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24 Cards in this Set
- Front
- Back
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Dx for women with recurrent vaginal candidiasis refractory to treatment
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Get finger stick for blood glucose (diabetes mellitus)
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Signs of Type I DM
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1. polyuria
2. polydipsia 3. weight loss 4. dehydration 5. blurred vision 6. fatigue 7. foot ulcers 8. restrictive cardiomyopathy |
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Tx for Type I DM
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insulin
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Dx for Type I DM
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1. fasting glucose >126
2. glycosuria (causes osmotic diuresis that leads to dehydration) 3. HbA1c - measure glucose control over past 3 mths (keep below 7%) |
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Corresponding blood glucose for HbA1c for 6,7,8,9
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6= 120
7=150 8=180 9=210 |
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what is DM type I
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insulin deficiency from autoimmune destruction of pancreatic beta cells
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who gets type I DM
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lean children, teenagers and young adults <30 yr old
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Type 1A diabetes
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-autoimmune-mediated diabetes.
-linkage to HLA DQA and DQR genes -autoantibodies (anti-islet, antiglutamic acid decarboxylase (GAD), anti-insulin, antibody tyrosine phosphatase) |
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Type 1B diabetes
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idiopathic, with no autoimmune markers, occurs more commonly in asians or africans
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diabetics have increased susceptibility to which infections
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-pseudomonas
-mucormycoses -actinomycoses -aspergillosis -renal abscesses (w/ UTI) |
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which diabetic medications are contraindicated in advanced heart dz patients
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-metformin
-thiazolidinediones |
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why should diabetics get there feet inspected frequently
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to look for small cuts that may develop into ulcers. due to neuropathy, diabetics can often have significant foot pathology and not feel anything
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Tx for diabetic with recurrent nightmares
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Sompgyi effect. Change to longer acting insulin at night to avoid 3am hypoglycemia
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what must Type I DM always take? Why?
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insulin. to avoid ketosis even if fasting
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Initial therapy for type I DM
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divide total daily dose to give 2/3 before breakfast and 1/3before dinner if using NPH or 70/30 preparations
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what is the Dawn Effect? WHat is the cause?
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rise in plasma glucose in the early morning hours before breakfast, secondary to an increase in growth hormone secretion
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Tx for diabetic with hypoglycemic finger sticks in AM.
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decrease bedtime NPH, even if bedtime finger sticks are high
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What is Somogyi effect
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nighttime hypoglycemia followed by dramatic increase in fasting glucose levels and increased plasma ketones in the morning (morning hyperglycemia is a rebound effect)
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Tx for Somogyi effect
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replacement of intermediate-acting insulin with long-acting insulin at bedtime to avoid peaking of insulin effect in the middle of the night
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cause of Type II DM
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1. insulin deficiency (impaired secretion of insulin)
2. insulin resistance (decreased cellular responsiveness to insulin) 3. impaired inhibition of hepatic gluconeogenesis |
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signs of Type II DM
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1. asymptomatic
2. complication of diabetes such as infection 3. increased susceptibility to fungal infections (cell mediated immunity is impaired by acute hyperglycemia) 4. Nonketotic hyperglycemic-hyperosmolar coma (NKHC) ...rare |
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Dx Type II DM
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1. random glucose > 200 + symptoms
2. fasting glucose >126 on 2 separate occasions 3. fasting glucose btw 100-126 require oral glucose tolerance test 4. positive oral glucose tolerance test >200 at 2 hrs after ingesting 75g of glucose |
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Initial treatment of type II DM
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education
diet exercise |
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Tx if diet and exercise does not work
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start oral hypoglycemic (combination of low dose insulin secretor (Glyburide) plus low dose insulin sensitizer (metformin) improve HbA1c
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