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What is the different between Type 1 and type 2
type 1 is no insulin production, younger age of development, DKA (hypergly, <PH, >anion gap).
Type 2 insulin resistence, obesity, behavioral, Hyperosmolar hypergycem, older development, more complication
What are the way to DX
>126 fasting venous plasma 2 different occassions
>200 OGTT (75) 2-hour
Random glucose >200 with symptoms of hyperglycemia
What is impaired fasting glucose
fasting venous value 100-125
What polyuria, polydipsia, polyphagia
Classic triad of hyperglycemia
What is the ADA recommendation for BS
90-130 and less than 180 postprandial
How often for HGBa1c
- Every 6months if BS controlled
- Every 3 months if uncontrolled or change in therapy
What is IGT
- Impaired glucose tolerance is
- 140-199 after 2 hour OGTT
Blood pressure goal of DM
- BS 400-800
- High anion gap (higher=severity)
- >serum ketone bodies
- Fluid replacement (fluid loss 4-10L)=give NS the 1/2 NS
- insulin for reversal of ketogensis (IV infusion bolus of 10-15 units) 0.1U/KG/HR=when BS reaches 250 <0.05u/kg/hr
- Plasma glucose hrly
- Normal decrease of 50/75 mg/hr is normal. > is concerning.
what causes DKA
NO insulin so body breaks down fatty acid and increase ketone resulting in metabolic acidosis
How is electrolyte effected
- K due to acidosis = extracellular shift
Insulin will reverse this and cause hypokalemia
hypophosphatemia is common during acidosis=phospate infusion not required
Which antidiabetic does not cause weigt gain or hypoglycemia
Which antidiabetic is FDA approved for dm2 prevent
Elevation of insulin an c-peptide during fast
Symptoms of (adregenic or neuroglycopenia) + Hypogylcemia+rapid recovery of BS with replacement.
Hyperosmolar hyperglycemia treatment
mostly common caused by iratrogenic cause. Insulin and sulfonylureas most common medications
Clinical manfestation of severve (45) hypoglycemia
Catecholamine (tremor, sweating, palpations)
neuroglycopenia (confusion, irritability, H/A, seizure)
a inactive cleavage fragment of proinsulin in same amount as insulin.
- inappropriate insulin use causing hypoglycemia.
- dx by low c-peptid level and high lvl of circulating insulin.
Urune level of sulfonylurea