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59 Cards in this Set
- Front
- Back
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10 year old girl has 2 hour postprandial blood glucose of 300 and a large amount of glucose and ketones in her urine. She has lost 1 kg of weight
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Type 1 diabetes
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typical symptoms of type 1 diabetes
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polydipsia
polyuria polyphagia weight loss |
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vs type 2
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overweight
acanthosis nigrans PCOS otherwise probably pretty asx |
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common first initial symptom of diabetes in a kdi
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enuresis- you should test the urine for glucose in these patients
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tx for type 1
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they have an absolute insulin deficieny so they rquire complete replacement
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cause of type 1
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autoimmune attack on the pancreatic beta cells
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chronological presentation of type 1 vs 2
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type 1 tends to be more acute in its disease process
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more common manifestation of type 1
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DKA
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What HLA is common reason to develop type 1 diabetes?
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HLA DR3 and DR4
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family hx for type 1 importance?
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not that important- only 5% have a family member affected
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level of insulin that you see in type 2 diabetics
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increased, normal or decreased (when beta cel function is terrible)
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pathophys of type 2
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insulin resistance
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does ketoacidosis hppen with type 2?
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more rare- tend to think of the hyperosmolar hyperosmotic state
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classic antibodies for type 1 DM?
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anti- glutamic acid decarboxylase
anti islet cell insulin autoantibody |
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common ethnicities affected by T2DM?
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Asians
Latinos Native Americans |
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red flags for DKA
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vomiting
dehydration abdominal pain |
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What is the abrupt triad of symptoms for T1DM?
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polyuria
polydipsia polyphagia |
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Dx criteria for diabetes
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fasting blood glucose over 126
random BG over 200 WITH symptoms BG over 200 with 75 g oral glucose tolerance (not very good though) |
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When do we test children routinely for T2DM>
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when they are overweight or obese and have 2 or more risk factors
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What risk factors?
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obesity
family history race signs and symptoms of insulin resistance |
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tx of diabetes
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insulin
education diet and exercise oral hypoglycemics in type 2 |
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examples of some oral anti-hypoglycemics?
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metformin
sulfonylureas TZDs |
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a 3.5 year old boy is found unconscious with a flushed face, pulse 160, shallow breathing of 30/min, and BP 40/20 and a strange odor on his breath. he develops a seizure and his mucous membranes are dry. He has been asking for juice more recently, and has had a 5 lb weight loss.
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DKA
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What is the shallow breathing?
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Kussmaul breathing
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Why do they develop this shallow breathiing?
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as compensation for their metabolic acidosis- they are trying to blow off CO2
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Why would a patient develop a seizure like this?
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because DKA can predispose to CVAs commonly
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What level of hyperglycemia is common to DKA?
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over 200
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What level of ketonemia?
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over 3 mmol/L
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What pH?
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under 7.3
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bicarb level?
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under 15 mmol/L
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Why does a diabetic patient develop ketonemia?
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because secondary to their complete insulin deficiency, they have highly altered metabolism, leading to increased lipolysis. These fatty acids that get released are further metabolized to ketones through Beta oxidation
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Why would someone who has been in good glucose control develop DKA suddenly?
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because of infections, stress, trauma etc.
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signs and symptoms of DKA
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dehydration
polydipsia polyuria fatigue N/V* abdominal pain* tachycardia tachypnea |
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high or normal gap acidosis?
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high gap
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Why might you confuse DKa for an infection?
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because it shows leukocytosis as well
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Why do they develop potassium abnormalities with DKA?
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because of the shift of K due to acidosis- acidosis draws K out of the cells
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Good dx test for DKA>
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urinary ketones or glucose
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Tx for DKA?
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insulin
potassium fluid replacement glucose |
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What complication do we have to careful to avoid?
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if we pump them full of normal saline, then they can subsequently develop cerebral edema
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What is the upper limit for rehydrating these patients?
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do not exceed 4000 mL/m2/day
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What is the bolus rate for fluids in DKA?
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10 to 20 cc/kg/hr
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How much insulin?
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0.1 U/kg/hr
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What cellular compartment is primarily the source of dehydration>
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intracellular- in other words, they may not appear as clinically dehydrated as they actually are
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what type of K for these patients>
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half KCl
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Why give glucose?
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to avoid sending them into sudden hypoglycemia
you want to bring them down gradually |
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tx for cerebral edema
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confirm with a head Ct if they show lethargy/stupor or abnormal behavior/delirium
tx is to stop the fluids abruptly and give mannitol |
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2 hour old newborn has a plasma glucose of 20. The baby has a huge head and is LGA.
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hyperinsulinism secondary to gestational diabetes
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What causes these IDMs to be LGA?
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it's due to the hyperinsulinism causing abnormally high cellular growth
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Is this hyperinsulinism usually permanent?
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there are apparently some weird causes of permanent hyperinsulinemia due to gene defects in the K+ channel
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another more rare form of permanent hyperinsulinemia
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autosomal dominant muttions in glucokinase and glutamate dehydrogenase genes
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tx for infantile hyperinsulinism
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frequent feedings
IV glucose if necessary |
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What about prolonged, severe cases?
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diazoxide
somatostatin pancreatectomy |
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14 yo boy with an 8 year history of DM has had frequent admissions for DKA for the past 18 months. His school performance is deteriorating and has frequent episodes of hypoglycemia
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poorly controlled diabetes due to noncompliance
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Adolescents have a really hard time with compliance as diabetics. they often develop really high blood sugars at times becasue they miss insulin doses
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They can also try to catch up on insulin and end up with hypoglycemia.
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What is Mauriac syndrome?
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it's the hepatomegaly related to insulin noncompliance
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causes of hypoglycemia
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there are like 1000
hyperinsulinism in a baby Addison disease (due to inefficient gluconeogenesis) growth hormone deficiency (due to inadequate levels of IGF-1) defects in gluconeogenesis |
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GSDs
organic acidemias malnutrition, prematurity |
tumors
poisons/drugs systemic disease |
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What is a good tx plan for patients with hyperinsulinemia?
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subcu glucagon
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Tx for acute symptomatic hypoglycemia
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3 mL/kg D10W IV for ten minutes then 10% dextrose at 6 to 8 mg/kg/min
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