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Endocrine > 1(E) T1DM, DKA > Flashcards

1(E) T1DM, DKA Flashcards

1
Q

What is T1DM

A

Autoimmune disease caused by destruction B-islet cells of the pancreas

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2
Q

What is Latent autoimmune diabetes of adults (LADA)

A

Autoimmune T1DM - that onsets during adulthood

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3
Q

When does T1DM usually onset

A

Adolescence

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4
Q

What are peak ages of onset of T1DM

A

4-6 years-old

10-14 years-old

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5
Q

What two genes are associated with T1DM

A

HLA DR3

HLA DR4

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6
Q

What is a risk factor for T1DM

A

FH

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7
Q

What autoimmune diseases is T1DM associated with

A
  • Coeliac
  • Addison’s
  • Hashimoto’s thyroiditis
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8
Q

What may be the first manifestation of T1DM

A

DKA

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9
Q

How else can T1DM present

A 
Polyuria 
Polydipsia 
Weight loss
Lethargy 
Poor wound healing 
Pruritus
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10
Q

What % of B-islet cells have to be destroyed to cause T1DM

A

80%

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11
Q

In T1DM, what investigation is first-line

A

Random plasma glucose

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12
Q

What random plasma glucose is diagnostic of T1DM

A

> 11

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13
Q

When can T1DM be diagnosed clinically

A

Hyperglycaemia and one of:

  • Rapid weight loss
  • BMI <20
  • Ketosis
  • Personal or FH autoimmune disease
  • Onset <50y
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14
Q

When is c-peptide offered

A

If suspect T1DM but has atypical features

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15
Q

What are atypical features that may warrant C-peptide

A

> 50
BMI >25
Slow evolution
Long prodrome

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16
Q

What monitoring is done in T1DM

A

HbA1c every 3-6 months

Capillary blood glucose QDS

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17
Q

What capillary blood glucose is expected after meals

A

5-9 mmol/mol

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18
Q

What HbA1c is aimed for

A

<48 (6.5%)

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19
Q

In paediatrics, if you suspect a child has T1DM what should be done

A

Same day referral to paediatric MDT to confirm diagnosis

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20
Q

In adults, what conservative measures are indicated for adults

A

Education - carbohydrate training

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21
Q

in adults, what is used to treat T1DM

A

Insulin

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22
Q

what insulin regimen is preferred in adults

A

Multiple daily injection basal-bolus regimen. Opposed to BD mixed-insulin

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23
Q

what are long-acting insulins offered in T1DM

A
  • Insulins glargine

- Insulin detemir

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24
Q

what is insulin detemir known as

A

Levemir

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25
what is insulin glargine known as
Lantus
26
when is rapid acting insulin given in T1DM
before meals
27
what is a rapid acting insulin
actarapid
28
what conservative measures are offered to young people with T1DM
- Education - Blood glucose monitoring - Support groups - Annual influenza vaccine - Dietician: advice about foods with low glycemic index - Exercise
29
how often should children attend diabetes clinic
four times per-year
30
how often should children have eye-exams in T1DM
2-yearly
31
what is first line insulin regimen for children tis T1DM
multiple daily basal-bolus insulin regimens
32
what is the multiple daily basal-bolus injection regimen
- short-acting before meals | - long-acting once daily
33
what is second-line for children with T1DM
continuous SC insulin infusion pump
34
Explain sick day rules in T1DM
- Increase monitoring BG (4-hrly) - Continue taking medications - 3L fluid in 24-hours
35
What fluid intake is aimed for
3L in 24h
36
Why are oral hypoglycaemic continued
as illness increases cortisol levels which can cause hyperglycaemia
37
When is metformin only stopped in diabetes
If severely dehydrated - as can worsen renal function
38
What is main complication of T1DM
DKA
39
How can complications of DM be divided
Microvascular | Macrovascular
40
What are the 4 microvascular complications of T1DM
- Diabetic retinopathy - Diabetic neuropathy - Diabetic nephropathy - Diabetic foot
41
What defines diabetic nephropathy
A:Cr >3
42
What screening is in place for diabetic retinopathy
Annual retinopathy screen
43
What is required to prevent diabetic neuropathy
Regular podiatry appointments for diabetic foot
44
What are 2 macrovascular complication of T1DM
CHD | PAD
45
What is given to prevent CHD
Statin (20mg)
46
How does DKA present
- Abdominal pain - Vomiting - Drowsiness - Coma - Kussmaul hyperventilation - Acetone-breathe
47
What is Kussmaul hyperventilation
Deep breathing pattern associated with metabolic acidosis
48
When should blood glucose always be checked
Anyone with abdominal pain and vomitting
49
Explain DKA
- Insulins deficiency causes uninhibited glycogenlysis, gluconeogenesis and lipolysis - As cells cannot take up glucose - it leads to starvation like state which encourages ketogenesis. FFA of lipolysis are used in ketogenesis.
50
What are the 3 general aspects required for diagnosis of DKA
- Acidosis - Ketosis - Hyperglycaemia
51
What is requirement for acidosis
VBG pH <7.3 HCO3- <15
52
What is requirement for hyperglycaemia
Blood glucose >11
53
What is requirement for ketosis
Serum ketones >3 | Or, significant ketonuria (>2)
54
What are 9 criteria when you should consider sending DKA patient straight to ITU
1. Ketone >6 2. Bicarbonate <5 3. pH <7 4. K <3.5 5. GCS <12 6. SpO2 <92% 7. Systolic BP <90 8. Pulse > 100 or <60 9. Anion gap >16
55
What is first-line management for DKA
0.9% Saline (Start with 1L over 1h) ( Then 1L over 2h)
56
What is given following fluid in DKA
KCl in next fluid bag
57
If potassium is >5.5 in first 24-hours what is done
No K+ replacement required
58
If potassium is 3.5 - 5.5 in first 24-hours what is done
Replace 40mmol/L of potassium
59
If potassium is <3.5 in first 24h what is done
Contact senior: requires further K+
60
After fluid and potassium - what is given
IV fast-acting human soluble insulin at 0.1 unit/Kg/h
61
When should insulin and 5% dextrose be started
Blood glucose reaches 14mmol/L - to avoid hypoglycaemia
62
What are 5 complications of T1DM
Gastric stasis AKI ARDS VTE
63
Why electrolyte anomaly occurs in T1DM
Hypokalaemia | Hyponatraemia
64
Why does hypokalaemia occur
Acidosis
65
Why does hyponatraemia occur
Glucose pulls water into vessels causing dilution of sodium
66
What can occur if fluid is corrected to aggressively
Cerebral oedema
67
What population are particularly vulnerable to cerebral oedema
Children, young-adults
68
What do children require
1:1 monitoring for headache, vomiting, irritability, visual disturbance
69
When does cerebral oedema usually occur
4-12h after treatment
70
If suspecting cerebral oedema, what should be done
CT head and contact senior for review

Endocrine (20 decks)

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