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Diabetes Flashcards

1
Q

What are the types of DM

A 
Type 1 = 99% 
Type 2 
MODY 
CF RD
Neonatal - transient or permanent
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2
Q

What is the aetiology of type 1

A

Genetics - usually FH
Trigger / environment - vit D?
Autoimmune destruction of beta cells
Can still have type 1 if obese but more likely type 2

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3
Q

How much destruction till symptomatic

A

90%

Possible role of detecting Ab before destroyed?

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4
Q

How does DM present

A 
Polyuria
Polydipsia
New onset nocturnal enuresis = red flag 
Fatigue
Weight loss 
\+- recurrent infection 
25% present in DKA
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5
Q

How does DM present in <5

A 
Heavier nappy
Blurred vision
Oral / vulval candidiasis
Constipation
Skin infection
Behaviour change
Irritable
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6
Q

How do you Dx DM

A

THINK, TEST, TELEPHONE TODAY

Test = finger prick capillary >11.1mol

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7
Q

What are other tests but don’t wait to get back to refer

A

Fasting BG >7
Venous BG increased on 2 occasions
OGTT - rare
Check AB - GAD +Ve if present = 100% type 1
Screen other autoimmune - TFT / coeliac - anti-TTG
FBC + U+E + formal lab glucose
HbA1c

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8
Q

How do you Rx new diagnosis of DM

A

Admit to hospital to start insulin and education

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9
Q

What education needs to be given

A 
Life-long 
BG testing 4x daily 
Injection technique 
Insulin regimen
Diet / carb counting
High low sugars
Sick day rules
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10
Q

What is sick day rule

A

Continue insulin when sick as liver produces glucose and insulin resistant when ill

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11
Q

What insulin regimen most popular

A 
Basal bolus 
1x LA
3x RA before meals
Need to work out insulin to carb ratio by carb counting
Correction doses if too high
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12
Q

What is new way to manage DM

A

Pump therapy

Programmed basal rate + bolus through the day

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13
Q

What is HbA1c

A

Glycoslated Hb
Shows control over 3 months as RBC 120 day life span
Aim <48 (NICE) or 58

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14
Q

What are symptoms with hypoglycaemia <4

A 
Dizzy
Weakness
Blurred vision
Sweating
Increased HR 
Anxious 
Headache
Hungry
Irritable
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15
Q

How do you Rx hypoglycaemia

A 
Fast acting sugar - tablets/ drink
Recheck after 10 min
Repeat if <4
If >10 give extra carb depending on weight
Glucogel if unable to swallow
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16
Q

How do you treat severe hypo e.g. unconscious / seizure

A 
IM glucagon to mobilise hepatic glucose
999
IV dextrose  
If low / still no return = IV steroid 
If normal BG but no return may be in post-octal state from seizure
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17
Q

What is hyperglycaemia

18
Q

What is important in hyperglycaemia

A

Teach sick day rules
Test ketones
Avoid DKA

19
Q

What are the symptoms of hyperglycaemia

A 
Same as Dx
Blurry
Drowsy
Dry skin
Hungry
20
Q

What causes DKA

A

Insulin omission leads to increased glucose, osmotic diuresis, increased FA and ketones
Poor compliance
Increased demand - illness / trauma

21
Q

What are symptoms of DKA

A 
N+V
Abdo pain
Sweet ketotic breath 
Dehydration
Kausmaul resp - rapid + deep
Drowsy
Coma 
Shock - RR, HR, cold periphery but with no focal chest/ abdominal reason
22
Q

What is the biochemical triad of DKA

A

Hyperglycaemia
Ketones > 1 in blood or urine
Acidosis - mild = 7.3, severe = 7.1, HCO3 <15

23
Q

What is the algorithm for hyperglycaemia

A

If BG >17 check ketones
If not elevated - keep rechecking till BG settles
If up give extra dose of RA insulin, repeat after 4 hours and if not improving = 999

24
Q

When do you call 999 instantly

A 
SYmptomatic
Vomiting 4 hours
Heavy rapid breathing
Abdominal pain
Dehydration
25
What should you remember with DM
Never stop insulin | Extra doses insulin + regular carb even if BG high
26
How do you Dx DKA
Beside glucose + ketone Capillary gas Urine dip
27
What is Ddx for DKA
Sespsi Cardiac Respiratory infection / TB
28
How do you manage DKA
``` ABCDE Senior True coma rare so must exclude May also have sepsis Treat shock ```
29
How do you treat DKA
If shock / decreased GCS / coma or vomiting - IV access +- 0.9% saline bolus (no K) - Caution as risk of cerebral oedema so only if shock IV insulin 1 hour after IV fluid - 0.1 unit / kg / hrRA - Switches of ketogenesis Maintenance - Over 48 hours - Calculare maintenace plus dehydration dose - K correction (KCL) + dextrose when BG falls <12
30
How do you monitor DKA
``` Monitor GCS as risk of cerebral oedema Look for signs of dehydration Blood gas + U+E 4 hourly BG + ketones hourly ECG Fluid inut Neuro obs 1 hour If headache / odd behaviour = REPOTT Infection screen - may have no fever ```
31
What are the symptoms of cerebral oedema
``` Headache = beware if this Vomit Irritable Decreased conscious Raised ICP Focal neuro Decreased HR Increased BP ```
32
What is the treatment of cerebral oedema
``` Senior Exclude hypo Mannitol 1g/kg IB Elevate head Restrict IV fluid CT PICU ```
33
What is important in the Hx
FH autoimmune / symptoms of DM when Dx Drinking - amount, type of fluid, timing, nocturnal? Micturition - how often, how much, nocturnal, wetting? Assocatied Sx - weight loss, FTT, lethargy, N+V, abdominal pain, irritable, fever, vision, coordination
34
What is nocturnal enuresis
Involuntary discharge ofurine in the absence of acquired defects of nervous / urinary system Primary - never continent Secondary - had been content for 6 months Majority reach continence by age 4 Abnormal if not by 5
35
What could be the underlying cause
``` Overactive bladder Constipated DM UTI Abuse ```
36
How do you treat / primary
Advise fluid / toilet Reward system - for toiling before bed Enuresis alarm <7 Desmopressiin >7 or failed alam (synthetic ADH)
37
What is the most common reason for polydipsia / uria
``` Habitual drinking Usually toddler Amount passed = amount drank Must exclude DM + URI Morning urine osmolarity may help ```
38
How do you treat habitual drinking
Offer only water Limit milk to 500ml Decreased flavoured drinks + sugar
39
What are most rarer reasons
Central diabetes inspidus | Nephrogenic DI
40
What is mild acidosis
7.3
41
Moderate acidosis
7.2
42
Severe acidosis
7.1 | HCO3 <15

Paediatrics (35 decks)

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