Diabetic Ketoacidosis (DKA) Quiz

Study Notes

DKA is a medical emergency, particularly common in type 1 diabetes.
DKA is often triggered by missed insulin doses, illness, or infection.
DKA patients may present with varying levels of consciousness, from alert to stuporous or comatose.
Key diagnostic markers include high blood sugar (hyperglycemia), acidic blood (anion gap acidosis), and high ketone levels in blood or urine.
DKA symptoms often develop quickly over 24 hours and include:
- Nausea, vomiting, abdominal pain
- Rapid breathing (hyperventilation)
- Excessive urination (polyuria)
- Excessive thirst (polydipsia)
- Weight loss
- Lethargy, seizures, coma (in severe cases)
DKA treatment focuses on:
- Restoring fluid volume with intravenous saline solution
- Replacing electrolytes, especially potassium
- Administering insulin through a continuous IV infusion to correct metabolic imbalances

Nephropathy (Kidney Disease):
- Good blood sugar and blood pressure control are crucial for preventing or slowing kidney damage.
- Medications like ACE inhibitors and ARBs can help protect the kidneys.
Coronary Heart Disease (CHD):
- Multiple risk factor management including:
  - Controlling cholesterol and blood pressure
  - Smoking cessation
  - Antiplatelet therapy (aspirin or clopidogrel)
- Reduce the risk of heart attacks and strokes.
Dyslipidemia (High Cholesterol):
- Statins are recommended for all patients with CHD or those over 40 with diabetes and other risk factors, regardless of cholesterol levels.
Hypertension (High Blood Pressure):
- Target blood pressure for diabetic patients: less than 130/80 mm Hg
- ACE inhibitors and ARBs are recommended as first-line treatment.
- Other medications like diuretics and calcium channel blockers might be needed.

Long-Term Glycemic Control:
- Measure HbA1c (glycosylated hemoglobin) at least twice a year to assess average blood sugar levels over the past 3 months.
- In patients with stable blood sugar control and no changes in treatment.
Hypoglycemia Monitoring:
- For type 1 diabetes patients, inquire about frequency and severity of low blood sugar episodes at each visit.
- Document any episodes requiring assistance or medical attention.
- Take steps to prevent future episodes.

Eye Exams:
- Annual dilated eye exams recommended for type 2 diabetes.
- Initial exam within the first 5 years of diagnosis for type 1 diabetes followed by annual exams.
Blood Pressure (BP):
- Check BP at every visit.
Foot Exams:
- Examine feet at each visit for:
  - Distal pulses
  - Skin integrity
  - Calluses
  - Deformities
Foot Sensation:
- Annual screening for foot sensory loss using a 10-g monofilament.
Nephropathy Screening:
- Urine microalbumin testing recommended at diagnosis for type 2 diabetes and 5 years after diagnosis for type 1 diabetes.
- Assess urinary albumin, creatinine ratio, and estimated glomerular filtration rate (eGFR) at least once a year for both type 1 and type 2 diabetes.
Lipid Panel:
- Annual fasting lipid panel for patients on lipid-lowering therapy.

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