1]

Answer 134

A complete loss of adrenal cortices (Primary) Loss of glucocorticoid and mineralacoritcoid secretion Arises when cortisol levels are not sufficient to meet the needs of the body Cortisol helps to maintain vascular tone, hepatic gluconeogenesis and maintaining glycogen

Answer 135

Destruction from autoimmune disease (most common) Metastatic disease Deposition diseases: hemochromatosis, amyloidosis, sarcoidosis Congenital adrenal hyperplasia (2nd most common cause)Bilateral hemorrhage Infection Drug induced: ketoconazole, etomidate, Rifampin, anticonvulsants

Answer 136

``` Stress Abrupt ACH withdrawal Adrenalectomy Pituitary destruction Adrenal injury Etomidate administration ```

Answer 137

``` Acute worsening of the chronic manifestations Hypotension Shock Hypoglycemia Profound dehydration ```

Answer 138

``` Fatigue Increased skin pigmentation Weakness weight loss N/V Anorexia Pain Postural hypotension Anxiety Irritability ```

Answer 139

``` Hyponatremia Hyperkalemia Hypoglycemia Elevated ESR Hypercalcemia Elevated BUN Metabolic acidosis Neutropenia Lymphocytosis Eosinophilia ``` Check cultures to look for infection

Answer 140

Adrenal CT to look for enlarged glands

Answer 141

When you suspect chronic AI not to be used in acute scenarios

Answer 142

AM cortisol < 3 ACTH > 200 Or cortisol levels that fails to rise above 20 with the cosyntropin stim test Stongly suggestive of chronic primary adrenal insufficiency

Answer 143

Glucocorticoids - Hydrocortisone 10-15 mg BID - Prednisone 2-4 mg AM, 1-2 mg PM Mineralocorticoids -Fludrocortisone 0.05-0.2 mg PO daily or every other day

Answer 144

``` Abdominal s/s hypotension shock stupor loss of consciousness ```

Answer 145

Endocrinology consultation- nephrology can also be used STAT cortisol, ACTH, Chem, Cultures Hydrocortisone (100-300 mg) + IVF without delay Continue hydrocortisone 50-100 IV Q 6 Treat electrolyte disturbances, glucose monitoring ABX- if suspect infection Once stable: Hydrocortisone + Fludrocortisone (once off IV hydrocortisone and it has been tapered)

Answer 146

Euvolemic hyponatremia Tumors - small cell lung CA - Prostate - Thymic - Pancreatic - Lymphoma PNA, TB, Lung Abscesses ETOH withdrawal Head injury, vasculitis, SLE, SDH ``` Drugs: Clorpropamide carbamazepine cyclophosphamide vincristine phenothiazines ``` Surgical procedures

Answer 147

Due to hyponatremia ``` Malaise NV HA Decreased UOP edema lethargy decreased DTR Resp arrest seizure coma death ```

Answer 148

``` Hyponatremia decreased serum osmo < 280 Urine Na >20 Absence of heart, kidney liver disease normal thyroid and adrenal function ```

Answer 149

- Fluid restriction 500 ml/dau - Increase Na by 1-2 mEq/L/h then decrease to 0.5 - 1 mEq/h - 3% saline +/- lasix monitor serum and urine Na Q 2-4 h seizure precautions

Answer 150

- Fluid restriction 500-1000 ml/day - NS or 3% - Correct serum Na by 0.5 - 1 mEq/l/h - Demeclocycline can be given if they cannot adhere to fluid restriction -Vasopressin receptor antagonist- Tolvaptan

Answer 151

- Cerebral osmotic demyelination - Stripping of the myelin sheath in the mid brain, thalamus, basal nuclei and cerebellum - Catastrophic and irreversible - Can be delayed 2-6 days after overcorrection

Answer 152

Check pre-test AM cortisol Then administer 0.25 mg IV cosyntropin Second cortisol level 30-60 minutes after administration Normal response should be a rise above 20 mg/dL of cortisol Hydrocortisone should be held 8 h prior to testing.

Answer 153

Clinically improved, normal WBC, absence of s/s of cushings

Answer 154

Orthostatic BP measurements NA, K ratio

Answer 155

Rare Tumor that arises from the adrenal medulla- increased catecholamine secretion Triggered by stress, exercise, trauma, vaginal delivery, anesthesia, IV contrast

Answer 156

-Presents 3rd-5th decade of life - 5 Ps: (know for exam) Pain- HA Perspiration-Excessive Palpitations- Tachyarrhythmias Pressure- HTN Pallor- initially- flushing late Feeling of doom lower chest/abdominal pain multisystem crisis: ARDS, AKI, Acute HF, hepatic failure

Answer 157

``` Migraine HA Essential labile HTN Thyrotoxicosis Anxiety/panic attacks Angina Gastritis Hypoglycemia Amphetamine or cocaine use ```

Answer 158

``` Hyperglycemia Proteinuria Glycosuria Leukocytosis Thyroid normal ```

Answer 159

CT/MRI abdomen- tumor | Whole body Iodine-IMBG scan- lights up the adrenal tumor

Answer 160

Alpha blockers is the 1st line therapy (phenoxybenzamine, Doxazosin) Beta blockers (propranolol, metoprolol) CCB (Nifedipine) For HTN crisis: Nicardipine, Nipride, phentolamine For cardiac arrhythmias (Lidocaine, esmolol)

Answer 161

Plasma free metanephrines initially (screening) - normal levels exclude -Must be drawn in supine position in a quiet dark room 24 hour urine testing- confirmatory Fractionated metanephrines, Fractionated and free catecholamines False positives occur in 10-20% of patients Review table 26-13 in CMDT

Answer 162

Laparoscopic resection is the treatment of choice After 4-7 days of BP control IV nicardipine or Nipride intra-op

Answer 163

Hypotension secondary to catecholamine depletion Cardiac arrhythmias Adrenal insufficiency Adrenal hemorrhage

Answer 164

DKA are Type 1 DM or very obese type 2 DM | HHS are Type 2 DM patients. Most likely in elderly patients with DM

Answer 165

Elevated BG, Acidosis, ketosis Polydipsia, Lethargy, fatigue, Acute confusion Kussmaul breathing Confusion, Nausea, Vomiting, Abdominal pain Polyuria, glycosuria, ketonuria Muscle wasting

Answer 166

``` Polyuria Weakness Lethargy/confusion Hypotension Tachycardia Profound dehydration Poor skin turgor ```

Answer 167

HHS has no or small ketones and are not acidotic Serum bicarbonate is normal They have a high serum osmolality and usually BG levels are higher DKA are positive for ketones, have an anion gap. Are acidotic and low serum bicarbonate

Answer 168

``` Fluid replacement (1L/hr NS) -Fluid determination by corrected Na -Once BG is 200 then you switch the D51/2NS at 150-250 / hr Replace potassium -Check renal function -replace per hospital protocol Insulin -IV infusion -0.1 u/kg as a bolus -0.1 u/kg/hour infusion -should drop by 50-75 mg/dL/hour if not double insulin -Once BG is 200 reduce the insulin infusion. Keep BG between 150-200 until anion gap closes Assess the need for Bicarb -only use for pH<6.9 -This is controversial ```

Answer 169

``` IV fluid replacement- very important, may never require insulin. -determined by volume status -start with NS -Use 1/2 NS for high or normal serum NA -Use D51/2 once serum BG 300 Correct hyperosmolar state Insulin -0.1 u/kg as bolus -0.1 u/kg/hr continuous Replace potassium ```

Answer 170

In order to convert to SQ insulin in DKA patients should: Be eating Alert BG < 200 Resolution of acidosis (AG < 12, HCO3 > 15) In order to convert to SQ insulin in HHS: Be eating Alert BG < 250

Answer 171

``` Cortisol deficiency Tumors- pancreatic B cell Certain medications -BB can mask s/s of hypoglycemia DM medications Accidental/Malice overdose insulin ```

Answer 172

``` Neuroglycopenic effects: Confusion Fatigue Seizures Focal neuro deficits Adrenergic effects: Palpitations Tachycardia Tremors Anxiety Cholinergic effects: Diaphoresis Hunger Paresthesia ```

Answer 173

``` Check plasma glucose level Insulin C-peptide Sulfonylurea Beta-hydroxybutyrate Proinsulin insulin antibody Cortisol level Growth hormone level CT scan- tumors ```

Answer 174

If alert with gag reflex: 16 grams glucose tabs or 15 grams carbs- juice/candy recheck in 15 minutes ``` Decreased LOC: D50 IV 25-50 grams Glucagon 1 mg IM or SQ D50 or D10 infusion -Q1 h BG, increase infusion by 10 until improved ``` All patients: DC offending meds monitor closely

Answer 175

``` Elevated BG Hyperkalemia progressing to Hypokalemia Anion gap Need to look at corrected sodium ABG- Decreased Ph Low bicarbonate Elevated WBC check CXR and EKG ```

Answer 176

2(Na) + Glucose/18

Answer 177

Na-(HCO3 + Cl)

Answer 178

Na + [0.016 (measured glucose-100]

Answer 179

``` incorrect insulin dosing Fasting Exercise ETOH Renal dysfunction GI illness Age Prior episodes of hypoglycemia Increased insulin sensitivity ```

Answer 180

0.4 x body weight x [(serum Na/140)- 1]

Answer 181

3-5 mEq increase in sodium

Diabetes Mellitus Flashcards

(208 cards)