-
what drugs can induce DM?
Thiazides, diuretics, steriods, phenytoin
-
What are the classical findings/symptoms of DM?
polydispsia, polyphagia, polyuria
-
What is the oral glucose test?
75g of glucose in 300ml of water after overnight fast. Positive for DM if above 200mg/dl at both 2 hours and at least one other time before the 2 hour mark.
-
What is the life of a RBC?
120 days, basically correlates with Hemoglobin A1c levels
-
What are the characteristic findings of ketoacidosis in the blood?
pH,7.2, hyperglycemia, hyperventilation, increase in anion gap, hyponatremia, hyperkalemia, increase in bun/cr ketones in blood and urine
-
How do you tx ketoacidosis?
- Fluids to restore intravascular volume
- Bicarb w/ shock or coma
- Monitor EKG
- Phosphate, because serum levels may be low
-
What is the glucose level of a nonketotic hyperglycemic coma?
- >600mg/dl
- Lethargy, confusion, seizures, coma, dehydration, HTN, polyuria, polydipsia
-
What is infection greater with DM?
- Neuropathy, vascular problems, immunopathy
- Overall decrease in granulocytes and defective phagocyte ingestion
-
What is the whipples triad?
- Risk of hypoglycemia
- BS 40 mg/dl
- Immediate recurrence following admin of glucose
-
What is the somogyi phenomenon?
Hypoglycemia results in rebound hyperglycemia and may be due to secretioin of counter hormones such as glucagon and epinephrine
-
What is the major likely cause of Dm neuropathy?
Sorbitol pathway and schwann cell hyperosmolaity due to sorbitol excess.
-
What are the stages of DM charcot?
- Developmental
- Colescence
- Reconstruction
-
What if you are going to do a major surgery on a DM 1 or IDDM?
- Preop tests- EKG, UA, Chem 2, CBC, A1c
- If on oral hypoglycemics discontinue morning before surgery
- Well controlled with insulin take 1/2 the dose morning of.
-
How should you manage a DM during surgery?
- Pre-op start IV of 1000ml of 5% dextrose with 40 mEq/L of KCl run at about 100ml/hr
- Then decrease down to 80 ml/hr but monitor them with regular insulin coverage
-
When can they start their oral hypoglycemics again?
next day after surgery
-
What is a intermediate insulin?
NPH (Neutral protamine hagedorn)
-
What is Metformin?
Biguanide: Classified as a antihyperglycemic not a hypoglycemic
-
What is the MOA of Metformin?
- Decreases intestinal glucose uptake
- Increases peripheral glucose uptake
- Decreases hepatic glucose production
-
What is the does of Metformin?
500mg bid
-
What is the MOA of thiazolidinediones?
Increase target cell response in insulin
-
What is a combo therapy for DM tx?
Sulfonylureas, Metformin, Insulin
|
|