Diabetes and Thyroid Problems Flashcards
What is the most common type of DM below age 40? Above?
Below = DM I Above = DM II
What is maturity onset diabetes of youth (MODY)?
DM occurring before 18 yo
What are the HLA haplotypes that are associated with DM I?
HLA-DRB1 and DQB1
What are the environmental factors that can cause DM I in susceptible individuals?
Viral disease
Chemicals
Early cow’s milk
What is the rate of DM I in an identical sibling if the other has it?
35-50%
What is the drug that may be able to preserve beta islet cells in newly diagnosed pts with DM I?
Cyclosporine
What are the histological characteristics of islet cells of DM I?
WBCs, insulin auto-antibodies
Which is the more common presentation: DKA or polydipsia/polyphagia
Polydipsia/polyphagia
What is the fasting glucose level that is diagnostic for DM?
More than 126 mg/dL (200 for him)
What is the random glucose measurement that is diagnostic of DM?
More than 300 mg/dL
What are the two most important factors of the prognosis for kids with DM I?
Parental and pt education
Stress management
What should happen to insulin doses with emesis?
May need to tone back d/t loss of sugar
What, generally, is the dosing scheme for insulin?
2/3 daily dose NPH in AM, 1/3 regular before dinner
What foods should be avoided with DM I pts?
- High salt
- Fatty
- High protein
- High cholesterol
- Pure sugar
What type of food should be increased in the diets of DM I pts?
Fibrous
What is the role of regular aerobic exercise with DM I?
Increases insulin sensitivity
Improves circulation
What role does stress play in DM I?
Need to avoid d/t BG elevation that can occur
In general, how often should BG be measured with DM I?
twice daily, but more if sick
What is the target BG level for 0-4, 5-12, and 13+ two hours after a meal?
0-4 = 100-200 5-12 = 80-180 13+ = 70-150
When should urine ketone monitoring be performed? (3)
Illness
Emesis
BG above 250 mg/dL
HbA1C level below what value are associated with reduced risk of renal/retinal complications?
10%
What are the ssx of hypoglycemia?
Hunger, weakness, drowsiness, HA, confusion
What are the components of preventing hypoglycemia? (4)
- Consistent eating schedules
- Insulin dosing
- BG monitoring
- Edu
What are the two criteria for DKA?
BG more than 200
VBG with pH less than 7.3 or HCO3 less than 15
What other common medical condition leads to low HCO3 levels?
Emesis
What are the IVF goals with DKA?
Correct shock and/or ~15 ml/kg of NS or LR
What is the problem with bolusing fluids too fast with DKA?
Too much will start to pool fluids in the brain d/t the slower diffusion of glucose through the BBB
How is insulin administered to patients in DKA?
IV insulin at 0.1 nits/kg/hr until 100 mg/dL.
Add D5 to IVF when BG is less than 300 mg/dL, to ensure a slow decline in BG
What happens to K with acidosis?
H+ is exchanged for K in an attempt to bring pH of the blood back up.
What type of fluids should be used for DKA: NS or LR?
NS initially to prevent hyperkalemia, then switch to LR once urine output is adequate to maintain K levels
What is the effect of insulin on the acidosis of DKA?
Reduces ketone body production, and thus acidosis
When should HCO3 be used with DKA?
iff severely acidotic. Otherwise will overshoot and cause a rapid fall in K
True or false: all pts with DKA have some degree of cerebral edema
True
How do you prevent the cerebral edema with treating DKA?
Close monitoring, and administer NS then LR slowly
How do you prevent the long term complications from DM? (3)
- HbA1C less than 10%
- BP less than 90th
- no nicotine
What week of gestation is the thyroid capable of hormone synthesis?
14 weeks
True or false: maternal and fetal pituitary-thyroid axes are dependent on one another
False–totally independent
Can anti-thyroid hormones like PTU and methimazole cross the placenta?
Yes
How can hyperthyroid mothers cause thyrotoxicosis in their fetuses?
Human specific thyroid stimulator immunoglobin can cross the placenta, and produce thyrotoxic newborns
What are the proteins that bind T3/T4 in the serum? Which binds more readily?
Thyrobinding hormone
T4 binds more readily
What is the most accurate measure of thyroid function? What is the situation in which this is not true?
TSH
Not true if there is a pituitary problem
True or false: if there is a normal TSH level, then the patient does not have thyroid issues
True
What should be added to the orders if TSH is high?
Free T4 to evaluate for hypothyroidism
What should be added to the orders if TSH is low?
Free T3 and T4 to determine degree of hyperthyroidism
What is the most common cause of acquired hypothyroidism?
Chronic lymphocytic thyroiditis (Hashimoto’s)
What are the ssx of hypothyroidism in children?
Growth retardation
Sluggishness
Poor perfusion
Macroglossia
What is the classic x-ray finding of hypothyroidism in children?
Epiphyseal stippling
What type of anemia is usually found with hypothyroidism, assuming there is not dietary uptake issues 2/2 to it?
Normocytic
What happens to cholesterol and carotene levels with hypothyroidism?
Increased
What happens to CrCl with hypothyroidism?
Decreased
What are the three major congenital thyroid issues?
Aplasia
Hypoplasia
Maldescent
What is the inheritance pattern of inborn errors of thyroid hormone metabolism?
AR
What are the lab values that should be followed with Levothyroxine administration?
Free T4 and TSH
What is acute suppurative thyroiditis?
TTP thyroid in a toxic appearing child d/t infection with GAS or Staph Aureus
What are the TFTs like with acute suppurative thyroiditis?
Normal
What is the treatment for acute suppurative thyroiditis?
Abx
What causes the exophthalmos and pretibial myxedema in hypothyroidism and Grave’s disease?
TSH receptors on fibroblasts in these areas.
- If hypothyroid, elevated TSH
- If graves, autoantibodies stimulate these receptors
What are the ssx of hyperthyroidism in children?
- premature closure of suture lines
- Advanced bone age
What is the cause of congenital hyperthyroidism?
Placental passage of TSI IgG from a thyrotoxic mother, causing hyperthyroidism in the infant
What is the short and long term prognosis with congenital hyperthyroidism?
Short = significant death rate Long= will be normal
In whom does idiopathic hyperthyroidism usually occur?
12-14 yo with a 5:1 female to male ratio
What is the natural history of idiopathic hyperthyroidism?
Cyclic spontaneous exacerbations and remissions