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Endo II > DM pales > Flashcards

DM pales Flashcards

1
Q

DKA definition

A

hyperglycemia >250
pH <15
serum ketones

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2
Q

DKA and DMI

A

usually initial presentation in kids
insulin non-compliance
increase in anti-insulin hormones d/t stress

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3
Q

DKA and DMII

A

late stages of beta cell failure

during stress or in extremely high BG

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4
Q

signs and symptoms of DKA

A

onset 1-2 days
weakness
anorexia, nausea, abdominal pain
mental status changes (confusion, lethargy, coma, seizures)

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5
Q

signs of acidosis

A

confusion
lethargy
kussmal respiration (hyperventilating)
fruity breath odor

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6
Q

signs of dehydration

A

oral membranes dry
turgor of skin
hypotensive/tachy

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7
Q

finger stick glucose

A

not accurate if 500

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8
Q

labs of DKA

A 
high glucose
low CO2/bicarb/pH
high ketones, acetone, ketoacids
high BUN and Cr
low Na
high K
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9
Q

DKA Tx

A

INSULIN- do not stop insulin until anion gap is corrected, give glucose once glucose is under 200
IV FLUIDS
electrolytes
ventilatory support

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10
Q

hyperosmolar, hyperglycemic, non-ketotic state

A 
aka hyperosmolar coma
hyperglycemia >600
serum osmolality >310 (thick blood)
no acidosis
bicarb >15
normal anion gap
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11
Q

pathology of hyperosmolar hyperglycemic non-ketotic state

A

hyperglycemia -> osmotic diuresis -> dehydration -> increased osmolality -> decrease in free fluid -> hyperglycemia
ONLY IN DMII, type I would get DKA

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12
Q

causes of hyperosmolar hyperglycemic non-ketotic state

A 
non-compliance with meds
acute infection/stress
dehydration
usually older patients with poor care and/or dementia
insidious onset
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13
Q

Tx of hyperosmolar hyperglycemic non-ketotic state

A

IV FLUIDS!!!
A little IV insulin
electrolyte replacement
ventilatory support

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14
Q

hypoglycemic coma

A

symptoms at 80 (unless long standing hyperglycemia can become symptomatic at 200 or 150)
coma/passing at 50 (usually only DM or insulinoma)

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15
Q

non-proliferative retinopathy

A 
most common cuase of visual impairment in DMII
earlier stage
microaneurisms
dot hemorrhages
retinal edema
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16
Q

proliferative retinopathy

A

growth of new capillaries and fibrous tissue w/in retina d/t ischemic infarcts (cotton wool spots)
more common in DMI
vitreous hemorrhage and retinal detachment

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17
Q

other eye issues

A

lens swelling- reversible with correction of BG

diabetic cataracts

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18
Q

Diabetic nephropathy

A

focal segmental glomerulosclerosis (FSGS)
screen for albuminurea early, later proteinuria
can lead to nephrotic syndrome or end-stage renal disease and dialysis

19
Q

what CN are often involoved in DM neuropathy

A

III
IV
VI
diploplia

20
Q

femoral n neuropathy

A

diabetic amyotrophy
severe pain on front of thigh and quads
may last for months or even years

21
Q

charcot foot

A 
deformity dt neuropathy -> collapse of arch 
loss of sensation
initial trauma
repetitive traumas (mircrofractures)
not a vascular issue
22
Q

autonomic neuropathy

A

NO Tx, most frustrating symptoms

  • postural hypotension
  • diabetic gastroparesis (Dx with GES)
  • diarrhea/constipation
  • neurogenic bladder (urinary retention, incontinence)
  • impotence
  • profuse sweating/temp dysregulation
23
Q

acclerated atherosclerosis in DM dt

A 
hyperglycemia
hyperlidemia
abnormalities of platelet adhesion
HTN
oxidative stress
inflammation
24
Q

CV complications

A

heart disease (2-4x more likely )
Stroke
PVD

25
Q

derm in DM

A

pyogenic infections- boils
yeast
necrobiosis lipoidica diabetorum

26
Q

factors which affect glycoemoglobin

A
  • conditions that shorten erythrocyte life span will falsely decrease hA1C
  • diseases with lack of new reticulocytes with falsely raised hA1C (aplastic anemia)
27
Q

goal for HA1C

A

7

28
Q

oral meds

A 
secretagogues (SUs, and nonSUs)
incretins
metformin
TZDs
alpha-glycosidase inhibiotors
29
Q

injectable meds

A

insulins
pramlintide
incretins

30
Q

down fall of SUs

A

tolerance

50% failure in 5 yrs

31
Q

CIs of SUs

A

prego/breast feeding
liver or renal insufficiency
sulfa allergies

32
Q

side effects of SU

A 
GI upset
urticaria
jaundice
SIADH (low Na, high BP)
weight gain
hypoglycemia
33
Q

which SU can be used in renal failure

A

glipizide
glimeperide
only metabolized by liver

34
Q

meglitinides

A

-glinide

very short acting so can be taken right before meal

35
Q

biguandies

A

metformin

DOC

36
Q

metformin side effects

A

GI
lactic acidosis
decrease B12 and folate absorption

37
Q

CI of metformin

A

renal and liver insufficiency
chronic hypoxia
past Hx of lactic acidosis
alcoholism

38
Q

TZDs

A 
-glitazone
not great
significant weight gain
water retention cannot be used with CHF pt
liver damage
39
Q

alpha-glycosidase inhibiots

A 
acarbose
miglitol
decrease absoroption of CHO 
GI issues
not really used dt side effects
40
Q

incretins

A 
oral- DPP4 inhibitors (-agliptine)
injectible- GLP1 (-tide)
significant weight loss
early satiety
glucose dependent insulin production
41
Q

pramlintide

A

analoge of amyloid
supresses glucagon secretion
rarely used

42
Q

beginning insulin Tx

A

long acting first to increase baseline

fixed combos should not be used right away

43
Q

dawn phenomenon

A

diurnal increase of anti-insulin hormones secretion in am
3 am BG normal or high
no night sweats
insulin dose not high enough

44
Q

samojyi effect

A

rebound hyperglycemia after night time lows
3am BG very low
night sweats present
dose of insulin too high
if you think its dawn effect and increase insulin can kill them

Endo II (15 decks)

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