hypoglycemia Flashcards

Question

What is your T1DM treatment plan (with each type of provider)

Answer 1

PCP: refer to endocrine (if not sick) or ED if needs immediate Tx Dietician: carb, fat, protein meal planning Nursing: draw insulin- injection instruction or pen device Pharm: SMBG, ketone monitoring, med education, hypoglycemia management Behavioral: discharge planning, etc.

Answer 2

INSULIN BITCH | also ASA from primary prevention

Answer 3

Rapid acting: Novolog (insulin aspart) 3-6 hr Short acting: Humilin R U-100, or, Novolog R (regular) 0-12 hr Intermediate acting NPH: Humilin N, or, Novolin N 0-18 hr Long acting: Latus (insulin glargina), or, Levemir (insulin detemir) 0-24 hr

Answer 4

if high risk CVD; men >50 women >60 +1: HTN, HLD, smoking, FHx, albuminuria

Answer 5

Pancreas transplant w/ or w/o kidney transplant (better with kidneys for some reason) Islet cell transplant (injected in liver, but you need a LOT) -but T1DM cant receive pancreatic islet auto- transplant

Answer 6

Ultrafast insulin to maintain euglycemia fully closed loop system (glucose monitoring + insulin pumps with glucagon) artificial pancreas vaccines better transplants

Answer 7

Neuropathy | (MC GI complication is gastroparesis

Answer 8

Slight LDL elevation- but levels normal out when hyperglycemia is corrected

Answer 9

diabetic foot ulcers gangrene of the feet optic neuropathy Coronary atherosclerosis, MI, PVD, CVA

Answer 10

``` level 1 (mild): <70, can be treated with fast acting carbs (bread, crackers, juice, etc.) level 2 (mod): <54 level 3 (severe): severe cognitive impairment, external assistance for recovery ```

Answer 11

too much insulin, too much EtOH, post exercise loss of glucagon response, sympatho-adrenal response Gastroparesis, ESRD hypopituitarism addison's disease. myxedema liver failure GI surgery Insulinoma (high insulin, high c-peptide)

Answer 12

``` shaky tachy sweaty blurry vision weak, tired headache hungry anxious ```

Answer 13

``` *Beta Blockers Sulfonylureas Gatifloxacin and Levofloxacin ACE-I Salicylates Quinine Pentamidine ```

Answer 14

glucose tab/juice give carbohydrate 15g, wait 15 min -Parenteral emergency glucagon kit (1mg injection) -50mL of 50% glucose solution by rapid IV infusion

Answer 15

when you have nocturnal hypoglycemia leading to a surge of hormones causing pre-breakfast hyperglycemia (high BG by 7am) -Eliminate dose of intermediate insulin at dinnertime; give a lower dose at bedtime/increase food at bedtime

Answer 16

number os solutes in a solution/kg (norm 275-295) 2xNA + glu/18 + bun/2.8 -predominating factor is sodium!

Answer 17

You have more glucose in the vessels, attracting more water into the vessel; but the sodium in the vessels stays the same. So in hyperglycemia, you get a falsely low sodium level

Answer 18

advanced renal failure alcohols (mannitol, ethanol, glycerol, isopropanol) hypertonic hyponatremia hyperglycemia

Answer 19

*Hyperglycemia without ketones! MC in T2DM* BG >600 w/ serum osmolality >310 NO acidosis (pH >7.3) Bicarb >15 (not ridiculously low) Normal anion gap, min to no ketonuria/ketonemia

Answer 20

profound dehydration non-ketotic polydipsia, polyuria +/- neuro changes (nystagmus-coma)

Answer 21

plasma glucose 800-2400 | BUN >100

Answer 22

FLUIDS!! Insulin Potassium Phosphate

Answer 23

250-300; reduces the risk of cerebral edema | when BG reaches 250, can give insulin subQ

Answer 24

restore UOP 50ml+ if w/ hypovolemic Sx: 0.9% NS maintenance: 0.45% saline When blood glucose gets to 250, give 5% dextrose in water, 0.45% NS, or 0.9% NS

Answer 25

can be delayed, mainly bc fluid replacement usually decreases BG = increase GFR and renal excretion of glucose If in ketonemia: insulin infusion at 0.5 units/kg/hr (no bolus)- goal is lower BG 50-70/hr

Answer 26

K+ declines rapidly (insulin drives K+ intracellularly)- eventually, it increases! so monitor closely Give KCl liberally, unless in CKD or w/ oliguria

Answer 27

If severe hypophosphatemia (<1mg) during insulin therapy, give to ketoacidotic patients at 3 mmol/hr

Answer 28

severe insulin deficiency, MC in T1DM (often first manifestation! people get first diagnosed after this event) Develops rapidly (w/in 24 hrs) Marked elevation of glucagon, cortisol, GH, Epi, and NE *Preventable by SBGM and blood or urine ketones

Answer 29

*Infection* insulin omission, pancreatitis, MI, stroke, drug use, glucocorticoids AKA- the 6 I's (insulin deficiency, iatrogenic, infection, inflammation, ischemia/infarct, intoxication)

Answer 30

hyperventilation = low PaCO2 = metabolic acidosis (pH <6.8)= death from diabetic coma increased glucose production= polyuria/polydipsia= dehydration= death from diabetic coma decreased protein synthesis= fatigue

Answer 31

*N/V, abdominal pain, hyperventilation | polydipsia, polyuria, enuresis, fruity acetone breath, Kussmaul breathing, tachy/orthostasis (hypovolemia), AMS, coma

Answer 32

``` ABC's CBC (infection?) BMP (glucose, AG, bicarb, K, Na) ECG UA + dipstick (ketones) Plasma osmolality serum ketones ABG if HCO is low amylase will be high w/o pancreatitis ```

Answer 33

DKA: BG>250, pH <7.3, HCO3 <18, moderate ketonuria or ketonemia HHS: BG >600, pH >7.3, HCO3 >15, min-no ketonuria or ketonemia

Answer 34

MET acidosis (2/2 high ketoacids) K and Phosphate: labs normal/high, but body actually depleted (mag as well) occasionally BG can be <250 if in starvation, EtOH, or pregnancy

Answer 35

determine hydration status first! Hypovolemia: 0.9% NS Mild dehydration: eval corrected serum Na Cardiogenic shock: hemodynamic monitoring and vasopressors -High or normal serum Na: 0.45% NS -Low Na: 0.9% NS

Answer 36

``` restore plasma volume and tissue perfusion decrease BG and osmolality correct acidosis replenish electrolyte losses ID and treat precipitating factors ```

Answer 37

AFTER addressing K+ | monitor K+ frequently!!

hypoglycemia Flashcards

(61 cards)