Diabetes Flashcards
What lifestyle interventions are proven for diabetes?
- Diet: DASH/med/whatever is sustainable
- Exercise: both activity and focused exercise, including both cardio and strength
- Alcohol: less than 1-2/day
- Smoking: stop
How does diabetes usually present?
1c weight loss/ fatigue
- Changes in vision- due to glucose in vitreous humour
- Polyuria +polydipsia
- May be asymptomatic but have risk factors like metabolic syndrome
What are the monogenic forms of diabetes?
Rare: IPEX (treg) and APS-1 (thymus) MODY: 1=lipid profile abnormal 2=glucokinase mutation 3=post prandial hyperglycemia 5=renal/uterine development
MELAS: diabetes& deafness
What mutations are linked to type 1 diabetes?
- Insulin gene mutations (IDDM2)
2. HLA gene mutations (IDDM1)
What environmental triggers in DM1 act via molecular mimicry?
- Diet (cow’s milk, nitrosamines)
2. Viruses (coxsackie, rubella, mumps)
What environmental triggers in DM1 act via direct destruction?
- Viruses
- Drugs/toxins
- Stressors
At what point in DM1 does pre-diabetes occur?
- Less than 50% beta cell mass
- Blunted glucose response
- No symptoms
At what point is DM1 official?
- Less than 10% beta cell mass
2. Symptoms (polyuria, polydipsia, weight loss)
What is a predictor of future progression to DM1?
- Number of autoantibodies detected
2. During immune attack stage
What are the risk factors for severe hypoglycemia in DM1
- Adolescents
2. Unable to detect or treat themselves
What causes DKA?
Severe and absolute insulin deficiency leading to:
Glycogenolysis
Gluconeogenesis
Lipolysis
Vicious cycle as counter regulatory hormones activated
Presentation DKA
Rapid onset, severe acidosis
Osmotic dieresis: polyuria, polydipsia dehydration, decreased LoC
Ketones: vomiting, abdo pain, Kussmaul respiration, fruity breath
Presentation HHS
Onset can be insidious
Delirium
Lethargy
Dehydration (osmotic, vomit, not enough drinking)
May have neuro SX: seizures etc
Investigations DKA
PH less than 7.3
Bicarb less than 15
High urine and plasma ketones
Anion gap
Apparent hyponatremia
Hypophosphatemia
Investigations HHS
Glucose >33
Serum osmolarity >320
Treatment DKA
- Fluid resuscitation
- Give potassium (40mmol/L)
- Insulin bolus + infusion, avoid hypoglycemia (0.1 units/kg/hr)
- Sodium to avoid dropped plasmolality
- Maybe give bicarb if terrible acidosis
Treatment HHS
- Fluid resuscitation (up to 10L in 24 hours)
- Give potassium
- Give sodium
- Treat underlying cause
5 maybe insulin i foredeck
What predisposes to HHS?
Type 2 diabetes Older Renal insufficiency Drugs (steroids) Endocrine disorders
Precipitated by inadequate fluid intake, severe stress, infection, non compliance
If a child has diabetes before age 1, what should we consider?
Monogeneans diabetes like MODY
What are those with type 1 diabetes more at risk for?
Other autoimmune diseases like thyroid, celiac, addisons etc
What test is diagnostic of DM in children?
Random glucose if they have symptoms
Lipohypertrophy
Accumulation of fat following repeated injections at the same site. Can make insulin absorption unpredictable
How should hypoglycemia be treated?
- Immediate oral glucose (mild/moderate 15g, severe 20g)
2. If unconscious, IM or subcutaneous glucagon