Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Latent autoimmune diabetes of adults (LADA)

A

Autoimmune T1DM - that onsets during adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When does T1DM usually onset

A

Adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are peak ages of onset of T1DM

A

4-6 years-old

10-14 years-old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What two genes are associated with T1DM

A

HLA DR3

HLA DR4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a risk factor for T1DM

A

FH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What autoimmune diseases is T1DM associated with

A
  • Coeliac
  • Addison’s
  • Hashimoto’s thyroiditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What may be the first manifestation of T1DM

A

DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How else can T1DM present

A 
Polyuria 
Polydipsia 
Weight loss
Lethargy 
Poor wound healing 
Pruritus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In T1DM, what investigation is first-line

A

Random plasma glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What random plasma glucose is diagnostic of T1DM

A

> 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is c-peptide offered

A

If suspect T1DM but has atypical features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are atypical features that may warrant C-peptide

A

> 50
BMI >25
Slow evolution
Long prodrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What monitoring is done in T1DM

A

HbA1c every 3-6 months

Capillary blood glucose QDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What capillary blood glucose is expected after meals

A

5-9 mmol/mol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What HbA1c is aimed for

A

<48 (6.5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In adults, what conservative measures are indicated for adults

A

Education - carbohydrate training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

in adults, what is used to treat T1DM

A

Insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what insulin regimen is preferred in adults

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are long-acting insulins offered in T1DM

A
  • Insulins glargine

- Insulin detemir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is insulin detemir known as

A

Levemir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is insulin glargine known as

A

Lantus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when is rapid acting insulin given in T1DM

A

before meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is a rapid acting insulin

A

actarapid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what conservative measures are offered to young people with T1DM

A
  • Education
  • Blood glucose monitoring
  • Support groups
  • Annual influenza vaccine
  • Dietician: advice about foods with low glycemic index
  • Exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how often should children attend diabetes clinic

A

four times per-year

30
Q

how often should children have eye-exams in T1DM

A

2-yearly

31
Q

what is first line insulin regimen for children tis T1DM

A

multiple daily basal-bolus insulin regimens

32
Q

what is the multiple daily basal-bolus injection regimen

A
  • short-acting before meals

- long-acting once daily

33
Q

what is second-line for children with T1DM

A

continuous SC insulin infusion pump

34
Q

Explain sick day rules in T1DM

A
  • Increase monitoring BG (4-hrly)
  • Continue taking medications
  • 3L fluid in 24-hours
35
Q

What fluid intake is aimed for

A

3L in 24h

36
Q

Why are oral hypoglycaemic continued

A

as illness increases cortisol levels which can cause hyperglycaemia

37
Q

When is metformin only stopped in diabetes

A

If severely dehydrated - as can worsen renal function

38
Q

What is main complication of T1DM

A

DKA

39
Q

How can complications of DM be divided

A

Microvascular

Macrovascular

40
Q

What are the 4 microvascular complications of T1DM

A
  • Diabetic retinopathy
  • Diabetic neuropathy
  • Diabetic nephropathy
  • Diabetic foot
41
Q

What defines diabetic nephropathy

A

A:Cr >3

42
Q

What screening is in place for diabetic retinopathy

A

Annual retinopathy screen

43
Q

What is required to prevent diabetic neuropathy

A

Regular podiatry appointments for diabetic foot

44
Q

What are 2 macrovascular complication of T1DM

A

CHD

PAD

45
Q

What is given to prevent CHD

A

Statin (20mg)

46
Q

How does DKA present

A
  • Abdominal pain
  • Vomiting
  • Drowsiness
  • Coma
  • Kussmaul hyperventilation
  • Acetone-breathe
47
Q

What is Kussmaul hyperventilation

A

Deep breathing pattern associated with metabolic acidosis

48
Q

When should blood glucose always be checked

A

Anyone with abdominal pain and vomitting

49
Q

Explain DKA

A
  • 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
Q

What are the 3 general aspects required for diagnosis of DKA

A
  • Acidosis
  • Ketosis
  • Hyperglycaemia
51
Q

What is requirement for acidosis

A

VBG pH <7.3

HCO3- <15

52
Q

What is requirement for hyperglycaemia

A

Blood glucose >11

53
Q

What is requirement for ketosis

A

Serum ketones >3

Or, significant ketonuria (>2)

54
Q

What are 9 criteria when you should consider sending DKA patient straight to ITU

A
  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
Q

What is first-line management for DKA

A

0.9% Saline
(Start with 1L over 1h)
( Then 1L over 2h)

56
Q

What is given following fluid in DKA

A

KCl in next fluid bag

57
Q

If potassium is >5.5 in first 24-hours what is done

A

No K+ replacement required

58
Q

If potassium is 3.5 - 5.5 in first 24-hours what is done

A

Replace 40mmol/L of potassium

59
Q

If potassium is <3.5 in first 24h what is done

A

Contact senior: requires further K+

60
Q

After fluid and potassium - what is given

A

IV fast-acting human soluble insulin at 0.1 unit/Kg/h

61
Q

When should insulin and 5% dextrose be started

A

Blood glucose reaches 14mmol/L - to avoid hypoglycaemia

62
Q

What are 5 complications of T1DM

A

Gastric stasis
AKI
ARDS
VTE

63
Q

Why electrolyte anomaly occurs in T1DM

A

Hypokalaemia

Hyponatraemia

64
Q

Why does hypokalaemia occur

A

Acidosis

65
Q

Why does hyponatraemia occur

A

Glucose pulls water into vessels causing dilution of sodium

66
Q

What can occur if fluid is corrected to aggressively

A

Cerebral oedema

67
Q

What population are particularly vulnerable to cerebral oedema

A

Children, young-adults

68
Q

What do children require

A

1:1 monitoring for headache, vomiting, irritability, visual disturbance

69
Q

When does cerebral oedema usually occur

A

4-12h after treatment

70
Q

If suspecting cerebral oedema, what should be done

A

CT head and contact senior for review

Endocrine (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions