MMD exam 2 pt 323 cards

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1

DKA

Severe insulin def assoc with stress; high blood sugar, acidosis, and high levels of ketone bodies; DM type 1

2

Glycogenesis

Glucose to Glycogen

3

Glycogenolysis

Glycogen to Glucose

4

Cluconeogenesis

Amino acids to glucose

5

Lipogenesis

Fatty acids+glycerol to triglycerides

6

Lipolysis

Triglycerides to fatty acids+gylcerol

7

What don't depend on insulin to absorb glucose?

RBCs, neurons, pancreatic B cells

8

Ketones

Used by the heart and brain as extra energy source Lg amts are produced the blood ph drops causing ketoacidosis

9

DKA SX

Extreme tiredness and thirst, constant urination, acetone breath, Kussmaul breathing, muscle wasting and wt loss, N/V abd pain, aggression, confusion and lethargy

10

DKA TX

Fluids, insulin and K; avoid rapid correction >100 because risk of osmotic encephalopathy Bicarb: pt in shock or coma or severe acidosis 6.9-7.1

11

DKA Complications

Arterial Thrombosis ie stroke but anticoag is not recommend Cerebral edema: more often in children; dx: head CT; TX: IV Mannitol Rebound Ketoacidosis can occur when insulin prematurely ceased

12

Hyperglycemic Hyperosmolar State

Severe hyperglycemia >600; most elderly pts with mild DM; precipitating events: infection, MI, stroke or recent surgery or implicated drugs: phenytoin, corticosteroids or diuretics

13

HHS SX/labs/tx

weakness, polyuria/dip, dehydration, lethargy and confusion (310) and coma (320-330) labs: glucose >600 and BUN >100 TX: fluid, insulin, correct electrolytes and tx factors

14

Hypoglycemia

SX start at 60 and impaired brain fct at 50; DX: Whipple triad- hx of hypoglycemic sx, fasting blood glucose=40 and immed recovery with glucose Causes: Hyperinsulinemai due to pancreatic b cell tumors, islet hyperplasia or wrong admin of insulin

15

Pancreatic B cell tumors

SX: blurred vision, diplopia, HA, slurred speech, anxiety, convulsions and coma early in morning, after missed meal or after exercise elevated proinsulin level MEN 1= insulinoma+ pTH tumor+ pituitary tumor sx: epigastric distress, renal stones, ed

16

Islet Hyperplasia

Partial Pancreatectomy

17

Non-Insulin producing extra pancreatic tumors

DX: fasting hypoglyc with no insulin TX: diet and surgery

18

Postgastrectomy Alimentary Hypoglycemia

Rapid d/c of ingested carbs into sm. bowel+rapid glucose absorption and hyperinsulinism TX: more frequent po meals of smaller portions

19

Functional Alimentary Hypoglycemia

Not explained by prior GI surg SX: chronic fatigue, anxiety, weakness, poor concentration, dec libido, HA, humger after meals and tremors DX: Postprandial hypoglycemia after high carb breakfast

20

Late Hypoglycemia

Delay in insulin release SX: obesity TX: Wt loss, reduce carbs with many sm. meals

21

Fasting Hypoglycemia after ETOH

Malnourished ETOH or anyone with ETOH induced gastritis and vomiting TX: glucose until stores are filled

22

Post ETOH reactive hypoglycemia

greater insulin release with sugar soft drinks and ETOH causing hypoglycemia 3-4 hours later TX: avoid mixed drinks and eat food

23

Immunopathologic Hypoglycemia

Very rare; anti-insulin Ab