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what drugs can induce DM?
Thiazides, diuretics, steriods, phenytoin
What are the classical findings/symptoms of DM?
polydispsia, polyphagia, polyuria
What is the oral glucose test?
75g of glucose in 300ml of water after overnight fast. Positive for DM if above 200mg/dl at both 2 hours and at least one other time before the 2 hour mark.
What is the life of a RBC?
120 days, basically correlates with Hemoglobin A1c levels
What are the characteristic findings of ketoacidosis in the blood?
pH,7.2, hyperglycemia, hyperventilation, increase in anion gap, hyponatremia, hyperkalemia, increase in bun/cr ketones in blood and urine
How do you tx ketoacidosis?
- Fluids to restore intravascular volume
- Bicarb w/ shock or coma
- Monitor EKG
- Phosphate, because serum levels may be low
What is the glucose level of a nonketotic hyperglycemic coma?
- Lethargy, confusion, seizures, coma, dehydration, HTN, polyuria, polydipsia
What is infection greater with DM?
- Neuropathy, vascular problems, immunopathy
- Overall decrease in granulocytes and defective phagocyte ingestion
What is the whipples triad?
- Risk of hypoglycemia
- BS 40 mg/dl
- Immediate recurrence following admin of glucose
What is the somogyi phenomenon?
Hypoglycemia results in rebound hyperglycemia and may be due to secretioin of counter hormones such as glucagon and epinephrine
What is the major likely cause of Dm neuropathy?
Sorbitol pathway and schwann cell hyperosmolaity due to sorbitol excess.
What are the stages of DM charcot?
What if you are going to do a major surgery on a DM 1 or IDDM?
- Preop tests- EKG, UA, Chem 2, CBC, A1c
- If on oral hypoglycemics discontinue morning before surgery
- Well controlled with insulin take 1/2 the dose morning of.
How should you manage a DM during surgery?
- Pre-op start IV of 1000ml of 5% dextrose with 40 mEq/L of KCl run at about 100ml/hr
- Then decrease down to 80 ml/hr but monitor them with regular insulin coverage
When can they start their oral hypoglycemics again?
next day after surgery
What is a intermediate insulin?
NPH (Neutral protamine hagedorn)
What is Metformin?
Biguanide: Classified as a antihyperglycemic not a hypoglycemic
What is the MOA of Metformin?
- Decreases intestinal glucose uptake
- Increases peripheral glucose uptake
- Decreases hepatic glucose production
What is the does of Metformin?
What is the MOA of thiazolidinediones?
Increase target cell response in insulin
What is a combo therapy for DM tx?
Sulfonylureas, Metformin, Insulin