Pales DM CIS part I Flashcards Preview

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Flashcards in Pales DM CIS part I Deck (51):
1

What is diabetic ketoacidosis

glucose >250
acidosis with blood pH <15
serum + ketones

2

When does DKA present in DM II

late stages beta cell failure
during stress

3

signs DKA

weakness, decreased appetite, nausea, vague abdominal pain
mental status changes: confusion, lethargy, coma

4

signs of acidosis

confusion, lethargy, kussmal respration
fruity breath

5

signs of dehydration

oral membranes
turgor of skin
hypotension/tachycardia

6

DKA labs

high blood glucose
low CO2/bicarb/pH
high ketones/acetone/ketoacids
high BUN Cr
high serum K with decrease total body K
low Na
high PO4

7

how to correct Na for high glucose

for every 100 over add 1 to Na

8

Tx DKA

IV insulin to correct acidosis!!!
give glucose too to buffer the insulin because need enough insulin to correct acidosis

9

labs for hyperosmolar hyperglycemic non-ketotic state

high glucose
serum osmolality>310
no acidosis (pH>7.3)
serum bicarb>15
normal anion gap <14
low K
Na can be low (correct for glucose and then hgih)
elevated BUN/Cr

10

what causes hyperosmolar hyperglycemic non ketotic state

hyperglycemia causes osmotic diuresis causing dehydration increaseing osmolality, decrease free fluid and resulting in hyperglycemia

11

what can hyperosmolar hyperglycemic nonketotic state lead to

hypovolemic shock
end organ damage: coma, renal failure

12

what DM can have hyperosmolar hyperglycemic non ketotic state

DM II
non compliance to medications

13

Tx hyperosmolar hyperglycemic non-ketotic state

IV fluids
a little IV insulin
electrolyte replacement
ventilatory support at times

14

when can hypoglycemic coma happen

blood glucose <50

15

2 conditions when can have diabetic coma

DM
or those with metabolic disturbance

16

hypoglycemia Sx

HA
sweat
shaky
hungry
confused
grumpy
dizzy

17

Tx hypoglycemic coma

sugar orraly
glucagon SQ

18

microvascular complicaitons DM

neuropathy: peripheral sensory and motor. also autonomic
nephropathy: chronic kidney disease
retinopathy: blindness

19

macrovascular complications D

atherosclerosis of big arteries
coronary- MI
cerebral/carotid-stroke
LE- LE amputation
Renal-HTN- MI/stroke
mesenteric-bowel ischemia

20

leading cause blindness in US

diabetic retinopathy

21

2 types retinopathy

-nonproliferative "background"
-proliferative

22

what is most common retinopathy

non proliferative from microaneurysms, dot hemorrhages, retinal edema

23

cause of proliferative retinopaty

new capillaries and fibrous tissue in retina from ischemic retinal infarcts (wool spots)

24

other ocular complications (not retinopathy) form DM

lens swelling (reversible)
cataracts

25

what causes the diabetic nephropathy

from the increased pressure. focal segmental diabetic nephropathy

26

how to screen for diabetic nephropathy

microalbuminuria screen

27

stocking glove pattern

diabetic neuropathy

28

what are the + and - signts peripheral neuropathy

burning pain, paresthesias
hyposthesia, decrease temp and vibratory sensation, loss of achilles reflexes

29

what is mononeuropathy

isolated nerve, likely ischemic
cranial nn
femoral nerve- diabetic amyotrophy, severe pain on front of thigh and quad weakness

30

charcot foot

diabetic neuropathy

31

4 conditions of charcot foot formation

loss of sensation, initial trauma, repetitive traumas
good blood flow to feet

32

signs diabetic gastroparesis

nausea/vomiting
abdominal pain
weight loss.malnutrition
diagnosed by gastric empyting study

33

what is neurogenic bladder

urinary retention
incontinence
frequency

34

cholesterol levels in DM

high LDL
high TG
low HDL

35

red lesions on shins with DM

necrobiosis lipidoica diabetorum

36

best indicator for increased risk complications in DM

HbA1c

37

what can decrease HbA1c

if patient has shortened RBC life span
like hemolytic anemia, frequent transfusions or bleeding

38

glucose control prevents what complications of DM

microvascular

39

oral medications used in DM

secretogogues, insuline sensitizers, glucourics inhibitors (increase glucose loss in urine)

40

MOA sulfonulure

block K channel on beta cells so increase insulin secretion

41

contraindications sulfonylureas

pregnancy, liver or renal insufficiency

42

what DM med can cause hypoglycemia

sulfonylurea

43

side effects sulfonylurea

GI upset, urticaria, weight gain
jaundice
SIADH
hypoglycemia

44

rule for meglitinides

skip a meal skip the pill

45

how does incretin/GLP-1 or DDP-4 inhbiitors work

increase insulin, meal dependent
does not cause hypoglycemia

46

what drugs are insulin sensitizers

biguanides (metformin)

47

results metformin

weith loss
does not cause hypoglycemia
improves cholesterol

48

side effects metformin

lactic acidosis, GI upset, dec B12/folate absorption

49

Contraindications metformin

renal or liver insufficiency, chronic hypoxia
alcholism

50

TZDs MOA

increase sensitivity to insulin
decrease hepatic gluconeogensis

51

side effects TZDs

significant weigh gain
water retention (CHF contraindication)