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excessive hepatic glucose production, rebound hyperglycemia, dawn phenomena -
Answer✅✅reasons for AM hyperglycemia
Rebound hyperglycemia (Somogyi effect) - Answer✅✅hypoglycemia during sleep
protease inhibitors (HIV treatment), corticosteroids, thiazide diuretics, calcineurin
inhibitors (anti-rejection meds), fluoroquinolone antibiotics, beta-blockers, atypical
antipsychotics - Answer✅✅medications associated with hyperglycemia
Atenolol/metroprolol/propranolol - Answer✅✅beta blockers
beta blockers - Answer✅✅decrease heart rate and dilate arteries by blocking beta
receptors; used for CVD and high BP
Hyperglycemic Hyperosmolar State (HHS) - Answer✅✅severe dehydration, usually
with older adults with comorbidities, relative insulin deprivation
Diabetic Ketoacidosis (DKA) - Answer✅✅absolute insulin depravation
, characteristics of HHS - Answer✅✅usually >60 years old, >5 days symptoms,
glucose >600, beta hydroxybutyrate <3, urine ketones <2, ph normal, bicarb more
than 18, serum osmolality 300+, usually type 2, 10-20% mortality
causes of HHS - Answer✅✅massive fluid loss from osmotic diuresis (burns,
hyperglycemia, diarrhea, hemodialysis, diurectics, steroids), heart attack, infections,
hypertonic feedings, medications
HHS - Answer✅✅hyperosmolar hyperglycemic state
clinical signs of HHS - Answer✅✅polydipsia, polyuria, weakness, wt loss,
hypothermia, hypotension, tachycardia, altered sensorium
treatment for HHS - Answer✅✅labs (especially K+), rehydrate, correct glucose
(insulin), correct lytes
resolution of HHS - Answer✅✅pH 7.3+, bicarb 18+, glucose less than 250,
osmolality less than 300, urine output .5mg/kg/hr, improved cognition
DKA and hyperglycemic crisis - Answer✅✅type 1 in youth, highest in persons <45,
often a cry for help
DKA - Answer✅✅profound insulin deficiency; accounts for 14% of all hospital
admits for T1; in young people accounts for 50% all admits; 16% DM related fatalities;
incidence ~2 episodes per 100 pt years of DM
DKA precipitating factors - Answer✅✅40% illness and infection; 25% inadequate
insulin dosage; emotional stress (especially with teens, neglect, mismanagement);
disordered eating; pregnancy; hyperglycemia inducing meds; insulin omission (fear
of hypo or wt gain); stress; can't afford insulin; drug use
DKA labs/presentation - Answer✅✅glucose 200+, osmolality 300+, dehydration,
ph<7.3, beta-hydoxybutyrate (3 mmol/L+), 2+ ketones in urine, bicarb less than 18
DKA clinical signs - Answer✅✅polydipsia, polyuria, weakness, wt loss, N/V/abd pain,
ileus, kussmaul breathing, acetone breath, hypothermia, tachypnea, tachycardia,
altered sensorium
SGLT-2 inhibitor - Answer✅✅when combined with insulin, what med increases risk
of DKA in T1DM and T2DM?
SGLT-2 inhibitor meds - Answer✅✅farxiga, jardiance, steglatro, brenzavvy,
invokana
Euglycemic diabetic ketoacidosis - Answer✅✅BG 200+, uncommon complication
associated with surgery, pregnancy, anorexia, gastroparesis, fasting, alcohol use
disorder, SGLT-2 inhibitors, pancreatitis, surgery, infection, cirrhosis
Questions with 100% Correct Clear
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excessive hepatic glucose production, rebound hyperglycemia, dawn phenomena -
Answer✅✅reasons for AM hyperglycemia
Rebound hyperglycemia (Somogyi effect) - Answer✅✅hypoglycemia during sleep
protease inhibitors (HIV treatment), corticosteroids, thiazide diuretics, calcineurin
inhibitors (anti-rejection meds), fluoroquinolone antibiotics, beta-blockers, atypical
antipsychotics - Answer✅✅medications associated with hyperglycemia
Atenolol/metroprolol/propranolol - Answer✅✅beta blockers
beta blockers - Answer✅✅decrease heart rate and dilate arteries by blocking beta
receptors; used for CVD and high BP
Hyperglycemic Hyperosmolar State (HHS) - Answer✅✅severe dehydration, usually
with older adults with comorbidities, relative insulin deprivation
Diabetic Ketoacidosis (DKA) - Answer✅✅absolute insulin depravation
, characteristics of HHS - Answer✅✅usually >60 years old, >5 days symptoms,
glucose >600, beta hydroxybutyrate <3, urine ketones <2, ph normal, bicarb more
than 18, serum osmolality 300+, usually type 2, 10-20% mortality
causes of HHS - Answer✅✅massive fluid loss from osmotic diuresis (burns,
hyperglycemia, diarrhea, hemodialysis, diurectics, steroids), heart attack, infections,
hypertonic feedings, medications
HHS - Answer✅✅hyperosmolar hyperglycemic state
clinical signs of HHS - Answer✅✅polydipsia, polyuria, weakness, wt loss,
hypothermia, hypotension, tachycardia, altered sensorium
treatment for HHS - Answer✅✅labs (especially K+), rehydrate, correct glucose
(insulin), correct lytes
resolution of HHS - Answer✅✅pH 7.3+, bicarb 18+, glucose less than 250,
osmolality less than 300, urine output .5mg/kg/hr, improved cognition
DKA and hyperglycemic crisis - Answer✅✅type 1 in youth, highest in persons <45,
often a cry for help
DKA - Answer✅✅profound insulin deficiency; accounts for 14% of all hospital
admits for T1; in young people accounts for 50% all admits; 16% DM related fatalities;
incidence ~2 episodes per 100 pt years of DM
DKA precipitating factors - Answer✅✅40% illness and infection; 25% inadequate
insulin dosage; emotional stress (especially with teens, neglect, mismanagement);
disordered eating; pregnancy; hyperglycemia inducing meds; insulin omission (fear
of hypo or wt gain); stress; can't afford insulin; drug use
DKA labs/presentation - Answer✅✅glucose 200+, osmolality 300+, dehydration,
ph<7.3, beta-hydoxybutyrate (3 mmol/L+), 2+ ketones in urine, bicarb less than 18
DKA clinical signs - Answer✅✅polydipsia, polyuria, weakness, wt loss, N/V/abd pain,
ileus, kussmaul breathing, acetone breath, hypothermia, tachypnea, tachycardia,
altered sensorium
SGLT-2 inhibitor - Answer✅✅when combined with insulin, what med increases risk
of DKA in T1DM and T2DM?
SGLT-2 inhibitor meds - Answer✅✅farxiga, jardiance, steglatro, brenzavvy,
invokana
Euglycemic diabetic ketoacidosis - Answer✅✅BG 200+, uncommon complication
associated with surgery, pregnancy, anorexia, gastroparesis, fasting, alcohol use
disorder, SGLT-2 inhibitors, pancreatitis, surgery, infection, cirrhosis
