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109 Cards in this Set
- Front
- Back
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Diabetes Mellitus
What is it? |
metabolic disease resulting from breakdown in the ability of the body to either produce and/or utilize insulin resulting in inappropriate hyperglycemia |
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Diabetes Mellitus
What is the incidence? |
~14 million Americans have diabetes ~50% of all persons w/ DM are undiagnosed |
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Diabetes Mellitus
What is Type I DM? |
- the result of an infectious or toxic environmental insult to pancreatic B cells of genetically predisposed persons |
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Diabetes Mellitus
What antibodies are found in patients with Type I DM? |
90% of patients have islet cell antibodies within 1 year of diagnosis |
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Diabetes Mellitus
What antigens are found in Type I DM? |
- human leukocyte antigens |
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Diabetes Mellitus
What did Type I DM used to be called? |
insulin dependent or juvenile DM |
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Diabetes Mellitus
What is the onset of Type I DM? |
acute onset |
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Diabetes Mellitus
What are 4 differentiating characteristics b/w type 1 and type 2 DM? |
- human leukocyte antigens - Islet cell antibodies - ketone development - acute onset |
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Diabetes Mellitus
What was type II DM called? |
non-IDDM adult onset DM |
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Diabetes Mellitus
Which is the most common type of DM? |
- type 2 - 90% of diabetics |
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Diabetes Mellitus
What is Type II DM? |
circulating insulin exists enough to prevent ketoacidosis, but inadequate for the patient's needs |
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Diabetes Mellitus
What causes Type II DM? |
- tissue insensitivity to insulin or insulin secretory defect resulting in resistance/impaired insulin production |
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Diabetes Mellitus
What syndrome is it associated with? |
Syndrome X - obesity, htn, abnormal lipids |
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Diabetes Mellitus
What is metabolic syndrome? |
- having 3 or more: - waist circumference - BP elevation - triglycerides - FBG increased - HDL |
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Diabetes Mellitus
What is the waist circumference in metabolic syndrome? |
- men: > 40 inches (101.6cm) - women: >35 inches (88.9 cm) |
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Diabetes Mellitus
What is the BP elevation in metabolic syndrome? |
>130/85 |
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Diabetes Mellitus
What is the triglycerides in metabolic syndrome? |
>150 |
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Diabetes Mellitus
What is the FBG in metabolic syndrome? |
>100 |
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Diabetes Mellitus
What is the HDL in metabolic syndrome? |
men: <40 women: <50 |
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Diabetes Mellitus
What are s/s of Type I DM? |
- polyuria - polydipsia - polyphagia - nocturnal enuresis - weight loss - weakness/fatigue - changes in LOC |
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Diabetes Mellitus
What are s/s of Type II DM? |
- polyuria - polydipsia - recurrent vaginitis in women - peripheral neuropathies - blurred vision - chronic skin infections including pruritis |
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Diabetes Mellitus
What are labs findings in Type I DM? |
- Random plasma glucose >200 - serum fasting BS >126 - ketonemia, ketonuria - BUN/Creatinine elevated - Oral glucose tolerance test >200 - HgbA1c- not used for diagnosis
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Diabetes Mellitus
What is impaired glucose tolerance? |
FBG >100, <125 |
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Diabetes Mellitus
What is a normal HgbA1C? |
5.5 - 7 |
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Diabetes Mellitus
What are lab findings in Type II DM? |
same as type 1 but no ketones in blood/urine - random plasma glucose >200 - serum fasting bs >126 - oral glucose tolerance test >200 |
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Diabetes Mellitus
What is dietary management of Type I DM? |
- dietary teaching
- carbs: 55-60% of total caloric intake - fats: 20-30% of total caloric intake - fiber: 25g/1000 calories - protein: 10-20% of total caloric intake |
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Diabetes Mellitus
What do you do if the patient presents with ketones in type I DM? |
- begin insulin |
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Diabetes Mellitus
What is the baseline for starting insulin? |
0.5 u/kg/day - 2/3 of amount in the morning - 1/3 remaining at night |
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Diabetes Mellitus
What is given in the morning dose of insulin? |
2/3 NPH 1/3 Regular |
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Diabetes Mellitus
What is given in the evening dose of insulin? |
1/2 NPH 1/2 Regular |
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Diabetes Mellitus
What are insulin analogs? |
Aspart (Novolog) Glargine (lantus) prolonged duration Lispro (humalog) rapid onset |
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Diabetes Mellitus
What baseline studies are taken for Type I DM? |
- obesity - cardiac risk factors - ketones - cardiac markers - cholesterol, triglycerides - ECG - renal studies - peripheral pulses, neuro fxn, eyes, and foot exam |
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Diabetes Mellitus
Where do you start therapy for Type II DM? |
- dietary treatment - exercise - early use of oral anti-diabetics |
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Diabetes Mellitus
What are the 5 classes of antiduretics? |
- sulfonylureas - biguanides - alpha-glucosidase inhibitors - thiazolinediones - non-sulfonylurea insulin resistance stimulators |
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Diabetes Mellitus
Wwhat do sulfonylureas do? |
- stimulate the pancrease |
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Diabetes Mellitus
Which oral antidiabetics are most widely prescribed? |
sulfonylureas |
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Diabetes Mellitus
What are examples of sulfonylureas? |
- Glipizide (glucotrol) - Glyburide (DiaBeta, Micronase) - Glimepiride (Amaryl) |
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Diabetes Mellitus
What do biguanides do? |
- adjunct sulfonylureas - used for obese patients |
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Diabetes Mellitus
What are side effects of biguanides? |
nausea and anorexia lactic acidosis |
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Diabetes Mellitus
What are examples of biguanides? |
- metformin (Glucophage) |
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Diabetes Mellitus
What do alpha-glucosidase inhibitors do? |
- bind to disaccharidases so less glucose is absorbed by the gut |
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Diabetes Mellitus
What are examples of alpha-glucosidase inhibitors? |
- acarbose (precose) - miglitol (glyset) |
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Diabetes Mellitus
What do thiazolidinediones do? |
decrease gluconeogenesis (Kreb's cycle) |
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Diabetes Mellitus
What are some examples of thiazolidinediones? |
- rosiglitazone maleate (avandia) - pioglitazone hydrochloride (Actos) |
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Diabetes Mellitus
What do non-sulfonylurea insulin release stimulators do? |
- mimic the effect of rapid acting insulin |
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Diabetes Mellitus
What are examples of non-sulfonylurea insulin release stimulators? |
Repaglinide (Prandin) |
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Diabetes Mellitus
What are other agents used to manage Type II DM? |
- Exanatide (Byetta)- injectable that signals pancreas to increase insulin secretion - N/V and diarrhea common - Sitagliptin (Januvia)- breaks down incretins - Pramlintide (Symlin)- slows glucose absorption and inhibits glucagons |
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Diabetes Mellitus
What is the somogyi effect? |
- nocturnal hypolycemia turns into hyperglycemia b/c of released regulatory hormones
- hypoglycemic at 0300, hyperglycemic at 0700 |
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Diabetes Mellitus
How do you treat the somogyi effect? |
- reduce or omit bedtime insulin - or snack at bedtime |
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Diabetes Mellitus
What is the dawn phenomenon |
- bloodglucose is elevated progressively throughout the night
hyperglycemic at both 0300 and 0700 |
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Diabetes Mellitus
What is the treatment for the dawn phenomenon? |
- increase bedtime dose of insulin |
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Diabetes Mellitus
What kind of diabetic is the somogyi effect common in? |
type I |
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Diabetes Mellitus
What kind of diabetic is the dawn phenomenon common in? |
type II |
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Diabetes Mellitus
What is diabetic ketoacidosis? |
- intracellular dehydration d/t elevated blood glucose levels |
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Diabetes Mellitus
What kind of diabetics gets Diabetic Ketoacidosis |
Type I |
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Diabetes Mellitus
What does HHNK stand for? |
hyperosmolar hyperglycemic non-ketosis |
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Diabetes Mellitus
What is HHNK? |
- state of greatly elevated serum glucose, hyperosmolality, and severe dehydration w/o ketone production |
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Diabetes Mellitus
What kind of patients get HHNK? |
Type II Diabetics |
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Diabetes Mellitus
What is the mortality rate of HHNK? |
30-50% |
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Diabetes Mellitus
What happens to insulin production in HHNK |
the patient can not produce enough insulin to prevent hyperglycemia, osmotic diuresis, and extracellular fluid depletion |
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Diabetes Mellitus
What can be HHNK Triggers? |
- Infection - MI |
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Diabetes Mellitus
What are s/s of DKA? |
- polyuria with nocturia - polydipsia - weakness, fatigue - N/V - Kussmaul's respirations - altered LOC - fruity breath - hypotension, tachycardia - poor skin turgor |
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Diabetes Mellitus
What are kussmaul's respirations for? |
the body's way of blowing off CO2 (respiratory alkalosis) to counteract metabolic acidosis |
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Diabetes Mellitus
What are s/s of HHNK? |
- polyuria - weakness - altered LOC - hypotension - tachycardia - poor skin turgor - signs of dehydration |
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Diabetes Mellitus
What is seen on the labs of a DKA patietn? |
- hyperglycemia - ketonemia +/- ketonuria - glycosuria - acidosis (<7.3) metabolic - hyperkalemia - hyperosmolality |
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Diabetes Mellitus
What is the serum glucose of a person on DKA? |
- >250, frequently >300 |
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Diabetes Mellitus
What is seen on the labs of a person with HHNK? |
- elevated serum glucose - hyperosmolality (>310) - elevated BUN and creatinine - elevated Hgb A1C - normal pH - normal anion gap |
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Diabetes Mellitus
What is the serum blood glucose of a patient with HHNK? |
>600, commonly >1000 |
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Diabetes Mellitus
What is done to manage DKA? |
- O2, airway - fluid resuscitation - Normal saline then - 1/2 NS then - D5 1/2 NS - 0.10 U/kg regular insulin bolus followed by 0.1 u/kg/hr |
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Diabetes Mellitus
What is done to manage HHNK? |
- O2, airway - NS IV massive replacement (6-10 L) then 1/2 NS, then D5 1/2 NS
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Hyperthyroidism vs. Hypothyroidism
Who is hyperthyroidism more common in? What is the ratio? |
- Women - 8:1 |
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Hyperthyroidism vs. Hypothyroidism
What is the age of onset of hyperthyroidism? |
20-40 y/o |
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Hyperthyroidism vs. Hypothyroidism
What is the most common presentation of hyperthyroidism? |
Grave's disease |
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Hyperthyroidism vs. Hypothyroidism
What are some other causes of hyperthyroidism? |
- toxic adenoma - subacute thyroiditis - TSH secreting pituitary tumor - high dose amiodarone |
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Hyperthyroidism vs. Hypothyroidism
What are some causes of hypothyroidism? |
- pituitary TSH deficiency - Hypothalamic TRH deficiency - iodine deficiency - Hashimoto's - gland damage |
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Hyperthyroidism vs. Hypothyroidism
What are s/s of hyperthyroidism? |
- nervous - anxious - increased sweating - fatigue - emotional lability - tremors - hyperreflexia - increased appetite - weight loss - smooth, warm, moist skin - fine/thin hair - exopthalmos - lid lag - tachycardia - heat intolerance |
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Hyperthyroidism vs. Hypothyroidism
What are s/s of hypothyroidism? |
- extreme weakness - muscle fatigue - arthralgia - cramps - cold intolerance - constipation - weight gain - dry skin - hair loss - brittle nails - puffy eyes - face/hand edema - bradycardia - slowed DTRs - hypoactive bowel sounds |
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Hyperthyroidism vs. Hypothyroidism
What are the T3, T4 and TSH values in hyperthyroidism? |
- Increased T3 and T4 - Decreased TSH |
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Hyperthyroidism vs. Hypothyroidism
What are the T3, T4, and TSH values in hypothyroidism? |
- decreased T3, T4 - increased TSH |
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Hyperthyroidism vs. Hypothyroidism
What is the most sensitive test? |
TSH assay |
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Hyperthyroidism vs. Hypothyroidism
What other test is elevated in hyperthyroidism? |
ANA w/o evidence of lupus or other collagen disease |
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Hyperthyroidism vs. Hypothyroidism
What is done in hyperthyroidism to establish etiology of hyperthyroidism? |
- thyroid radioactive iodine uptake and scan |
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Hyperthyroidism vs. Hypothyroidism
What is a high radioactive iodine uptake consistent with? |
grave's disease |
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Hyperthyroidism vs. Hypothyroidism
What is a low iodine uptake associated with? |
subacute thyroiditis |
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Hyperthyroidism vs. Hypothyroidism
How is Grave's ophthalmopathy evaluated? |
MRI of the orbits |
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Hyperthyroidism vs. Hypothyroidism
What is seen in a patient with hypothyroidism? |
hyponatremia hypoglycemia |
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Hyperthyroidism vs. Hypothyroidism
What is managemetn of hyperthyroidism? |
- specialist referral - Propanolol (inderal) for symptoms - 10mg PO and up to 80mg PO QID - thiourea drugs for small goiters - radioactive iodine 131-I to destroy goiter - thyroid surgery - Lugol's soln 2-3 gtts PO qd x 10 days |
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Hyperthyroidism vs. Hypothyroidism
What is Lugol's soln for? |
decrease vascularity of the gland |
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Hyperthyroidism vs. Hypothyroidism
What are examples of thiourea drugs? |
-methimazole (tapazole) 30-60mg in 3 divided doses - propyltiouracil 300-600mg /day in 4 divided doses |
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Hyperthyroidism vs. Hypothyroidism
What is the management for hypothyroidism? |
- levothyroxine (synthroid) 50-100mcg daily, increase dose by 25mcg every 1-2 weeks until symptoms stabilize - decrease dose for those over 60 |
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Hyperthyroidism vs. Hypothyroidism
What is the treatment of thyroid crisis? Who gets this? |
- hyperthyroid patients - PTU 150-250 mg q6hr OR - Tapazole 15-25 mg q6hr w/ one of the following in one hour - Lugol's soln 10 gtts tid OR - Sodium iodide 1gm slowly IV Plus Propanolol 0.5-2g IV q4h or 20-120mg PO q6hr PLUS hydrocortisone 50mg q6hr with rapid reduction as situation improves |
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Hyperthyroidism vs. Hypothyroidism
What should be avoided in thyroid crisis? |
ASA |
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Hyperthyroidism vs. Hypothyroidism
Who gets myxedema coma? |
hypothyroidism |
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Hyperthyroidism vs. Hypothyroidism
What do you do to manage myxedema coma? |
- protect airway - fluid replacemnt - synthroid 400 mcg iv x 1 then 100mcg daily - support hypotension - slow rewarming with blankets |
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Cushing's syndrome
What is it? |
ACTH hypersecretion by the pituitary |
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Cushing's syndrome
What causes it? |
- adrenal tumors - chronic administration of glucocorticoids (steroid) |
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Cushing's syndrome
What are s/s? |
- central obesity - moon face w/ buffalo hump - acne - poor wound healing - purple striae - hirsutism - HTN - weakness - amenorrhea - impotence - h/a - polyuria and thirst - labile mood - frequent infections |
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Cushing's syndrome
What do you see on labs? |
- hyperglycemia - hypernatremia - hyperkalemia - glycosuria - leukocytosis - elevated plasma cortisol in the morning |
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Cushing's syndrome
What other labs should be done to eval for cushings? |
- dexamethasone suppresion test - serum ACTH |
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Cushing's syndrome
What is the management? |
- D/c whatever meds are causing the symptoms - manage electrolyte imbalance - refer for transphenoidal resection of pituitary adenoma, surgical removal of adrenal tumors, resection of ACTH secreting tumors |
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Addison's disease
What is it? |
- deficient cortisol, androgens, and aldosterone |
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Addison's disease
What are causes? |
- autoimmune distruction of adrenal gland - metastatic cancer - bilateral adrenal hemorrhage - pituitary failure |
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Addison's disease
What are s/s? |
- hyperpigmentation in buccal mucosa and skin creases - diffuse tanning and freckles - orthostasis and hypotension - scant axillary and pubic hair - fever (acute) - LOC changes (acute) |
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Addison's disease
What do you see on labs? |
- hypoglycemia - hyponatremia - hyperkalemia - elevated ESR - lymphocytosis - plasma cortisol <5mcg/dL at 0800 |
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Addison's disease
What is outpatient management? |
- specialist referral - glucorcotricoid and mineralcorticoid replacement |
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Addison's disease
What medications can be given for steroid replacement? |
- hydrocortisone - fludrocortisone acetate (Florinef) |
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Addison's disease
What is inpatient management? |
- Hydrocortisone (solu-cortef) 100-300 mg IV initially w/ NS, then D5NS at 500mL/hr x 4 then taper - vasopressors usually do not work - treat underlying cause |
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Addison's disease
What is a common cause of an addisonian crisis? |
infection |
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What electrolytes go in the same direction and which is opposite? |
- sugar and sodium go together - potassium is the opposite |
