DKA & HHS Crisis
In the management of DKA, insulin should be withheld or delayed if the serum potassium level is below this value.
What is 3.3 mEq/L?
This long-acting insulin analog provides a peakless profile for up to 42 hours, but in the inpatient setting its long half-life makes it difficult to titrate quickly.
What is Insulin Degludec/Tresiba?
A 65-year-old with T2D is admitted for a hip fracture. He is NPO for surgery tomorrow. His home regimen is Metformin and Glargine 30 units. Your order: Hold Metformin and give this many units of Glargine tonight.
What is 24 units (or 80% of the home dose)?
SGLT2 inhibitors lower blood sugar by inhibiting reabsorption in this specific part of the nephron.
What is the Proximal Tubule?
You should advise a patient starting an SGLT2i that they may experience an increase in this, particularly if they have a history of UTIs.
What is mycotic genital infections/yeast infections?
This clinical calculation, representing the difference between unmeasured anions and cations, must be "closed" before transitioning a patient from IV to SQ insulin in DKA.
What is the Anion Gap?
To calculate a patient's Correction Factor (sensitivity factor) using the "Rule of 1800", you divide 1800 by this number.
What is the Total Daily Dose (TDD) of insulin?
A patient with DKA has a BG of 210 mg/dL, but their anion gap is still 18. To continue the insulin drip without causing hypoglycemia, you should add this to their IV fluids.
What is 5% dextrose?
The landmark trial for Empagliflozin was the first to demonstrate a significant reduction in cardiovascular death and HF hospitalizations in T2D.
What is the EMPA-REG OUTCOME trial?
For T2D patient with HFrEF, an SGLT2i is now considered this "pillar" of GDMT, regardless of their baseline A1C.
What is Foundation/First-line therapy?
This laboratory parameter is the primary differentiator between HHS and DKA, typically exceeding 320 mOsm/kg in the former.
What is the serum osmolality?
When a patient is NPO, the basal insulin dose should typically be reduced by this percentage to prevent hypoglycemia while still suppressing ketogenesis.
What is 20% to 50%?
An elderly patient is admitted with urosepsis and a BG of 550 mg/dL. They are alert, have no ketones, and a serum osmolality of 330 mOsm/kg. This is the most likely diagnosis.
What is HHS?
SGLT2i therapy causes a "favorable" reduction in intraglomerular pressure by restoring this physiologic feedback mechanism.
What is Tubuloglomerular Feedback?
When initiating a GLP-1 RA, the most common reason for patient discontinuation that providers must counsel on is this?
What is N/V?
When blood glucose reaches 200 mg/dL in DKA, the IV fluid should be changed to 5% dextrose with 0.45% saline to allow for the continued administration of this.
What is insulin, to resolve the ketosis?
This rapid-acting insulin analog, formulated with niacinamide for faster absorption, has an onset of action approximately 5 minutes faster than standard aspart.
What is Fiasp/Faster-acting insulin aspart?
A patient on your floor is receiving Q6H bolus tube feeds. To best match their nutritional intake, you order this type of insulin to be given at the start of each feed.
What is Regular Insulin?
In the inpatient setting, SGLT2i must be held if a patient develops this condition, defined by systemic inflammation and potential for hypovolemia.
What is Sepsis or Critical Illness?
If a patient's eGFR drops below this level, the ADA recommends continuing an SGLT2i for renal protection, even if the glycemic benefit is diminished.
What is 20-30 mL/min/1.73m^2?
This rare but "not-to-be-missed" complication of overly rapid fluid resuscitation in DKA occurs more frequently in pediatric patients but can occur in young adults.
What is cerebral edema?
The "1500 Rule" is used similarly to the 1800 Rule, but specifically for patients using this older type of insulin.
What is Regular Insulin?
Your patietn with T1D has been on an insulin drip for 24 hours. The gap is closed and they are eating. Their drip rate has been stabel at 2 units /hr. You calculate their new 24-hour SQ basal dose based on this drip rate.
What is 38-40 units (80% of the 48-unit TDD)?
This rare but life-threatening soft tissue infection of the perineum has been associated with SGLT2i use in FDA safety communications.
What is Fournier's Gangrene?
This specific GIP/GLP-1 agonist has shown significant benefit in clinical trials for treating this liver condition, recently named MASH.
What is Metabolic Dysfunction-Associated Steatohepatitis?