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Endo II Exam 2 > Diabetes Pales > Flashcards

Diabetes Pales Flashcards

(65 cards)

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1
Q

DKA

A

hyperglycemia >250
acidosis <15
serum ketone positive

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2
Q

DKA path

A

body needs energy - liver breaks down fats into ketones

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3
Q

DKA in DM I and II

A

only in insulin deficient states

DM I - kids - presentation
-college kid forgets to take insulin

DM II - late stage beta cell failure - during stress
-very high blood glucose

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4
Q

DKA clinical

A

high mortality

polyuria/polydipsia
weak
decreased appetite
nausea/abdominal pain
mental status changes
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5
Q

kussmauls respirations

A

DKA

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6
Q

fruit breath

A

ketones

-DKA

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7
Q

potassium in DKA

A

high in serum
decreased total body K

develop arrhythmia

important to replace K early with insulin therapy

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8
Q

insulin and K

A

drives back into cells

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9
Q

DKA tx

A

IV insulin

most important** - normalization of anion gap

also give glucose - to correct low sugars

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10
Q

patient with DKA dies from

A

low pH

-so use insulin to treat the acidosis

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11
Q

hyperosmolar hyperglycemic non-ketotic state

A

hyperosmolar coma

hyperglycemia >600
serum osm >310 (thick)
no acidosis**
bicarb >15
normal anion gap

hypovolemic shock

only DM II

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12
Q

patient dehydrated with no acidosis

A

hyperosmolar coma

osmotic diuresis - increased serum osm - causes hyperglycemia - cycle continues

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13
Q

older patient neglected, lives at home

A

hyperosmolar hyperglycemic non-ketotic state

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14
Q

high glucose with no acidosis

A

hyperosmolar hyperglycemic non-ketotic state

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15
Q

tx hyperosmolar hyperglycemic non-ketotic state

A

IV fluids**

some insulin
electrolytes
ventilation

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16
Q

DKA

A

insulin tx

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17
Q

hyperosmolar hyperglycemic non-ketotic state

A

fluid tx

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18
Q

hypoglycemic coma

A

blood glucose <80

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19
Q

BG <50

A

coma/passing out

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20
Q

beta blockers

A

mask hypoglycemic response
-tachy, sweating

hypoglycemia unawareness

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21
Q

hypoglycemia

A

symptom - not diagnosis

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22
Q

hungry, headache, shaky, confused, dizzy, grumpy, sweaty

A

hypoglycemia

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23
Q

tx hypoglycemic coma

A

oral glucose
IV dextrose

glucagon subQ

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24
Q

microvascular complications of DM

A

neuropathy
nephropathy
retinopathy

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25
macrovascular complications of DM
atherosclerosis - MI - stroke - amputations - bowel ischemia
26
non-proliferative retinopathy
most common DM II aka background microaneurysms, dot hemorrhages, retinal edema
27
proliferative retinopathy
most common DM I growth of new caps and fibrous tissue within retina -cotton wool spots
28
DM I
more microvascular
29
DM II
more macrovascular
30
diabetic cataracts
more quickly than non-DM
31
lens swelling
ocular complication of DM high BG draws fluid into lens - blurry vision
32
diabetic nephropathy
focal, segmental, glomerulosclerosis lots of fluid to kidney (osmotic diuresis) - infiltration - increased pressure and scarring screen for albumin**
33
peripheral neuropathy
often first complication of DM stocking-glove pattern positive and negative signs motor neuropathy - in advanced cases
34
severe pain on front of thigh and quad weakness
femoral nerve | -diabetic neuropathy
35
monofilament test
one sharp sensation in multi spots test for diabetic neuropathy
36
charcot foot
collapse of midfoot diabetic neuropathic atrophy
37
4 conditions of charcot foot formation
1 loss of sensation 2 initial trauma 3 repetitive trauma 4 good blood flow to foot
38
postural hypotension
autonomic neuropathy -complication of diabetes no tx
39
diabetic gastroparesis
weight loss, malnutrition, N/V complication of diabetes
40
diagnosis of diabetic gastroparesis
gastric emptying study
41
neurogenic bladder, impotence, sweating, temp dysregulation
complication of diabetes | -autonomic neuropathies
42
heart disease and stroke
2-4x more likely to have heart disease with diabetes 4x more likely to have stroke
43
metabolic complications of diabetes
dyslipidemia high LDL high triglycerides low HDL
44
dermatologic complications of diabetes
chronic pyogenic infections frequent boils from immune dysregulation yeast infections
45
necrobiosis lipoidica diabetorum
derm complication of diabetes can be treated with steroids - mistaken for cellulitis
46
blood sugar finger stick
just gives a snapshot of particular time but several throughout day can give trend
47
measure of HbA1c
measure of blood sugar over last 8-12 weeks goal is 7%
48
correlates with risk of complications
HgA1c
49
conditions that shorten RBC life span**
will falsely decrease HbA1c hemolytic anemia hypersplenism frequent transfusions
50
aplastic anemia
RBC live longer | -gives false rise in HbA1c
51
continuous glucose monitoring
gives you a graphy over about 3 days of monitoring
52
study conclusion
intensive control of DM - positive effect on decreasing microvascular complications modest positive effect on rate of macrovascular complications goal of HbA1c = 7**
53
sulfonylurea
increase insulin secretion - block K channels of beta cells in pancreas glyburide - 2nd generation - -excreted by kidney - renal disease - get hypoglycemia
54
adverse effect sulfonylurea
hypoglycemia
55
chronic renal failure
use 1st gen sulfonylurea | -glipizide/glimepride
56
meglitinides
close ATP dependent K channels on beta cells take with meals - skip meal/skip dose very short acting***
57
biguanides
metformin - DOC decresed glucose production by liver** increased insulin sensitivity of receptors promote weight loss and no hypoglycemia
58
averse of biguanides
lactic acidosis
59
TZD
increased insulin sensitivity** decreased hepatic gluconeogenesis may cause weight gain
60
lots of weight gain
with TZDs
61
alpha glycosidase inhibitor
decreased absorption at brush border CI - GI disorder
62
tx approach to DM
diet and lifestyle mods plus metformin if fail oral hypoglycemics - insulin
63
insulin therapy
longer effect with renal insufficiency
64
sabojyi effect
rebound hyperglycemia - high dose of insulin at night - high drop in BP - stimulate cortisol secretion - very high glucose in morning night sweats tx - decrease meds
65
dawn phenomenon
morning - spike of hormones that work against insulin - high blood glucose tx - increase meds

Endo II Exam 2 (16 decks)

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