DM day 2 Flashcards Preview

Medicine > DM day 2 > Flashcards

Flashcards in DM day 2 Deck (46)
Loading flashcards...
1
Q

what is critical about a DM physical exam?

A

look at their feet

they may not look at their feet

2
Q

what kind of pain do DM pts feel with ulceration?

A

none

3
Q

what is the primary goal of working with DM pts and peripheral neuropathy?

A

prevention of ulcers, infections/early txment
patient education
examination of feet regularly
proper foot wear

4
Q

what 6 things are involved in the foot exam?

A
  1. inspect the skin (temp, infections, ulcers, nails)
  2. foot architecture
  3. palpate PT and DP pulses
  4. check ankle reflexes
  5. check fine touch
  6. check vibration sense
5
Q

what are txment choices for peripheral neuropathy?

A

1st line Tricyclics (amitriptyline, nortriptyline)-start low, go slow, PM dosing b/c sedation-25mg
gabapentin-neurontin
pregabalin-lyrica
duloxetine-cymbalta

6
Q

which type of neuropathy is hard to treat?

A

autonomic neuropathy

7
Q

what are common autonomic complaints?

A
gastroparesis
constipation
neurogenic bladder (lacks full sensation or motor capacity to go)
erectile dysfunction
orthostatic hypotension
resting tachycardia
8
Q

what is orthostatic hypotension?

A

bodies ability to adjust constriction of blood vessels when going from sitting to standing position

9
Q

when would you be suspicious of resting tachycardia?

A

pt who is resting and has a high-normal heart rate

10
Q

what is cardiac denervation?

A

inability to feel chest pain or palpitations

11
Q

what is esophageal dysfunction?

A

bolus is not moved through the esophagus correctly

12
Q

what is symmetrical anhidrosis?

A

inability to sweat (causes inability to disapate heat)

13
Q

what is gustatory sweating?

A

sweating while you eat

14
Q

what is a pupillary autonomic neuropathy?

A

decreased diameter of dark adapted pupil

argyll-robertson type pupil

15
Q

what is the most common cause of death in the US and the most common cause of death in ppl with DM?

A

cardiovascular dz

16
Q

why are small, dense LDL’s the bad ones?

A

they combine with the macrophages and become foam cells

17
Q

what is a stimulus for atherogenesis?

A

inflammation

18
Q

what is the trifecta of DM CV dz?

A

atherosclerosis PLUS no ability to feel CP

19
Q

RED FLAG?

A

Type 2 DM
active
“feeling wierd”?

20
Q

what happens with a plaque ruptures?

A

platelet plug forms
blockage
BOOM
heart attach

21
Q

what are the 5 steps to manage cardiac risks of a cardiac pts?

A
  1. ASA QD
  2. control BP
  3. control lipids
  4. weight reduction
  5. STOP SMOKING
22
Q

what is the most common cause of renal failure in the US?

A

diabetic nephropathy

23
Q

what are the two key ways to prevent nephropathy?

A
  1. glycemic control

2. BP control

24
Q

what is considered normal albuminuria?

A

<30mcg/mg

25
Q

what is considered microalbuminuria?

A

30-300mcg/mg

26
Q

what is considered macroalbuminuria?

A

> 300mcg/mg

27
Q

what is a screening test for nephropathy?

A

morning spot urine

28
Q

what lab values are dx of nephropathy?

A

2-3 elevated readings over 2-3 months

29
Q

what is a late finding of renal dz (40% of kidney damage)?

A

elevated creatinine

30
Q

what are management options for DM nephropathy?

A

ACE inhibitors (normotensive w/microalbuminuria)
low protein diet (in macroalbuminuria)
aggressive BP management in HTN pts

31
Q

what is the most common cause of DKA?

A

infection

32
Q

what is the most important electrolyte abn of DKA?

A

hypokalemia

33
Q

why does ETOH become a problem with diabetes?

A
missing insulin
mixing drinks (high sugar)
34
Q

what should you consider when you have a pt in DKA?

A

psychiatric concerns (less common,but should be considered)

35
Q

what are dx lab features of DKA?

A
high blood glucose
low pH
high ketonuria
low bicarb (getting bound while trying to compensate)
dehydration (high BUN and creatinine)
hypokalemia (total body stores)
high anion gap
36
Q

how do you correct serum sodium?

A

serum value + 1.6 (glucose-100)

37
Q

why is someone in DKA hypokalemic?

A

K+ is switching places with H+ to try to compensate for the acidosis
then you pee out a lot of potassium

38
Q

what are the 3 types of ketone bodies?

A
  1. acetone
  2. acetoacetate
  3. beta hydroxybuterate
39
Q

which ketone bodies to test strips detect?

A

acetone

acetoacetate

40
Q

why should you not check serial ketones?

A

the ketones will move backwards in the enzymatic process and it will look like they are getting worse

41
Q

why do you have to be careful when treating DKA and the glucose gets down to 250?

A

too low too quickly causes major fluid shifts and can cause cerebral edema and death

42
Q

what are clinical features of hyperosmolar hyperglycemic state (HHS)?

A

hyperglycemic
dehydration
hx of type 2 diabetes

43
Q

what are lab features of HHS?

A
marked hyperglycemia
high serum osmolaltiy
high dehydration
no acidosis
no ketosis
AMS (common in elderly pts)
\+/- K level (massive diuresis)
44
Q

what is the definition of hypoglycemia?

A

BS <60 mg/dl

45
Q

what are neuroglycopenic sxs?

A

nonsense
acting silly
unable to concentrate

46
Q

what is autonomic hyperactivity?

A

sweaty
clammy
impending doom

Decks in Medicine Class (146):