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Flashcards in Kirila CIS Deck (46)
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1

capillary glucose monitoring- terms

-FSG- fingerstick glucose
-BSG- bedside glucose
-accucheck
-HGM- home glucose monitoring
-GSM- glucose self-monitoring
-SBGM- self blood glucose monitoring

2

basal and bolus insulin

-basal- long acting insulin- steady state of glucose control
-bolus- adjusted at mealtime and based on FSG (sliding scale) +/- carbohydrate count anticipated

3

average 3 month glucose- all terms mean the same test

-Hemoglobin A1c
-HbA1c
-GHbA1c
-glycosylated hemoglobin

4

presentations when DM should be included in diff dx

-mental status changes
-abd pain
-dehydration

5

Mental status changes- diff dx

AEIOUTIPS
-alcohol
-epilepsy with seizure activity
-infection
-overdose
-uremia
-trauma
-Insulin (high or low blood sugar)
-poisoning/psychosis
-stroke

6

Abd pain- diff dx

BAD GUT.. PAINS
-bowel obstruction
-appendicitis, adenitis
-diverticulitis, DIABETIC KETOACIDOSIS, dysentery/diarrhea, drug withdrawal
-gastroenteritis, gall bladder dz
-UTI or obstruction
-testicular torsion, toxin (lead, black widow bite)

7

Abd pain- diff dx- 2

PAINS
-pneumonia, pleurisy, pancreatitis, perforated bowel, ulcer, porphyria
-abdominal aneurysm
-INfarcted bowel, MI, incarcerated hernia, IBD
-splenic rupture, infarction, sickle cell pain crisis

8

Acute complications of DM

-DKA- seen in Type 1!!
-NKHS (non-ketotic hyperosmolar state)- aka hyperosmolar non-ketotic coma (HNKC); Hyperglycemic hyperosmolar state (HHS)- seen in type 2!!!

9

DKA- etiology

-inadequate insulin admin
-infection- pneumonia, UTI, gastroenteritis, sepsis
-infarction- coronary, cerebral, mesenteric, peripheral
-surgery
-drugs (Cocaine)

10

DKA- initial sx's

-anorexia
-N/V
-polyuria
-thirst

11

DKA- progression of sx's

-abd pain
-altered mental fxn
-coma

12

DKA- signs

-kussmaul respirations- rapid/deep
-acetone (Fruity) breath odor (or like nail polish remover)
-dry mucous membranes
-poor skin turgor
-tachycardia
-hypotension
-fever
-abd tenderness

13

DKA- lab

-hyperglycemia
-ketosis
-metabolic acidosis:
Anion gap inc
pH 0.1 dec = K 0.6 inc- since acidosis causes K to shift out of cells

14

DKA- lab 2

-measured Na is low secondary to hyperglycemia- for every 100 mg/dL that glucose is over 100, there will be a 1.6 meq dec in Na
-K- serum may be normal or somewhat high- actually total body deficit!!!
-hypertriglyceridemia
-hyperlipoproteinemia
-hyperamylasemia- can suggest pancreatitis
-leukocytosis

15

High anion gap acidosis- diff dx

MUDPILES
-methanol
-uremia
-diabetic ketoacidosis
-paraldehyde
-isopropyl alcohol, iron, INH
-lactic acidosis
-ethylene glycol
-salicylates

16

DKA- tx

-ICU:
frequent monitoring of general status, vital signs, glucose, and other labs
-acid base status
-renal fxn
-K and other electrolytes

17

DKA- fluid replacement

1-2-3 rule
-2-3 L NS (0.9%) over first 1-3 hrs (5-10 ml/kg/hr)
-then 0.45% saline at 150 ml/hr
-when glucose reaches 250 mg/dl, switch to 5% dextrose and 0.45% saline at 100-200 ml/hr
*fluid deficit is often 2-5 L

18

DKA- initial insulin administration

regular insulin
-10-20 units IV or IM
-then 5-10 units/hr continuous IV
-Inc if no response in 1-2 hrs

19

DKA- eval for underlying causes

-cultures
-EKG
-CXR
-drug screen
-history from family or pt

20

DKA- initial monitoring

-blood work- BSG at least hourly; electrolytes q 2-4 hrs +/- ABG's
-clinical status hourly- vital signs, mental status, fluid I and O

21

DKA- K replacement

-consider when serum K < 5.5 mEq/L
-when supplementing K, keep in mind:
-renal fxn
-baseline EKG and continuous cardiac monitoring
-verify urinary output and measure hourly

22

DKA- tx goals

-inc the rate of glucose utilization in insulin dep tissues- glucose goal of 150-250 meq/dL
-reverse ketonemia and acidosis
-correct depletion of water and electrolytes

23

start intermediate or long-acting insulin- when?

-when pt is able to eat- mental status improved, no N/V, no abd pain
-anion gap normalized
-allow overlap timing of IV with SQ insulin- 30-60 min

24

NKHS (non-ketotic hyperosmolar state)- etiology

-insulin def
-inadequate fluid intake
-osmotic diuresis induced by hyperglycemia

25

NKHS- precipitating factors

-sepsis
-MI
-glucocorticoids
-phenytoin
-thiazide diuretics
-impaired access to water

26

NKHS- sx's

-polyuria
-thirst
-altered mental status
-ABSENT- N/V, abd pain, kussmaul respirations (seen in DKA)

27

NKHS- lab

-lactic acidosis may produce a MILD inc in anion gap
-moderate ketonuria from starvation
-CORRECTED serum Na usually inc

28

NKHS- tx

ICU
-frequent monitoring of general status, vital signs, glucose, other labs
-acid base status
-renal fxn
-K and other electrolytes

29

NKHS- fluid replacement

-2-3 L NS over first 1-3 hrs
-fluid deficit is usually 8-10 L- reverse over next 24-48 hrs using 0.45% saline
-when glucose reaches 250 mg/dl, switch to 5% dextrose and 0.45% saline at 100-200 ml/hr

30

NKHS- insulin admin

regular insulin
-5-10 units IV bolus
-3-7 units continuous infusion
-transition when eating as with DKA
monitor, replace K, investigate and address underlying causes