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Foundations III- Endocrine > Type 1 DM, hypoglycemia, HHS & DKA > Flashcards

Type 1 DM, hypoglycemia, HHS & DKA Flashcards

(68 cards)

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1
Q

what is the patho of T1DM?

A

Beta-cell destruction

pancreas failure to produce insulin

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2
Q

what is T2DM?

A

progressive insulin secretory defect

or decreased sensitivity of insulin receptors

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3
Q

what are the different classifications of diabetes?

A

prediabetes
T1DM
T2DM
gestational DM

other: monogenic diabetes syndromes, dz’s of the exocrine pancrease (CF), drug or chemical induced

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4
Q

what do beta cells produce?

what do alpha cells produce

A

insulin and amylin

glucagon

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5
Q

what pt’s is T1DM most common in the US?

A

non-white hispanic white children

increased risk if fam hx

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6
Q

what are modifiable risk factors of T2DM?

A

physical inactivity, high body fat or body wt., high BP, high cholesterol

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7
Q

Causes of T1DM

A

immune-mediated (type 1A)

Idiopathic T1DM (type 1B)

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8
Q

What factor is present in first-degree relatives of pt’s w/ T1DM?

A

persistent presence of 2 r more autoantibodies which is a predictor of clinical hyperglycemia and DM

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9
Q

what are circulating antibodies present at the time of dx in T1DM?

A 
islet cells
glutamic acid decarboxylase 65 (GAD65)
insulin
ICA-512
zinc transporter 8 (ZNT8)
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10
Q

what are some tests to dx T1DM?

A 
C-peptide
gada or anti-GAD
Insulin Autoantibodies 
insulinoma-assoc.-2 autoantibodies
ICA
ZnT8Ab
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11
Q

what is the C-peptide test and when can it be checked?

A

Low levels of C-peptide and insulin usually point to T1DM in presence of exogenous insulin

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12
Q

antibody levels ____ w/increasing duration of dz.

A

decrease

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13
Q

T1DM: ___ levels of anti-insulin antibodies develop in almost all patients once they are
treated w/____

A

low

insulin

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14
Q

The A1C test measures the average blood glucose for the past ____.

A

2-3 months

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15
Q

diabetes is dx’d at an A1C of greater than or equal to….

A

6.5%

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16
Q

what test rather than A1C should be used to dx type 1

diabetes in symptomatic individuals?

A

blood glucose

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17
Q

in what situations is screening for T1DM w/an antibody panel recommended?

A

ONLY in setting of a clinical research study or in

a first-degree family member of a proband with type 1 diabetes

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18
Q

The ADA recommends children under the age of 19 dx’d with T1DM strive to maintain an A1C level

A

7.5%

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19
Q

what are lab levels consistent w/prediabetes?

A 
FPG 100-125 
or
2h plasma glucose 140-199
or 
A1C 5.7-6.4%
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20
Q

what are some essentials of dx for T1DM?

A

polyuria, polydipsia, and wt. loss assoc. w/ RBG of 200mg/dL or more

FBG of 126 or more on more than one occasion

Ketonemia, ketonuria, or both

Islet autoantibodies are frequently
present.

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21
Q

what are some essentials of dx for T2DM?

A

often >40 y/o and obese

Polyuria and polydipsia

Candidal vaginitis may be 1st sxs

FBG of 126 or more; 2 hr after 75g PO glucose, BG 200mg/dL or more

HbA1c >6.5%

assoc. w/HTN, dyslipidemia, and atherosclerosis

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22
Q

s/s of T1DM

A

hyperosmolality and
hyperketonemia, increased urination and thirst, diuresis -> loss of glucose, blurred vision d/t lens exposure to hyperosmolar fluids

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23
Q

Common sxs of T1DM

A

lethargy, stupor, Kussmaul breathing, N/V, abd pain, smell of acetone

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24
Q

insulin resistance is characteristic of T1 or T2?

A

Type 2

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25
____ of pt's do not meet targets for A1C, BP, or lipids
33-49%
26
what specialty should a PCP refer to if pt has T1DM?
endocrinologist
27
what is the tx for T1DM?
insulin | acetylsalicylic acid
28
when should you prescribe acetylsalicylic acid for DM pt's?
pts w/incr CVD risk for primary prevention females over 50y/o, males over 60y/o, or 1+: HTN, HLD, smoking, family history of premature disease, or albumineria
29
what are transplantation options for DM pt's?
Pancreas transplantation with or without kidney transplantation Islet cell transplant
30
which pt's cannot receive pancreatic islet auto-transplantation?
pt's w/ T1DM
31
what is the MC T1DM complication?
peripheral neuropathy
32
T1DM complications lipoprotein abnormalities assoc. w/
slight elevation of LDL cholesterol and serum triglycerides
33
T2DM complications lipoprotein abnormalities assoc. w/
distinct “diabetic dyslipidemia” is characteristic of the insulin resistance syndrome High serum triglyceride level >300 low HDL cholesterol
34
what are 2 major DM neuro/vascular complications?
diabetic foot ulcers | gangrene of the feet
35
what is 1 major DM ocular complication?
diabetic retinopathy
36
what are 4 major DM heart dz complications?
Coronary atherosclerosis Myocardial infarction Peripheral vascular disease Stroke
37
what is the glycemic criteria for hypoglycemia?
70mg/dL or less
38
causes of hypoglycemia?
behavioral: too much insulin or alcohol, post exercise regulatory issues: loss of glucagon response, sympatho-adrenal responses DM complications: gastroparesis, ESRD Meds Others: hypopituitarism, GI surg, insulinoma, etc.
39
sxs of hypoglycemia
shaky, diizzy, anxious, hungry, tachy, sweaty, HA, weak/tired, blurry vision
40
Medications assoc. w/hypoglycemia?
``` BB's sulfonylureas Gatifloxacin & levofloxacin ACE inhibitors Salicylates Quinine Pentamidine (used for?) ```
41
how can you prevent/tx hypoglycemia?
Glucose tablets or juice Carbohydrates, 15 grams Parenteral glucagon emergency kit (1 mg) 50 mL of 50% glucose solution by rapid intravenous infusion
42
what emergent tx can be used for hypoglycemia?
glucagon injection
43
what is the somogyi effect?
Nocturnal hypoglycemia leads to a surge of counter-regulatory hormones to produce high blood glucose levels by 7 am (prebreakfast hyperglycemia)
44
how can you tx somogyi effect?
eliminating the dose of intermediate insulin at dinnertime and giving it at a lower dosage at bedtime or by increasing food intake at bedtime
45
what are the 2 worst side effects of DM T1 or T2?
hyperglycemic hyperosmolar state and DKA
46
what is the calculation of serum osmolality?
= (2 x [Na+]) + (glucose/18) + (BUN/2.8)
47
hypertonic hyponatremia is caused by?
hyperglycemia
48
what can cause hyperosomolality in DM pt's?
advanced renal failure (urea), alcohols
49
what are the classic findings in HHS?
``` MC in T2DM hyperglycemia >600mg/dL serum osmolality >310 blood pH >7.3 serum bicab >15 normal anion gap minimal *ketonuria/ketonemia ```
50
s/s of HHS
Profound dehydration - dx/tx are delayed until fluid deficit has reached levels of 6–10 L Non-ketotic, polydipsia, polyuria, possible neuro changes from nystagmus to coma
51
lab results consistent w/HHS?
BG: 800 - 2400 mg/dL Serum urea nitrogen elevations >100 mg/dL typical
52
tx for HHS
Fluids!!! restore UOP hypovolemic sxs --> .9% NS insulin (can be delayed) K+ and Phosp
53
what do you want to reduce the risk of in HHS by maintaining glycemic levels?
cerebral edema
54
what is DKA?
a severe insulin deficiency
55
DKA is marked by elevations of...
elevations of glucagon, cortisol, growth hormone, epinephrine, and norepinephrine concentrations
56
DKA may be the 1st manifestation of what type of DM?
T1DM
57
DKA MCly occurs in...
pts already dx'd w/T1DM
58
how is DKA preventable?
by self-monitoring of blood glucose and blood | or urine ketone levels
59
what are the MC precipitating factors in DKA?
MC = infection (UTI's and pneumonia's) ``` Insulin deficiency Iatrogenic (glucocorticoids) Inflammation (pancreatitis) Ischemia (MI, CVA) Intoxication (etoh, drugs) ```
60
S/s of DKA
signs of hypovolemia (tachycardia, orthostasis), | N/V, abd, polydipsia, polyuria, enuresis, "fruity" acetone breath, Kussmaul breathing, AMS, coma
61
initial studies for DKA eval
ABC's, mentation, volume status ``` CBC (leukocytosis) BMP EKG U/A +dipstick urine ketones? plasma osmo serum ketones ABG if bicarb is low amylase ```
62
production of ketoacids w/minor lactic acid and free fatty acid contributions causes...
metabolic acidosis
63
therapeutic goals
restore plasma volume and tissue perfusion, decr BG and somolality towards normal, correct acidosis, replenish, electrolyte losses, identify and tx precipitating factors
64
early sxs of DKA
N/V/abd pain and hyperventilation
65
As DKA worsens so does...
mental status
66
Is onset of DKA gradual or rapid?
rapid
67
Tx for DKA
ABC's Large IV's Fluids, fluids, fluids frequent monitoring, esp. K+
68
when do you give insulin for DKA?
after addressing K+

Foundations III- Endocrine (5 decks)

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