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78 Cards in this Set
- Front
- Back
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Definition of diabetes
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insulin resistance +/- decreased insulin secretion
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Fasting plasma glucose in DM
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>125
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Oral glucose tolerance test in DM
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>199
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Random plasma glc in DM
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>199, must also have sx of DM (polyuria, polydipsia, wt loss)
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Causes of type I DM
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Beta cell dysfxn
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Causes of Type II DM
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Insulin resistance and relative insulin deficiency
Acromegaly Cushings Glucagonoma Hyerthyroidism Pheochromocytoma Pancreatitis ---------- Trauma Cancer Cystic fibrosis Hemochromatosis |
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Metabolic syndrome
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Central obesity
HTN HLD (high TG) Low HDL High blood glc |
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Sign of insulin resistance seen in DM, PCOS, acromegaly
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Acanthosis nigricans
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Microvascular complications of DM
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Retinopathy (non-proliferative, proliferative, MD)
Nephropathy Neuropathy |
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Macrovascular complications of DM
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CAD
CVA PVD |
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Complications of both Neuropathy and PVD
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Charcot foot
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Diabetic feet
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Charcot foot
Ulcers |
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Which prevents DM better, metformin or wt loss?
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Wt loss
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Who to screen for DM
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Older
Obese Family hx Hx gestational DM HX big baby Metabolic syndrome Acanthosis |
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Results of DCCT trial in 1993
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Showed a 2.5-3.5 % risk reduction in microvascular complications per reduction in HgbA1C (goal 7%
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Goal HbA1C in DM
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<7%
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Goal postprandial glc in DM
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<180
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Goal preprandial glc in DM
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90-130
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Goal BP in DM
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<130/80
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Goal LDL in DM
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<100
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Goal TG in DM
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< 150
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Goal HDL in DM
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>40
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DM diet % CHO
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60%
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DM diet % protein
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10-20%
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DM diet % fat
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30%
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DM diet total calories
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25 kcal/kg of ideal body wt
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Alcohol in DM diet
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NONE
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Exercise in DM diet
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Increase exercise
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Glipizide is a type of
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Sulfonylurea
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Repaglinide is a type of
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Metiglinide
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which drugs increase secretion
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sulfonylureas
metiglinides |
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which drugs decrease hepatic glc production
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metformin
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which drugs decrease insulin resistance
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metformin
tzd's |
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which drugs prevent CHO absorption from the gut?
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alpha glucosidase inhibitors
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Most effective drug in reducing HgbA1C
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Sulfonylureas and metformin both reduce by 1-2%
TZDs reduce by 1-1.5% |
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LEast effective drugs in reducing HgbA1C
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Metiglinides
Alpha glucosidase inhibitors both reduce by 0.5-1% |
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Sfx of sulfonylureas
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hypoglycemia
wt gain |
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sfx metiglinides
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hypoglycemia
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sfx metformin
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GI sfx
Rare lactic acidosis |
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sfx tzd
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liver dz
wt gain |
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monitoring liver enzymes when giving tzd
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monitor lfts q 2 months x 1 year
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sfx alpha glucosidase inhibitors
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flatulence
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Which drug is a PPAR - gamma agonist that increases glc uptake and decreases FFA?
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TZD
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Which drug may cause pt to lose wt?
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metformin
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which drugs cause hypoglycemia
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sulfonylureas
metiglinides |
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Which drugs are short acting?
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Metiglinides (increase insulin secretion)
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Short acting insulin
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Regular
Novolog |
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Intermediate insulin
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NPH
Lente |
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Long acting insulin
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Ultralente
Glargine |
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Onset this insulin is in 30 min
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regular
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Onset of this insulin is in 10 min
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Novolog
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Onset of this insulin is in 2 hours
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NPH
Lente (intermediate) |
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Onset of this insulin is in 4 hours
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Ultralente
Glargine (both long acting) |
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Peak of this insulin is 1-1.5 hours
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Novolog
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Peak of this insulin is 2-3 hours
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Regular
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Peak of this insulin is in 4-6 hours
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NPH
Lente |
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Peak of this insulin is in 8-10 hours
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Ultralente
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This insulin has NO peak
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Glargine
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The 5 I's of DKA
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Insulin deficiency
Infxn Ischemia Intra-abdominal process (pancreatitis, cholecystitis) Iatrogenic (corticosteroids) |
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What causes the hyperglycemia that leads to DKA?
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Low insulin and high glucagon
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Pathophysiology of DKA
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Low insulin and high glucagon-> low glc uptake and gluconeogenesis-> hyperglycemia -> body cannot use glc -> ketosis due to increased FFA substrate
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Clinical signs of DKA
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Please give me KANDy:
PMNs Kussmaul's respirations AMS N/V/abdominal pain Dehydration |
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What are kussmaul's respirations?
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rapid and deep
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Diagnostic paramers of DKA
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AG metabolic acidosis
Ketosis (urine and serum) Hyperglycemia Pseudohyperkalemia Pseudohyponatremia High WBC High Amylase |
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Why is K "high" in DKA?
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Insulin pulls out water, K comes with it
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Why is Na "low" in DKA?
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Insulin pulls water out of cells -> dilutes serum
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Corrected Na formula
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(glucose - 100) x .016 + Na
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Treatment of DKA
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Normal saline at 10 mL/kg/hr
Insulin 10 units, then 0.1 U/kg/hr -Once glc lowers, add dextrose to IVF -Once AG normal, give SC insulin Electrolytes: add 20-40 mEq K to IVF when serum K < 4.5 |
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Extreme hyperglycemia without ketoacidosis
Hyperosmolality AMS |
HONK
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Causes of HONK
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SImilar to causes of DKA
Plus: dehydration and renal failure |
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Pathophysiology of HONK
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Hyperglycemia -> osmotic diuresis-> dehydration -> prerenal azotemia -> increased glc from the proteins? -> etc
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Clinical featurs of HONK
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Dehydration
AMS Very high serum glc High serum osmolality No ketoacidosis |
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Treatment of HONK
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Hydration
Low dose insulin |
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Etiologies of hypoglycemia in diabetics
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Allowing your bld sugar to ROME:
Renal failure (decreased clearance of insulin) Oral hypoglycemics Missed meal Excess insulin |
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Etiologies of hypoglycemia in non-diabetics
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Decreased glc production
-Adrenal insufficiency -Glucagon deficiency -Hepatic or renal failure -Sepsis Excess insulin |
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Glc level in hypoglycemia
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< 50
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Autonomic fx of hypoglycemia
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diaphoresis
palpitations tremor |
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neuroglycopenic fx of hypoglycemia
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CNS sx:
HA visual changes AMS |
