General
3 P's of DM
polyuria, polydipsia, polyphagia
which is more life-threatening between DKA and HHS
HHS
which DM patients can be in HHS
only type II
what medicine do you hold before and after IV contrast, it's also contraindicated in severe renal disease
metformin
what's the order for mixing regular and NPH
clear then cloudy
give an example of a macrovascular complication
cardiovascular disease, peripheral disease, cerebrovascular disease
is the glucose level high or low in DKA
high
BG minimum of a patient in HHS
600
which medicine has a BBW for heart failure
pioglitazone
what's the onset, peak, and duration of rapid acting insulin
onset: 10-30 mins
peak: 30 mins-3 hrs
duration: 3-5 hrs
continue to take insulin, drink glucose containing beverages if can't eat, check BG every 4 hrs, check for ketones in urine when BG >240
BG minimum of a patient in DKA
250
treatment for HHS
same as DKA (fluids, IV insulin, monitor/correct electrolytes) except needs more fluid replacement
50% dextrose
which insulin can you give continuous IV
regular insulin
explain the difference between dawn and somogyi effect
dawn: BG rises as sun rises
somogyi: boomerang effect, hypoglycemic period at night causes a rebound hyperglycemic period in the morning
treatment for DKA (3 steps)
1. fluids
2. IV insulin
3. monitor/correct electrolytes (K+)
pathophysiology of HHS
just enough insulin available to avoid ketoacidosis but extreme hyperglycemia still occurs
how does acarbose work
slows down the absorption of carbs
name a long-acting insulin
GLARGINE, detemir, degludec
4 methods of DM diagnosis
1. A1C ≥ 6.5%
2. fasting glucose > 126
3. random glucose ≥ 200 plus symptoms
4. two-hour OGTT level ≥ 200
pathophysiology of DKA
cells start metabolizing fat instead of glucose, creating ketones as a byproduct (ketosis) and lowering pH (acidosis)
what does HHS stand for
hyperosmolar hyperglycemic syndrome
meal education for patient taking glipizide/glimeperide
take 15-30 mins before a meal, don't skip meals
peak for long acting insulin
there is none