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Criteria for a diagnosis of diabetes
- Fasting glucose over 126, measured on 2 separate occasions
- Random glucose over 200
- HbA1c over 6.5% on two separate occasions
Treatments goals for diabetes
- Postprandial glucose under 180 mg/dL
- Fasting glucose between 70-130 mg/dL
- HbA1c under 7% (HbA1c is approximately equal to 20x the average glucose level over the past 3 months)
Two most common causes of DKA
Common presenting symptoms of diabetes
- Polyuria, polydipsia, polyphagia
- Candidal infection
- Blurry vision
What is diabetic gastroparesis, and how is it treated?
- Impaired autonomic NS prevents the stomach from emptying properly after meals, leading to early satiety, nausea, and vomiting
- Treat with motolity agents like metoclopramide
Timeframe of NPH
- Starts to work in 1--1.5 hours
- Peaks at 6--8 hours
- Total duration of 12--20 hours
What is the Somogyi effect?
- A physiological reaction to hypoglycemia that typically occurs in diabetics whose insulin doses are too high
- Hypoglycemia triggers release of stress hormones such as cortisol and glucagon that raise blood sugar
- Patients present with high 7 AM glucose; management is to reduce nighttime insulin dose
What is the dawn phenomenon?
- Early morning hyperglycemia, due to physiologic morning release of GH
- Unlike in the Somogyi effect, where 3 AM glucose is low, in the dawn phenomenon, 3 AM glucose will be normal or high
- Treat by increasing evening insulin dose (unlike Somogyi, where you decrease the evening dose)
How should the insulin dose of a diabetic be adjusted if the patient is NPO before surgery?
- Give 1/3--1/2 the normal dose
- Monitor glucose
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