Aquifer case 6
Physician tasks for diabetes care:
1. Confirm the diagnosis and classify diabetes.
2. Evaluate for diabetes complications and potential comorbid conditions.
3. Review previous treatment and risk factor control in patients with established
diabetes.
4. Begin patient engagement in the formulation of a care management plan.
5. Develop a plan for continuing care.
Which of the following are common manifestations of end-organ damage caused by
Type 2 diabetes? Select all that apply.
A. Coronary heart disease
B. Cerebrovascular disease
C. Inflammatory bowel disease
D. Hyperthyroidism
E. Retinopathy
F. Neuropathy
G. Nephropathy
H. Primary pulmonary hypertension
A. Coronary heart disease
B. Cerebrovascular disease
E. Retinopathy
F. Neuropathy
G. Nephropathy
Which of the following statements are true regarding hyperosmolar hyperglycemic state
(HHS)? Select all that apply.
A. Metabolic acidosis is the primary disturbance.
B. Dehydration is a common finding.
C. Plasma glucose levels are commonly >600 mg/dL.
D. Ketones are absent or mildly elevated.
E. The mortality rate is extremely low.
B. Dehydration is a common finding.
C. Plasma glucose levels are commonly >600 mg/dL.
D. Ketones are absent or mildly elevated.
, Hyperosmolar Hyperglycemic State (HHS) vs Diabetic Ketoacidosis (DKA)
Mortality?
HHS: Increases with increasing age and serum osmolality. The average mortality rate in
many studies is 15%, but can be as high as 20-30% in the presence of significant
infection.
DKA: Mortality rate is roughly 2% for patients under 65 years old, but as high as 22% for
patients over 65 years old.
Hyperosmolar Hyperglycemic State (HHS) vs Diabetic Ketoacidosis (DKA)
Serum pH?
HHS: Not a metabolic acidosis. Serum pH is generally > 7.3, with a bicarbonate > 15
mEq/L (>15 mmol/L).
DKA: Metabolic gap acidosis associated with a pH <7.30.
Hyperosmolar Hyperglycemic State (HHS) vs Diabetic Ketoacidosis (DKA)
Plasma glucose?
HHS:Plasma glucose levels are usually >600 mg/dL.
Hyperosmolar Hyperglycemic State (HHS) vs Diabetic Ketoacidosis (DKA)
Ketones?
HHS: Ketones are absent or only mildly elevated because type 2 diabetes patients
usually have enough endogenous insulin to suppress or greatly limit ketogenesis.
DKA: Ketosis
Physical findings of HHS:
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