Diabetic Ketoacidosis and Treatment
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Diabetic Ketoacidosis and Treatment

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Questions and Answers

What is the recommended frequency of A1C measurement for patients achieving treatment goals on a stable regimen?

  • Annually
  • Every three months
  • At least twice a year (correct)
  • Once a month

    • When should an initial dilated eye exam be conducted for patients with type 1 diabetes?

  • At diagnosis
  • Annually starting at diagnosis
  • Within the first year of diagnosis
  • In the first 5 years after diagnosis (correct)

    • What is the purpose of screening for nephropathy with urine microalbumin in diabetic patients?

  • To detect early signs of kidney damage (correct)
  • To assess eye health
  • To check for foot complications
  • To evaluate blood pressure control

    • At what point should a patient with type 2 diabetes undergo screening for pedal sensory loss?

    <p>Annually using a 10-g force monofilament</p> Signup and view all the answers

    What is the recommended annual assessment for patients with type 1 diabetes for at least five years after diagnosis?

    <p>Urinary albumin and eGFR</p> Signup and view all the answers

    What is the most common initial precipitating factor for diabetic ketoacidosis in type 1 diabetes patients?

    <p>Omitting insulin</p> Signup and view all the answers

    Which of the following laboratory values is NOT a hallmark of diabetic ketoacidosis?

    <p>Hypoglycemia</p> Signup and view all the answers

    Which of the following treatments is NOT part of the cornerstones of therapy for diabetic ketoacidosis?

    <p>Immediate dialysis</p> Signup and view all the answers

    In the management of nephropathy in diabetic patients, which class of medications is known to be effective in preventing progression of renal disease?

    <p>ACE inhibitors</p> Signup and view all the answers

    Which therapeutic intervention is recommended for all patients with established cardiovascular disease?

    <p>Statin therapy</p> Signup and view all the answers

    What is the recommended blood pressure goal for patients with diabetes?

    <p>Less than 130/80 mm Hg</p> Signup and view all the answers

    Which of the following is a common early symptom of marked hyperglycemia?

    <p>Nausea</p> Signup and view all the answers

    Which of the following does not contribute to coronary heart disease risk in diabetic patients?

    <p>Smoking cessation</p> Signup and view all the answers

    Study Notes

    Diabetic Ketoacidosis (DKA)

    • DKA is a serious medical emergency that can occur in people with type 1 diabetes and is often triggered by lack of insulin or illness.
    • Common causes of DKA: infection, noncompliance with insulin therapy, new-onset diabetes, myocardial ischemia.
    • DKA features: Hyperglycemia, anion gap acidosis, high levels of ketones in blood and urine.
    • Early symptoms of DKA: nausea, vomiting, abdominal pain, hyperventilation, polyuria, polydipsia, weight loss.
    • As DKA progresses, neurologic symptoms may appear including lethargy, seizures, and coma.
    • DKA requires immediate medical attention and treatment focuses on restoring fluid balance, electrolyte levels, and blood sugar using insulin.
    • Patients with DKA often have large fluid deficits, sodium and potassium imbalances.

    Treatment of Complications

    • Nephropathy: Glucose and blood pressure control are essential to prevent and slow progression of kidney disease. ACE inhibitors and ARBs are effective in preventing progression of renal disease.
    • Coronary Heart Disease: Multiple risk factor intervention, including treatment of dyslipidemia, hypertension, smoking cessation, and antiplatelet therapy reduces macrovascular events. Aspirin is recommended for patients with CVD. Clopidogrel can be used for aspirin-allergic patients.
    • Dyslipidemia: Statin therapy is recommended for patients with or without CVD, especially those over 40 or with other CVD risk factors.
    • Hypertension: The American Diabetes Association recommends a blood pressure goal of less than 130/80 mmHg for patients with diabetes. ACE inhibitors and ARBs are the first-line agents for hypertension. Diuretics and calcium channel blockers are useful secondary agents.

    Evaluating Therapeutic Outcomes

    • Measure A1C at least twice a year to monitor long-term glycemic control.
    • Document any hypoglycemic episodes requiring assistance.
    • Screen for Complications:
      • Annual dilated eye exams for type 2 diabetes and an initial exam within 5 years of diagnosis for type 1 diabetes.
      • Assess blood pressure at each visit.
      • Examine feet at each visit, checking for skin integrity, calluses, and deformities.
      • Screen for pedal sensory loss annually using a 10-g monofilament.
      • Screen for nephropathy with urine microalbumin at the time of diagnosis for type 2 diabetes and 5 years after diagnosis for type 1 diabetes.
      • Annual assessment of urinary albumin and eGFR for all patients with type 2 diabetes and for patients with type 1 diabetes for at least 5 years.
      • Annual fasting lipid panel if the patient is on lipid-lowering therapy.

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    Description

    This quiz covers the critical aspects of Diabetic Ketoacidosis (DKA), including its causes, symptoms, and the necessary treatment protocols. It also addresses the complications related to DKA, such as nephropathy, and emphasizes the importance of glucose and blood pressure control. Test your knowledge on this medical emergency and its management.

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