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34 Cards in this Set

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Central obesity is a risk factor for diabetes...what waist measurement increases risk? (consider M/F)
A waist measurement of more than 40 inches for men and more than 35 inches for women
What is your goal for LDLs so that you don't have a risk factor for diabetes?
LDL<70
what is one of the modifiable risk factors that doubles the risk of heart disease, narrows blood vessels, increases the risk of long term complicatoins, and increases atherosclerosis
SMOKING
what are the ABCDEFGH of diabetes?
Advice (smoking, diet, exercise)
Blood pressure (<130/80)
Cholesterol (HDL, LDL, TG goals)
Diabetes control (HbA1C <7%)
Eye examination (Annual exam)
Feet examination (Annual exam)
Guardian drugs (Aspirin, ACEI, statins)
Heart Disease
Why is important for a diabetic woman who is on ACEi to be on contraceptives?
ACEi's are teratogenic
Lifestyle targets (weight, fat intake, saturated fat, fiber, exercise)
weight reduction > 5% if obese
fat intake < 30% of energy intake
saturated fat < 10% of energy intake
fiber > 15g per 1000 calories
exercise for four hours/week.
what do you use to regulate BP in a diabetic?
Measure at EVERY VISIT
Pharmacologic therapy should include either an ACE inhibitor or an angiotensin receptor blocker (ARB).
If one class is not tolerated, the other should be substituted.
what drug should you use to modify cholesterol in diabetics?
Statin therapy should be added to lifestyle therapy, regardless of baseline lipid levels, for diabetic patients
What drug combo should you use for diabetes control?
metformin (sensitizes insulin receptor) + insulin (or sulfonylurea-->increases endogenous insulin)
why do you use aspirin (what dose?) as a primary prevention strategy for diabetes?
dose: 81

helps prevent CV events

don't give to kids
in addition to BP effects, what other benefits do we get from ACEi/ARB?
Have been shown to decrease progression to nephropathy
Monitor urine microalbumin yearly in those without signs of nephropathy

Measure serum creatinine yearly to stage chronic kidney disease
what are the cardiac risk factors?
CAD HDL

Cigarettes
Age & Sex
Diabetes
Hypertension
Death from MI in family
Lipids High
in a pt with CHF and diabetes, what drugs are contraindicated?

**TEST
In patients with treated CHF, metformin and thiazolidinedione use are contraindicated.

ESPECIALLY TZD
what drug combo should be used in a pt with diabetes, >40, and another cardiac risk factor?
ACE inhibitor, aspirin, and statin therapy should be used to reduce the risk of cardiovascular events.
DKA most commonly appears in what type of diabetes?
Type 1
definition of DKA?

****
Blood glucose level > 250 mg/dl
Ketones in serum > 5 meq/L
Blood pH < 7.3
most common cause of DKA in a compliant pt?
Infection

Pneumonia and UTI most commonly
most common trigger for DKA?
not taking insulin
what are 2 drugs that commonly trigger DKA?

**
Corticosteroids

Thiazide diuretics ****
in DKA, what causes hyperglycemia? (3)
Increased gluconeogenesis

Conversion of glycogen to glucose

Inadequate use of glucose by peripheral tissues
what causes the release of ketones in a pt with DKA?
Beta oxidation of FFA

Decreased concentrations of malonyl coA (an inhibitor of ketogenesis)
major cause of electrolyte loss in DKA?
osmotic diuresis Brought on by excess excretion of glucose.

Glucose is restricted to extracellular space pulling water from intracellular space

NaCl, K are excreted in urine, followed by massive amounts of water
DKA tx goals. in order.
Improve circulatory volume and perfusion (ISOTONIC SALINE)

Decrease serum glucose

Clear serum of ketoacids at steady rate

Correct electrolyte imbalances
very first step of DKA tx?
Initial fluid (BEFORE INSULIN!)

Isotonic saline (restricted to extracellular space)
after your initial fluid tx, what do you do for a pt with DKA?
so you started with Isotonic saline.

Then you should use Hypotonic saline!

then you give dextrose (glucose) at a level above normal
What is the key electrolyte to monitor in DKA?
Potassium

in DKA it shifts to extracellular space and is peed out because of osmolar diuresis
what is the goal of giving insulin in a pt with DKA?
Purpose of insulin is not to correct hyperglycemia, but to correct the acidosis
how do you kill your pt when treating DKA?
OVERHYDRATION
DKA DON'TS

flip and read
NEVER GIVE INSULIN FIRST
They are dehydrated!

Monitor fluids closely
Over-correction results in cerebral edema

Monitor potassium closely!
Hypokalemia can kill you quickly

NEVER GIVE BICARBONATE
Fluids shift to quickly
A 26 year old male with Type 1 Diabetes presents to your office with a 5 day history of nausea and vomiting. His appetite has been decreased and he is not keeping fluids down. He notes he has been urinating frequently. His blood sugar in the office is 488.
What is the most likely diagnosis?
Hyperglycemic hyperosmolar nonketotic syndrome
Diabetic ketoacidosis
Pyelonephritis
Acute ischemic cerebrovascular accident
sugar >250, he is type 1, he is throwing up (getting rid of acid), polyuria

Diabetic ketoacidosis
A 56 year old male with Type 2 Diabetes presents to your office with a 5 day history of nausea and vomiting. His appetite has been decreased and he is not keeping fluids down. He notes he has been urinating frequently. His blood sugar in the office is 488.
What is the most likely diagnosis?
Hyperglycemic hyperosmolar nonketotic syndrome
Diabetic ketoacidosis
Pyelonephritis
Acute ischemic cerebrovascular accident
Hyperglycemic hyperosmolar nonketotic syndrome
A 55 year old man with hypertension well controlled on 25mg of HCTZ daily presents to the office for follow-up. On routine laboratory examination, you note a fasting blood sugar of 201.
What is the most likely diagnosis?
Glucose Intolerance
Type I diabetes
Maturity Onset of Diabetes of the Young
Drug-Induced Diabetes
126 fasting glucose is needed for diabetes

Drug-Induced Diabetes
(Thiazide is the key)
You are seeing a 65 year old man for follow-up and he asks for Viagra because he notes difficulty with erectile dysfunction. His only medical problem is mild hypertension well controlled with HCTZ
Which of the following tests will be the most useful in determining the diagnosis
Urinalysis to rule out an infection
Cardiac stress test to rule out coronary disease
Fasting blood sugar to rule out diabetes
CT of the abdomen to exclude an adrenal mass
Fasting blood sugar to rule out diabetes
**Buzzwords**

Polyuria, polydipsia, weight loss Nausea, vomitting, abdominal pain, Fruity Breath, Kussmaul Respirations
DKA