lecture 2 - hypoglycemia + acute complications

hyperglycemia

* polyuria
* polydipsia
* polyphagia
* blurred vision
* fatigue
* infections, slow healing

are signs and symptoms of

< 7.0% for non-pregnant adults

A1C goal

80-130 mg/dL

FBG goal

< 180 mg/dL

post-pranial BG

54 mg/dL

what is the cut-off for hypoglycemia when monitoring glucose in house?

* hypoglycemia
* DKA
* HHS

what are the acute complications of DM?

* macrovascular
* microvascular
* neuropathic
* mixed vascular and neuropathic
* hypoglycemic unawareness

what are the chronic complications of DM (5)

* tremor
* agitation
* sweat
* hunger

signs and symptoms of hypoglycemia

* insulin errors (non-compliance, intensive therapy)
* nutrition (skip meal)
* exercise
* alcohol and drugs

what are the 4 causes of hypoglycemia?

rule of 15 (15g of carbs in 15 mins)

how to manage MILD hypoglycemia?

< 70 mg/dL

glucose level when someone has MILD hypoglycemia

< 54 mg/dL

glucose level when someone has MODERATE hypoglycemia

moderate hypoglycemia

* HA, mood change, irritability
* decrease attentiveness
* drowsiness
* confusion, impaired judgement
* weakness

are signs and symptoms of

* treat as mild hypoglycemia (rule of 15)
* may need repeated treatment

how to manage MODERATE hypoglycemia?

severe hypoglycemia

* unresponsive
* unconscious
* convulsions

(aka neuroglycopenic symptoms)

are signs and symptoms of

* buccal carbs
* glucagon
* IV dextrose

how to manage severe hypoglycemia?

glucagon

* increase glycogenolysis, gluconeogenesis
* decrease glycogenesis
* increase brain and blood glucose

are the effects of which hormone?

stimulate AC to increase cAMP to promote glucose production in the liver

what is the MOA of glucagon?

glucagon increase BG by 20 mg/dL per 10-15 minutes

which of the following is true?

\
A. glucagon increase BG by 20 mg/dL per 5-10 minutes

B. glucagon increase BG by 30 mg/dL per 10-15 minutes

C. glucagon increase BG by 20 mg/dL per 10-15 minutes

D. glucagon increase BG by 30 mg/dL per 5-10 minutes

* tachycardia
* NV

what are the adverse effects of glucagon? (2)

1 mg and may repeat in 20 minutes

what is the adult dosing of glucagon?

* hypoglycemia
* BB or non-dihydropyridine CCB overdose

what are the indications for glucagon?

true

true or fasle

\
whenever glucagon is used, CHO/IV dextrose must follow ASAP

baqsimi

nasal powder glucagon is called

3 mg intranasally, may repeat in 15 minutes

Baqsimi dosing

DKA

* hyperglycemia
* ketonemia
* metabolic acidosis

are the features of

HHS

* hyperglycemia
* no ketones
* no acidosis

are the features of

* glucagon
* catecholamines
* cortisol
* growth hormones

hormones that can trigger hyperglycemia includes

insulin deficiency

what is the primary abnormality of hyperglycemia?

true

true or false

\
glycosuria can cause osmotic diuresis, which can also trigger hyperglycemia

both type 1 and type 2 DM

DKA is only present in

\
A. type 1 DM

B. type 2 DM

C. both type 1 and type 2 DM

type 2 DM

HHS is only present in

A. type 1 DM

B. type 2 DM

C. both type 1 and type 2 DM

lipolysis and ketogenesis

what are the cause of DKA in type 1 DM?

catecholamine release that suppress beta-cells functions

what are the causes of DKA in type 2 DM?

HHS

which acute complication of DM has a higher mortality rate?

\
A. DKA

B. HHS

C. hypoglycemia

DKA

what is the first clinical presentation in DM1?

* illness/infection
* stress
* alcohol
* insulin noncompliance

name the 4 precipitating factors of DKA

false

true or false

\
DKA progress slowly

* infection/illness (pneumonia, UTI)
* pulmonary embolism/ AMI/ stroke
* GI hemorrhage, diarrhea
* substance use/abuse
* undiagnosed DM
* diarrhea

name the 8 precipitating factors of HHS

true

true or false

\
HHS progress slowly

gapped

DKA is a _____ acidosis

b-hydroxybutyric acid and acetoacetic acid

overproduction of _________ and _____ causes acidosis

A. b-hydroxybutyric acid and HCl

B. b-hydroxybutytic acid and H2CO3

C. b-hydroxybutyric acid and acetic acid

D. b-hydroxybutyric acid and acetoacetic acid

* NV + CRAMPS
* Polyuria, Polyphagia, Polygypsia
* Dehydration
* Kussmaul’s respirations
* weight loss
* fruity breath

what are 6 signs and symptoms of DKA?

in HHS, there are no

* Kussmaul’s respiration
* fruity smell

what are the difference between DKA and HHS signs and symptoms?

* K depletion
* Phosphate depletion
* bicarbonate ≤ 15 meq/L
* Mg depletion

what are the main electrolyte abnormalities in DKA?

K depletion

what is the main electrolyte abnormality in HHS?

5-7L

what is the amount of water loss in DKA?

7-12 L

what is the amount of water loss in HHS?

≥ 250 mg/dL

glucose level in DKA and HHS

1. NS when admitted
2. when BG 200-150: switch to D5W + 1/2 NS
3. when UO verify → add potassium
4. when K is normal → add insulin to prevent risk of acidosis

what is the stepwise approach to DKA treatment?

reverse volume depletion

what is the first priority in DKA?

with potassium when pH < 7.0

when to add bicarb for patients with DKA?

100 mmol NaHCO3 with 20 meq K

bicarb dosing when pH < 6.9

50 mol NaHCO3 with 10 meq K

bicarb dosing when pH 6.9 - 7.0

1 -2g IV PRN

Mg dosing for DKA patients that have Mg depletion

insulin infusion

what is the treatment approach to hyperglycemia?

initial bolus: 0.1 unit/kg

infusion: 0.1 - 0.14 unit/kg/hr (5-10 units/hour)

how to dose insulin for hyperglycemia treatment?

false

true or false

\
when using insulin for hyperglycemia treatment, we want to look for fast, steady drop in glucose level of 50-75 mg/dl/hour

glucose 200-250 mg/dL

when to add D5W + 1/2 NS for hyperglycemia treatment?