Flashcards in Non-vascular complications of diabetes Deck (20):
What populations are most likely to develop a hyperosmolar hyperglycemic state (HHS)?
Occurs almost exclusively in Type 2 DM, elderly and physically impaired or limited access to free water
What distinguishes HHS from DKA?
Severe hyperglycemia >600, Hyperosmolality. Develops more insidiously with polyuria, polydipsia, and weight loss several days before hospital admission. Greater degree of dehydration
What are the causes of hyperosmolar hyperglycemic state (HHS)?
Catabolic Stress, Insufficient intake of water, Excessive water loss, High sugar intake, Drugs
What are the clinical presentations of hyperosmolar hyperglycemic state (HHS)?
polyuria, polydipsia, weight loss, vomiting, tachycardia, hypotension, severe dehydration, seizures, hyperthermia
What are the lab findings of hyperosmolar hyperglycemic state (HHS)?
Blood glucose > 600. Serum osmolality >320. Serum Na+ - normal to high (135-145). Serum K+ - normal (4-5). Serum Bicarb >20. pH > 7.3. Ketones – negative. Complicated by thromboembolic events
What is the treatment of DKA and HHS?
medical emergencies. IV fluid and electrolyte replacement. Slower rate and greater volume needed for HHS. Insulin replacement starts after rehydration is in progress
How does HHS and DKA differ clinically?
to the presence of ketoacidosis and the degree of hyperglycemia
What diabetic population is hypoglycemia more common?
type 1 diabetes, Type 1’s suffer an average of 2 episodes of symptomatic hypoglycemia per week.
What are the causes of hypoglycemia?
Insulin injections, Oral hypoglycemic agents, Gastroparesis, Hepatic and renal dysfunction, Malnutrition
What are the neurogenic symptoms associated with a hypoglycemica episode?
catecholamine-mediated/adrenergic: Tremor, palpitations, and anxiety/arousal. acetylcholine-mediated/cholinergic: sweating, hunger, and paresthesias
What are the neuroglycopenic symptoms associated with a hypoglycemic episode?
cognitive impairment, behavioral changes, psychomotor abnormalities, seizure and coma
What are the cardiovascular signs associated with a hypoglycemic episode?
diaphoresis, pallor, tachycardia, HTN
What causes absent of symptoms of hypoglycemia?
Loss of autonomic warning due to recent antecedent hypoglycemia, prior exercise, or sleep. Autonomic neuropathy due to diminished epi response. Medications like beta-blockers
What is the criteria for a hypoglycemic coma and how is it treated?
Unconsciousness lasting more than 30 minutes after plasma glucose is corrected. IV mannitol (40 g as a 20% solution over 20 minutes). Glucocorticoids (e.g., dexamethasone, 10 mg)
What is the dawn phenomenon?
high morning blood glucose between 5-9am due to the release of counter-regulatory hormones (cortisol, GH, glucagon)
What is the Somogyi Effect?
Rebound Hyperglycemia—Iatrogenic, low sugars in the middle of the night, high sugars in the morning
How do you determine whether an early morning high blood sugar level is caused by dawn phenomenon or Somogyi effect?
check blood sugar levels around 2 a.m. to 3 a.m. for several nights. If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon
What defines hypoglycemia in patients without diabetes?
Whipple's triad: signs and symptoms of hypoglycemias, plasma glucose <60, and resolution of those signs/symptoms after raising plasma glucose
What is factitious hypoglycemia?
occurs secondary to the secret use of insulin. plasma insulin is high while C-peptide is low. This applies to nondiabetic patients and those with type II DM, not type I diabetics who always have low C-peptide levels