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85 Cards in this Set
- Front
- Back
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DKA - pathology
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incr lipolysis
decr glucose incr proteolysis |
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DKA - clin man
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hyperglycemia
ketonuria acidosis and pain tachy dehydration fruity breath |
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DKA - precipitating factors
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infections
inadequate insulin MI |
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DKA - mgmt
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IV fluid
insulin electrolytes underlying cause |
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DKA - concerns when managing insulin
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go slow, watch for cerebral edema
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DKA - electrolytes to manage
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potassium
phophorous magnesium |
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DM - FBG normal, pre, and diabetic
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> 126 diabetes
100-126, prediabetes < 100 normal |
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DM - PPG normal, pre, diabetic
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<140 nml
140-200 prediabetic >200 diabetic |
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DM - random normal, diabetic
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80-100
>200 diabetic |
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DM - Dr. Bedi's drug path of choice
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metformin + sitagliptide + long acting insulin + short acting insulin
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DM1 - def
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environmental insult provokes autoimmune reaction in genetically susceptible individual
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DM1 - progression
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cell mediated destruction of beta cells
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DM1 - asx until
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only 10-20% cells remain and are unable to compensate
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DM1 - honeymoon period
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after starting insulin, beta cell production increases but will fail within a year
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DM1 - age onset
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<30 usually, but LADA and MODY do happen
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DM1 - insulin
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dependent
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DM1 - genetic
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moderate, environment required for expression
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DM1 - autoantibodies
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HLA-DR3 or 4
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DM1 - most commonly associated with
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microvascular problems
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DM1 - microvascular problems
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nephropathy
retinopathy neuropathy |
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DM1 - prolonged fast results in
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hyperglycemia
ketoacidosis |
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DM1 - stress or insulin withdrawal results in
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ketoacidosis
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DM1 - endogenous insulin levels
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low or absent
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DM1 - presentation
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DKA
polyphagia polyuria polydipsia wt loss |
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DM1 - lab findings
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glycosuria
A1C ketonuria proteinuria (kidney damage) microalbumineria |
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DM1 - dietary mgmt
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10-20% protein
300 g of fat sat fat 10% sodium <2.4 g/day |
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DM1 - meds
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insulin only
lispro - short meal bolus lente - medium glargine - long basal |
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DM - quarterly assessments of
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feet
self test smoking A1c |
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DM - yearly assess of
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microalbumin
eyes neuro cardiac nephrology dental |
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DM - vaccines
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pneumo
flu |
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DM - lipid goals
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LDL < 100 or 70 with CV dz
HDL over 45 or 55 triglycerides < 150 |
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DM - alb:creatinine
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< 30 nml
micro 30-299 macro > 300 |
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DM - best indicator
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PPG
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DM2 - def
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peripheral insulin resistance resulting in hyperglycemia
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DM2 - risk factors
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age
obesity sendentary genetic ethnicity diet insulin resistance |
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DM2 - compensated insulin resistance
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euglycemia
hyperinsulinemia asx |
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DM2 - beta cell defect results in
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postprandial hyperglycemia
hyperinsulinemia asx |
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DM2 - beta cell decompensation results in
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fasting hyperglycemia
incr hepatic glucose production sx |
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DM2 - beta cell failure
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insulin requiring DM2
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DM2 - age onset
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> 40 but getting younger
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DM2 - genetic
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strong familial, no HLA, multifactorial
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DM2 - more common vascular complications
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most commonly macrovascular
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DM2 - complication incidence
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higher, d/t longer asx period
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DM2 - insulin
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relative deficiency to glucose, early hyperinsulinemia
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DM2 - insulin resistance
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usually
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DM2 - prolonged fast results in
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euglycemia
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DM2 - mortality d/t
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80-90% die of CV
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DM2 - clin man
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polyuria
polydipsia blurry vision fatigue weakness dizziness |
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DM2 - mgmt
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modest wt loss (5-7%)
oral meds self monitoring |
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DM2 - sulfonylureas moa, example
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incr beta cell production
incr tissue sensitivity glipizide |
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DM2 - biguanides moa, example
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decr HGP, IR, intestinal glucose absorption
metformin |
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DM2 - sulfonylureas side effects
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hypoglycemia
wt gain |
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DM - elderly most common
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Type 2
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DM - elderly underdiagnosed bc (3)
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renal threshold for glucose increases
polyuria and dipsia occur later thirst mechanism impaired |
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DM - elderly secondary etiologies (3)
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drugs
pancreatic dz endocrine dz |
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DM - elderly steroids
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may reveal tendency, bc they increase levels
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DM - elderly fasting sugars
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may be normal in lean elderly people, only revealed in PPG
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DM - elderly A1C
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not enough to dx DM
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DM - elderly mgmt in robust seniors
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A1C < 7
FBG 80-120 |
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DM - elderly severe dietary regimens
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not advised
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DM - elderly insulin regimen
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long acting once at bedtime, complicated schedules not advised
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DM - elderly neuropathy
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50% over 60 have
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DM - elderly eye complications
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cataracts and glaucoma more common
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DM - elderly Beta blockers
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may blunt sense of hypoglycemia even further
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DM - elderly microalbumineria
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not as good an indicator in Type 2 as Type 1
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DM - elderly feet
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neuropathy and vascular issues complicated by inability to evaluate feet
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DM1 - eye exams
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within 5 years of dx
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DM2 - eye exams
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immediately d/t to longstanding hyperglycemia
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HHS - mortality
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10-20%
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HHS - mgmt
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fluid resuscitation
electrolyte abnormalities insulin thromboprophylaxis |
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HHS - clin man
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dehydration
dry skin no kussmaul or fruity breath |
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HHS - ketones
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none
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HHS - pH
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> 7.3
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HHS - marked hyperglycemia
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> 600
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HHS - serum osmolality
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> 315
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malnutrition - elderly effect of agin
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decr caloric req
decr interest in food lack of taste buds lower reserves of macro and micro vitamins |
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malnutrition - elderly GI system changes
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loss of teeth
xerostomia dysphagia delayed gastric emptying overgrowth of intestinal bacteria - diarrhea gallstones incr, but are largely asx |
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malnutrition - elderly BMI
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impractical d/t difficulty with ht measurements
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malnutrition - elderly wt worry signs
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5 lbs or 5% in one month
10 lbs or 10% in 6 months |
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AK=alcoholic ketoacidosis
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x
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AK - precipitated by
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heavy ETOH ingestion with little or no food
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AK - onset
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24-72 hours after ingestion
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AK - lab result
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anion gap metabolic acidosis usually, but could be mixed
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AK - tx
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5% dextrose in normal saline, maybe B12
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AK - insulin
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no need, levels will regulate once volume is restored
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