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How should mild hypoglycemia be treated?
BG < 70 and no severe symptoms then 15-20 gm of glucose
How should severe hypoglycemia be treated?
altered mental status, needs assistance from others
glucagon 1 mg IM
IV dextrose
What are common causes of diabetic ketoacidosis?
2 most common
-nonadherence or inadequate insulin therapy
-infection
others:
-myocardial infarction
-pancreatitis
-stroke
-drugs such as corticosteroids
What are common signs of DKA?
polyuria, polydipsia, comitind, dehydration, weakness, AMS, coma, Kussmaul respirations, tachycardia, hyponatremia, hyperkalemia
What are Kussmaul respirations?
deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.
How should DKA be treated?
1. fluid replacement
2. Insulin drip
-0.1 unit/kg/hour
-increase if BG doesn't decrease 50-75 in first hour
-will eventually need to reduce rate to keep BG between 150-200
3. replace potassium if needed
4. IV sodium bicarb if pH less than 6.9
When is DKA considered resolved?
When BG is less than 200 mg/dL and 2/3 of the following are present:
i. venous pH greater than 7.3
ii. serum bicarb 15 mEq/L or greater
iii. calculated anion gap of 12 mEq/L or less
What is a normal albumin/creatinine ratio?
less than 30 mg/g
When is albuminuria diagnosed?
if 2/3 albumin/creatinine ratio are 30 mg or greater over a 3-6 mo period
What drug should be added to reduce risk of nephropathy? When should it be initiated?
ACEI or ARB
if albumin/creatinine ration is 30 mg/g or greater
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