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Flashcards in DM day 2 Deck (46):
1

what is critical about a DM physical exam?

look at their feet
they may not look at their feet

2

what kind of pain do DM pts feel with ulceration?

none

3

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

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

4

what 6 things are involved in the foot exam?

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

what are txment choices for peripheral neuropathy?

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

6

which type of neuropathy is hard to treat?

autonomic neuropathy

7

what are common autonomic complaints?

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

8

what is orthostatic hypotension?

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

9

when would you be suspicious of resting tachycardia?

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

10

what is cardiac denervation?

inability to feel chest pain or palpitations

11

what is esophageal dysfunction?

bolus is not moved through the esophagus correctly

12

what is symmetrical anhidrosis?

inability to sweat (causes inability to disapate heat)

13

what is gustatory sweating?

sweating while you eat

14

what is a pupillary autonomic neuropathy?

decreased diameter of dark adapted pupil
argyll-robertson type pupil

15

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

cardiovascular dz

16

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

they combine with the macrophages and become foam cells

17

what is a stimulus for atherogenesis?

inflammation

18

what is the trifecta of DM CV dz?

atherosclerosis PLUS no ability to feel CP

19

RED FLAG?

Type 2 DM
active
"feeling wierd"?

20

what happens with a plaque ruptures?

platelet plug forms
blockage
BOOM
heart attach

21

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

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

22

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

diabetic nephropathy

23

what are the two key ways to prevent nephropathy?

1. glycemic control
2. BP control

24

what is considered normal albuminuria?

<30mcg/mg

25

what is considered microalbuminuria?

30-300mcg/mg

26

what is considered macroalbuminuria?

>300mcg/mg

27

what is a screening test for nephropathy?

morning spot urine

28

what lab values are dx of nephropathy?

2-3 elevated readings over 2-3 months

29

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

elevated creatinine

30

what are management options for DM nephropathy?

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

31

what is the most common cause of DKA?

infection

32

what is the most important electrolyte abn of DKA?

hypokalemia

33

why does ETOH become a problem with diabetes?

missing insulin
mixing drinks (high sugar)

34

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

psychiatric concerns (less common,but should be considered)

35

what are dx lab features of DKA?

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

how do you correct serum sodium?

serum value + 1.6 (glucose-100)

37

why is someone in DKA hypokalemic?

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

38

what are the 3 types of ketone bodies?

1. acetone
2. acetoacetate
3. beta hydroxybuterate

39

which ketone bodies to test strips detect?

acetone
acetoacetate

40

why should you not check serial ketones?

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

41

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

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

42

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

hyperglycemic
dehydration
hx of type 2 diabetes

43

what are lab features of HHS?

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

44

what is the definition of hypoglycemia?

BS <60 mg/dl

45

what are neuroglycopenic sxs?

nonsense
acting silly
unable to concentrate

46

what is autonomic hyperactivity?

sweaty
clammy
impending doom

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