Diabetes

• Diabetes is characterized by hyperglycemia and abnormal insulin production.
• In type 1 diabetes person cannot produce insulin while in type 2 diabetes, there is abnormal absorption of insulin
• Prediabetes

  • OGTT 2hr is 140-199
  • Fasting glucose is 100-125
  • Person is asymptomatic and needs hgbA1c screening and lifestyle changes
• Clinical manifestations of diabetes are polydipsia, polyphagia, polyuria, prolonged wound healing, visual problems
• Insulin Therapy

  • Rapid Acting insulin (aspart, lispro): onset (10-30 minutes); peak (1 hour); duration (3-5 hours)
  • Short Acting Insulin (Regular): onset (30 minutes - 1 hour); peak (2-3 hours); duration (5-8 hours)
  • Intermediate (NPH): onset (1.5-4 hours); peak (4-12 hours); duration (12-18 hours)
  • Long-Acting Insulin (glargine, degludec, detemir): onset (45 minutes - 4 hours); peak (no peak); duration (16-24 hours)
• Oral Diabetic Medication

  • Metglinides: Take before eating; SE's causes weight gain
  • Biguanides: (Ex: metformin) SE's causes lactic acidosis. Do not use 1-2 days before and after dye study
  • Sulfonuryeas: (Ex: glipizide, glyburide) Take 30 minutes before meals. SE's weight gain, hypoglycemia
  • A Glucosidase Inhibitor (Ex: acarbose, migitol) Take with the first bite of food. SE's causes GI distress
• When blood sugar is >250, person has DKA. This happens mostly in patients with Type 1 diabetes
• Signs of DKA include sweet fruity breath due to ketones, Kussmaul respirations, tachycardia, dehydration, fever
• When blood sugar is >600, person has HHS. THis happens mostly in patient with Typer 2 diabtes
• Signs of HHS include dehydration, fever, tachycardia, coma, seizures, hemiparesis
• Treatment for DKA and HHS

  • ensure patent airway first
  • Give IVF until urine output is 0.3mL/hr
  • Correct electrolyte imbalance
  • Give short acting insulin
• Signs of hypoglycemia include cold clammy skin, tremors, neuroglycopenia, tachycardia, coma, and headache
• Check blood sugar every 3-4 hours when you have acute illness and drink noncaloric fluids
• Acanthosis nigricans is light brown thickening of the skin in the neck and armpit
• Treatment of neuropathy includes using medications such as antidepressants and pregabalin