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CSI - LEC 6 - DIABETES
Terms in this set (77)
Endocrine causes for Weight loss
Adrenal insufficiency, hyperthyroidism, diabetes
What is the most common cause of hyperthyroidism?
What is the cause of Grave's disease?
Thyroid-stimulating immunoglobulin (IgG) stimulates TSH receptors on thyroid
When does Grave's disease often present?
During periods of stress
What HLA type is associated with Grave's disease?
What medical emergency is associated with hyperthyroidism?
What is the treatment for thyroid storm?
4 P's: Propranolol, PTU, prednisone, potassium iodine (administered 1 hr after PTU)
What symptoms are associated with hyperthyroidism?
Bulging eyes, goiter, heart palpitations, tremors, heat intolerance, weight loss, and anxiety/nervousness
What happens to a patient with adrenal insufficiency?
Inability to generate glucocorticoids +/- mineralocorticoids for the body's needs
In the adrenal glands, what is produced in the Zona Glomerulosa?
What symptoms present with Adrenal Insufficiency?
Weakness, orthostatic hypotension, muscle aches, weight loss, GI upset, salt/sugar craving
In the adrenal glands, what is produced in the Zona fasiculata?
In the adrenal glands, what is produced in the Zona reticularis?
How do you diagnose primary adrenal insufficiency?
High ACTH, low cortisol
If a pt has primary adrenal insufficiency, where is the pathology?
How do you diagnose secondary/tertiary adrenal insufficiency?
Low ACTH, low cortisol
If a pt has secondary adrenal insufficiency, where is the pathology?
What symptoms present with primary adrenal insufficiency?
Low BP, hyperkalemia, metabolic acidosis, hyperpigmentation of skin/mucosa
Why does the pt present with hyperkalemia with primary adrenal insufficiency?
Low levels of aldosterone prevent pt from absorbing Na and secreting K+, H+, resulting in hypovolumia, hyperkalemia, and metabolic acidosis
Why is there hyperpigmentation of skin/mucosa in a pt with primary adrenal insufficiency?
Melanocyte pigment is a byproduct of ACTH
(Primary Pigments skin/mucosa)
How does acute primary adrenal insufficiency present?
Sudden onset (e.g. adrenal hemorrhage). Pt may present with shock/adrenal crisis
What is Waterhouse-Friderichsen syndrome?
Acute primary adrenal insufficiency due to adrenal hemorrhage associated with Neisseria meningitidis septicemia, DIC, and endotoxic shock
What is Addison's disease?
Adrenal atrophy or destruction by disease (TB worldwide, Autoimmune destruction in western world)
If a pt has tertiary adrenal insufficiency, where is the pathology?
What is the most common cause of tertiary adrenal insufficiency?
Exogenous steroid use with sudden withdrawal
(Tertiary from Treatment)
What is one way to differentiate primary adrenal insufficiency from secondary/tertiary adrenal insufficiency (without labs)
No hyperpigmentation in secondary/tertiary adrenal insufficiency (bc ACTH low)
What is primary defect in Type 1 Diabetes Mellitus?
Autoimmune destruction of pancreatic beta cells (no insulin produced)
What HLA system is associated with Type 1 DM?
HLA-DR4 and HLA-DR3 (4-3=Type 1 diabetes)
What is the primary defect in Type 2 Diabetes mellitus?
When do you screen a pt for gestational diabetes?
What symptoms present with diabetes?
Polydipsia, polyuria, polyphagia, weight loss, fatigue
When do you start screening for diabetes, and how often?
All patients starting at age 45, repeat every 3 years
When do you start screening for diabetes if pt has BMI>25?
How often do you screen a pt with pre-diabetes?
Every 1-2 years
How is diabetes most commonly diagnosed in adults?
Elevated A1c, most often found from screening
What is the fasting glucose and A1c for a normal person (without diabetes)
<100 fasting glucose, <5.7% A1c
What is the fasting glucose and A1c for a pre-diabetic?
100-125 fasting glucose, 5.7-6.4% A1c
What is the fasting glucose and A1c of a diabetic?
>126 fasting glucose, >6.5% A1c
What is the range for 2hr glucose tolerance test in a non-diabetic?
What is the range for 2hr glucose tolerance test in a pre-diabetic?
What is the range for 2hr glucose tolerance test in a diabetic?
What is the goal A1C for diabetics?
How does diabetic retinopathy present?
Microanuerysms, neovascularization, cotton wool spots, cataracts, edema (causing macular edema —>blindness)
What is the most common cause of blindness?
How does nephropathy manifest in a diabetic pt?
Nodular glomerular sclerosis (hyaline deposits)
Also known as Kimmelstiel-Wilson Nodules
How do you check for diabetic nephropathy?
Check urine for microalbumin, BUN/Cr
Microalbuminuria 30-299 mg/day
Macroalbuminuria >300 mg/day (pts with macroalbuminuria v at risk for needing dialysis)
How does diabetic neuropathy develop?
Non-enzymatic glycosylation and glyco-oxidation
How does diabetic neuropathy (peripheral) present?
Gloves and socks (Feet more affect than hands)
What body systems does diabetic neuropathy (autonomic) affect?
Cardiac, GI, GU
What are complications of diabetic autonomic neuropathy, concerning cardiac system?
Orthostatic hypotension, silent MI
What are complications of diabetic autonomic neuropathy, concerning GI system?
Gastroparesis (slowed peristalsis), Decreased esophageal motility
What are complications of diabetic autonomic neuropathy, concerning GU system?
Overflow incontinence, erectile dysfunction
What are potential complications of diabetic ulcers?
Prone to osteomyelitis (wound/infection hitting bone)
How does cardiovascular disease relate to diabetic pts?
Diabetic pts have increased risk of developing CV disease
How do you calculate ankle-brachial index?
Right ankle systolic/Right arm systolic
(Do same on left side, choose the LOWER of the two numbers for pts ABI)
What is a normal ABI?
What is the ABI for a pt with mild-moderate PAD, and what are their symptoms?
0.4-0.9, claudication (cramping when walking)
What is the ABI of a pt with severe PAD, and what are their symptoms?
<0.4, cramping pain at rest
What are symptoms of hyperglycemia?
3 P's: polyuria, polyphagia, polydipsia; fatigue; fungal infection; weightloss
What are the symptoms of hypoglycemia?
Dizzy, lethargic, tremors, palpitation, sweaty, stroke-like, seizures
How do you advise a diabetic pt on their lifestyle?
Diet- decrease carb intake
Exercise 30 min/5x a week
Physical exam for diabetic pt
Fundoscopic, CV (check for carotid bruit), foot exam (wounds, microfilament), measure ABI
When do you check A1c in a compliant diabetic pt?
Every 6 months
How often do you check A1C in a pt with uncontrolled DM (>7%) or pt with new meds?
Every 3 months
What diabetic labs do you check annually?
Lipid panel, urine microalbumin, BUN/Cr, opthalmology
What is Hyperosmolar Hyperglycemic State (HHS)?
An acute metabolic complication of DM characterized by impaired mental status and elevated plasma osmolality (dehydration) in a pt w/ hyperglycemia
Occurs predominantly in Type 2 DM
What is Diabetic Ketoacidosis (DKA)?
Acute, life threatening, complication of diabetes that mainly occurs in patients with Type 1 Diabetes. Characterized by hyperglycemia, ketoacidosis, ketonuria
What are signs/symptoms of DKA?
DKA is Deadly: Delirium/psychosis, Kussmaul respirations (rapid, deep breathing), Abdominal pain/nausea/vomiting, Dehydration. Also fruity breath odor (exhaled acetone)
What is glucose level in DKA pts?
What pH level do pts with DKA usually have?
<7.3 (<7 severe)
What bicarb level do pts with DKA usually have?
<18, with anion gap
What lab findings are consistent with a HHS pt?
>600 glucose, >320 serum osmolality
No anion gap, absent ketones
What labs do you run for a DKA/HHS pt?
CBC, BMP, Acetone, beta-hydroxybutyrate, serum osmolality, UA (ketones and glucose), VBG/ABG (pH level)
CXR, EKG, troponin (To see what caused it)
What are the most common precipitating factors in DKA/HHS?
Medication noncompliance, stress (infection, MI, post-op, trauma, CVA), new onset of DM (DKA)
Why is Na low in HHS/DKA?
Pseudohyponatremia due to osmotic shift, add 1.6 Na for every 100 increase in glucose over 100
How do you treat a pt with DKA?
-IV fluids: (2-3 L then drip), Switch to D5 .45NS when BGL is <250
-Insulin drip: DO NOT BOLUS, 0.1 u/kg/hr (slowly to prevent cerebral edema)
**Do not start insulin if K<3.3 (insulin lowers K+, will cause heart arrhythmia)
How do you treat pt with HHS?
-IV fluids (6-10 L then drip), Switch to D5 .45NS when BGL <250
-Insulin bolus IV, then low dose insulin drip (2-4 u/hr)
THIS SET IS OFTEN IN FOLDERS WITH...
CSI - LEC 1 - DELIRIUM
CSI - LEC 2 - TOXIDROMES
CSI - Lecture 11 - ABNORMAL BEHAVIOR
CSI - LEC 3 - TYLENOL/ASPIRIN/CO/ANTICOAG TOXICITY
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