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Flashcards in DM 1 Deck (53):
1

DM is 3rd leading cause of death due to....

80 perc due to accelerated atherosclerosis

2

DM is a syndrome of hyperglycemia due to....

- insulin resistance and/or - insulin def.

3

Normal BS before breakfast?

70-99

4

normal BS one hour after meals?

less then 140

5

normal BS 2 hour after meals OR before lunch, dinner, beadtime

less then or equal to 120

6

normal BS 2 hours into a glucose tolerance test

less then 140

7

What is considered a FBS that means prediabetic?

100-125

8

What is considered a 2h GTT that means prediabetic?

140-199

9

3 facts about HbA1C?

- Reflects average blood glucose level over past 8-12 weeks −Used for initial diagnosis of diabetes −Used for monitoring response to therapy

10

What is considered a normal HbA1C?

Normal 4.0-5.6 percent

11

what is considered a prediabetic HbA1C?

Prediabetes 5.7-6.4 percent

12

What is considered a diabetic HbA1C?

Diabetes ≥6.5 percent

13

What are the 4 ways to Dx Dm?

1. fasting plasma glucose greater then 126 on 2 sep 2. 2 hour plasma glucose greater then 200 during OGTT on 2 sep 3. HbA1C greater then 6.5 percent on 2 sep 4. random plasma glucose greater then or equal to 200 WITH sx

14

Sx are considered....

polyuria, polydypsia, unexplained weight loss

15

Type 1 Dm is.....

a lack of insulin.... 80 perc. desruction of beta cells

16

causes of type 1 DM

Autoimmune Genetic factors Environmental factors (Viruses, Exogenous antigens, Toxins)

17

Causes of type 2 DM

Genetic factors Obesity Environmental factors (Nutrition, physical activity)

18

what are 5 components of metabolic syndrome?

1. Insulin resistence (with ot without increase in glucose) 2. central obesity 3. HTN 4. accelerated CVD 5. High TG (low HDL; small dense LDL)

19

Diseases of the exocrine pancreas that are secondary causes of DM

pancreatitis, cancer, pancreatectomy, cystic fibrosis, hemochromatosis

20

Endocrinopathies that are secondary causes of DM

acromegaly, Cushing’s syndrome, hyperthyroidism, pheochromocytoma

21

drugs that are secondary causes of DM?

glucocorticoids (prednisone), niacin, thiazide diuretics, thyroid hormone (excess), protease inhibitors

22

time frame onset of DKA?

12-24 hours

23

What are the 6 symptoms of DKA?

1. Polydipsia 2. polyuria 3. Lethargy 4. N/V 5. Abd Pain 6. SOB

24

Physical signs of DKA

1. dehydration 2. tachypnea 3. fruity breath 4. abd. tenderness

25

What are the signs assoc with dehydration?

- low BP - Tachycardia - poor skin turgor - dry MM

26

Laboratory signs of DKA? (9)

1. Blood glucose greater then or equal to 250-600 mg/dL 2. Glycosuria 4+ 3. Serum osmolality 300-320 mOsm/kg 4. High anion gap metabolic acidosis 5. pH less then 7.30, HCO3- less then 15 mEq/L 6. Serum and urine ketones (acetone) 7. Elevated BUN and creatinine 8. Leukocytosis with left shift 9. Increased amylase (of salivary origin)

27

What is the time frame for NKS?

- slowly over days to weeks - most common in elderly with type 2 DM

28

What are the 4 sx of NKS?

- Polydipsia - Polyuria - Lethargy - weakness ** NO GI or ketoacidosis**

29

What are the lab features of NKS? (5)

1. Severe hyperglycemia 2. greater then 600-1200 mg/dL 3. Glycosuria 4+ 4. Serum osmolality 320-380 mOsm/kg 5. Elevated BUN and creatinine **No metabolic acidosis, No ketones (ketoacids), pH greater then 7.30, HCO3- normal, Normal anion gap

30

Symptoms due to excessive secretion of epinephrine (autonomic response)?

1. sweating (cool, moist skin) 2. tremor, shakiness 3. tachycardia 4. anxiety 5. hunger 6. seen with milder OR more rapid onset hypoglycemia 7. ABSENT with hypoglycemia unawareness, due to autonomic neutopathy

31

Sx of Somogyi Phenomenon

- May be asymptomatic or manifested by: night sweats nightmares early morning headaches excessive hunger

32

How to dx Somogyi phenomenon?

Test blood glucose at 3 A.M. and 7 A.M.

33

Tx of somogyi phenomenon?

Treat by lowering bedtime insulin dosage

34

Sx with dawn phenomenon?

None (there is NO nocturnal hypoglycemia )

35

Diagnosis with dawn phenomenon?

Check blood glucose at 3 A.M. to rule out Somogyi phenomenon

36

Tx of dawn phenomenon?

Treat by increasing bedtime insulin dosage

37

Tx of hypoglycemia: 1. awake 2. Lethargic 3. comatose or stuporous 4.

1. oral glucose or sugar 2. oral sugar viz synringe 3. IV 50 perc. dextrose

38

correlation of microvascular complications?

Duration and severity of hyperglycemia

39

correlation of macrovascular complications

Hyperglycemia Hypertension Dyslipidemia

40

What is the leading cause of blindness in ages 20-74?

diabetic retinopathy Early sign-- non proliferative late sign-- proliferative Tx-- prevention!

41

What is the leading cause of end-stage renal dz in the US?

diabetic nephropathy

42

What are the earliest findings of diabetic nephropathy?

Increase in GFR (glomerular hyperfiltration) Microalbuminuria (30-299 mg/d)

43

Hyporeninemic hypoaldosteronism is common and causes _____

hyperkalemia

44

what is the tx of diabetic nephropathy?

ACE inhibitors or angiotensin receptor blockers Goal: less then 140/90 and nephrology consult

45

what are the sx of DM polyneuropathy?

- Paresthesias - Numbness - Pain (lancinating, nocturnal)

46

signs of DM polyneuropathy?

- Impaired sensation - Loss of ankle jerks - Silent trauma (plantar ulcers, fractures, deformities (Charcot joints)

47

What are the cardiovascular complications of diabetic autonomic neuropathy?

1. Postural hypotension 2. Failure to increase heart rate with exercise, stress, standing 3. Silent myocardial ischemia

48

GI complications of diabetic autonomic neuropathy?

Gastroparesis Abnormal intestinal motility

49

GU complications of diabetic autonomic neuropathy?

Cystopathy (infrequent voiding, incomplete emptying, urinary hesitancy, dribbling, overflow incontinence, increased residual volumes, increase UTI’s) Sexual dysfunction

50

Sudomotor complications of diabetic autnomic neuropthay?

Anhydrosis of distal lower extremities Hyperhydrosis of face, trunk and upper extremities

51

metabolic complication of diabetic autonomic neuropathy?

Hypoglycemia unawareness

52

DM is a ______ risk?

cardiovascular (MI)

53

Black eschar is hallmark for what?

Rhino cerebral mucomycosis (invasive fungal infection of the sinus)