Diabetes

Question 1

T1DM Presentation

Answer 1

peak ages 4-6 and 10-14

polyuria/dipsia
weightloss
nocturia
enuresis
recent infection
vomiting
abdo pain
confusion
lethargy
dehydration

Question 2

Diagnosing T1DM

Answer 2

HbA1C > 6.5 OR
fasting glucose 7+
2h PG in 76g OGTT 11.1
OR random glucose 11.1 plus hyperglycemia symptoms

also do urinalysis for glucose + ketones

anti-GAD, anti-islet, insulin antibodies if diagnosis unclear

Question 3

DKA w/u

Answer 3

venous or ABG
osmolality
plasma glucose
HbA1C
extended lytes
bicarb
urea
Cr
CBC + diff
cultures if concern re infection

Question 4

Initial management of T1DM without DKA

Answer 4

initiate daily insulin dose: 0.4-0.6 units/kg/day
(premixed vs basal-bolus?)

accuchecks before each meal + bedtime

d/c with immediate outpatient management, interdisciplinary

Question 5

DKA management

Answer 5

1) Confirm Dx: ketonuria, glucose >11, pH <7.3, bicarb <18, lytes
2) Address dehydration: small NS bolus, then infusion
3) CAUTION: risk of cerebral edema! Give fluids slowly, use paediatric protocol. Signs: headache, irritable, LOC, decreased HR. If develops: mannitol or hypertonic saline.
4) Begin insulin infusion: early infusion increases risk of cerebral edema!
5) Watch for hypokalemia, insulin worsens it. Correct first.
6) monitor: vitals, sat, ECG. Bloodwork q1h: pH, glucose, lytes. Neuro exam.

Severe acidosis or cerebral edema = ICU!

Question 6

Intercurrent Illness with T1DM - managment

Answer 6

check glucose and ketones q4h

do not hold insulin

ensure fluid intake

to ER if vomiting + not tolerating fluids

Question 7

Managment of Hypoglycemia in T1DM

Answer 7

treat PG<4 with 10-15g of carbohydrates

wait 10-15min

recheck glucose, repeat carbs if still <4

if next meal >1hr away, have snack with carb + protein

Question 8

Blood surgar targets

Answer 8

<6 years: A1c <8, fasting 6-10

6-12y: <7.5, fastin 4-10

13-18yr: A1C <7, fasting 4-7 (post prandnial 5-11)