7.1 Diabetes Mellitus Flashcards
What brings down glucose in body?
Insulin
Somatostatin
Amy Lin
GLP-1
What brings glucose up?
Glucagon
Cortisol
Growth hormone
Epinephrine
Pancreas exocrine cells secrete?
Digestive enzymes
Beta cells secrete?
Insulin
Alpha cells secrete?
Glucagon
Delta cells secrete?
Somatostatin
What are secondary causes of inadequate insulin production?
CF
Drugs
Surgery
Malignancy
Criteria for Diabetes mellitus fasting glucose?
> 7mmol/L
Criteria for Diabetes mellitus OGTT?
> 11.1 two hours post-load
Criteria for Diabetes mellitus hba1c?
> 6.5%
Seasonal variation in DM1?
Peak in winter
Definition of T2DM?
High body mass index
Acanthosis nigricans
Negative DM autoantibodies
Elevated fasting insulin and C-peptide
When to suspect Monogenic diabetes?
Dx first 6/12 of life No islet antibodies No insulin requirements after 5 years old No DMII features Mild stable fasting hyperglycaemia Associated deafness/renal disease
Criteria for Diabetes mellitus random blood glucose?
Plasma glucose of >11.1
Associated autoimmunity in DMI?
Thyroid
Coeliac
DMI when to refer?
If ketones are present
What are the blood glucose targets for paeds?
Before meals: 3.5-7
After meals: 4-9
Parent’s bedtime (5-8)
BEfore exercise (7-10)
What is considered hypo in kids?
<3.5
What is target Hba1c for paeds?
<7.5%
Principles of insulin pump?
Vary the rate
Bonus for meals
Diabetes ketoacidosis presentation?
Polyuria Polydipsa Weight loss Kiss all respiration Ketone breath
Vomiting
Lethargic
Abdo pain
Diabetes ketoacidosis Mx: main things
- 10mL/KG bolus 0.9% saline over 1-2 h
- K+ replacement
- Insulin infusion 0.05-0.1units/kg/hour, 1-2 hours after fluids
When is Diabetes ketoacidosis severe pH wise?
<7.1
When is Diabetes ketoacidosis severe sodium wise?
<130
>160
When is Diabetes ketoacidosis severe potassium wise?
<3.0 or >5.5
When is Diabetes ketoacidosis severe age wise?
<2
What does metformin do?
Acts on insulin target cells in liver, fat, muscle
Inhibits hepatic glucose production
Improves insulin sensitive
Lipids: decreases TG, vLDL
When child is sick, what is Mx of diabetes?
Test BGL Q2h Treat underlying illness Give extra fluids Never omit insulin May need extra insulin
Sick day mx, when to seek medical review?
If checking BGLs every 2 hours and after 2 extra insulin doses still not improving
Sick day management with pump?
Increase insulin
Extra via pen until ketones cleared
Mild to moderate hypoglycaemia Rx?
10-15g carbs 150-200mL juice 2tsp honey 4-7 jelly beans Recheck BGL after 10-15 minutes
Severe hypoglycaemia Rx?
IM glucagon 0.5-1.0mg
IV 10% dextrose 2mL/kg continuous infusion
