Chronic disorder of impaired glucose metabolism due to insulin deficiency/resistance → hyperglycemia.

1 Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency. Requires insulin. 2 Insulin resistance & relative insulin deficiency. lifestyle and diet oral/insulin

Hormone that lowers blood glucose: facilitates cellular glucose uptake, inhibits gluconeogenesis.

Polyuria (osmotic diuresis), Polydipsia (thirst), Polyphagia (cell starvation). Weight loss in T1DM.

3 P's, fatigue, blurred vision, headaches, slow healing, recurrent infections; Shakiness, sweating, tachycardia, hunger, confusion, irritability, seizures, coma (<70 mg/dL).

Diabetic Ketoacidosis

Life-threatening complication of T1DM: hyperglycemia, ketosis, metabolic acidosis. 3 P's, Kussmaul respirations, fruity breath, N/V, abdominal pain, altered LOC, dehydration.

Blood glucose >250, arterial pH 12.

IV fluids (1st), IV regular insulin drip, electrolyte replacement (K+), monitor for cerebral edema.

Hyperosmolar Hyperglycemic State

Life-threatening in T2DM: extreme hyperglycemia (>600), dehydration, no ketosis.

Severe dehydration, altered LOC, neurological signs, polyuria, polydipsia. Higher mortality than DKA.

Aggressive IV fluid resuscitation, insulin drip, electrolyte replacement. Correct underlying cause.

Metformin First-line for T2DM. Decreases hepatic glucose production. SE: GI upset, lactic acidosis (rare). Sulfonylureas insulin secretors: Hypoglecemia weight gain

Self-monitoring of blood glucose. Fasting goal 80-130 mg/dL. Postprandial <180 mg/dL. A1C <7%.

Glycated hemoglobin. Reflects avg blood glucose over 2-3 months. Goal <7% for most diabetics.

Nerve damage from chronic hyperglycemia. Peripheral (numbness, pain), autonomic (gastroparesis).

Microvascular damage to retinal blood vessels. Leading cause of blindness. Yearly eye exams.

Kidney damage from hyperglycemia/HTN. Leading cause of ESRD. Monitor urine microalbumin.

Daily inspection, proper footwear, avoid barefoot, moisturize (not between toes), prevent injury.

Continue insulin/meds, monitor BG/q4h, check for ketones if BG >240, stay hydrated, contact MD.

Consume 15g fast-acting carb (juice), recheck BG in 15 min, repeat if <70.

Morning hyperglycemia from nocturnal growth hormone release. Manage with adjusted evening insulin.

Rebound morning hyperglycemia from nighttime hypoglycemia. Manage with bedtime snack/reduced insulin.

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Diabetes

Question	Answer
Diabetes Mellitus	Chronic disorder of impaired glucose metabolism due to insulin deficiency/resistance → hyperglycemia.
Types	1 Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency. Requires insulin. 2 Insulin resistance & relative insulin deficiency. lifestyle and diet oral/insulin
Insulin Function	Hormone that lowers blood glucose: facilitates cellular glucose uptake, inhibits gluconeogenesis.
DM Sx: 3 P's	Polyuria (osmotic diuresis), Polydipsia (thirst), Polyphagia (cell starvation). Weight loss in T1DM.
Hyperglycemia Hypo	3 P's, fatigue, blurred vision, headaches, slow healing, recurrent infections; Shakiness, sweating, tachycardia, hunger, confusion, irritability, seizures, coma (<70 mg/dL).
Diabetic Ketoacidosis	Life-threatening complication of T1DM: hyperglycemia, ketosis, metabolic acidosis. 3 P's, Kussmaul respirations, fruity breath, N/V, abdominal pain, altered LOC, dehydration.
DKA Labs	Blood glucose >250, arterial pH <7.3, serum bicarb <18, ketonemia/ketonuria, anion gap >12.
DKA Treatment	IV fluids (1st), IV regular insulin drip, electrolyte replacement (K+), monitor for cerebral edema.
Hyperosmolar Hyperglycemic State	Life-threatening in T2DM: extreme hyperglycemia (>600), dehydration, no ketosis.
HHS Sx	Severe dehydration, altered LOC, neurological signs, polyuria, polydipsia. Higher mortality than DKA.
HHS Treatment	Aggressive IV fluid resuscitation, insulin drip, electrolyte replacement. Correct underlying cause.
Oral Antidiabetics	Metformin First-line for T2DM. Decreases hepatic glucose production. SE: GI upset, lactic acidosis (rare). Sulfonylureas insulin secretors: Hypoglecemia weight gain
SMBG	Self-monitoring of blood glucose. Fasting goal 80-130 mg/dL. Postprandial <180 mg/dL. A1C <7%.
A1C Test	Glycated hemoglobin. Reflects avg blood glucose over 2-3 months. Goal <7% for most diabetics.
Diabetic Neuropathy	Nerve damage from chronic hyperglycemia. Peripheral (numbness, pain), autonomic (gastroparesis).
Diabetic Retinopathy	Microvascular damage to retinal blood vessels. Leading cause of blindness. Yearly eye exams.
Diabetic Nephropathy	Kidney damage from hyperglycemia/HTN. Leading cause of ESRD. Monitor urine microalbumin.
Diabetic Foot Care	Daily inspection, proper footwear, avoid barefoot, moisturize (not between toes), prevent injury.
Sick Day Rules	Continue insulin/meds, monitor BG/q4h, check for ketones if BG >240, stay hydrated, contact MD.
15 Rule Hypoglycemia	Consume 15g fast-acting carb (juice), recheck BG in 15 min, repeat if <70.
Dawn Phenomenon	Morning hyperglycemia from nocturnal growth hormone release. Manage with adjusted evening insulin.
Somogyi Effect	Rebound morning hyperglycemia from nighttime hypoglycemia. Manage with bedtime snack/reduced insulin.

Created by: Wasurenboh

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