Diabetes part 2 Flashcards
What is the etiology of T1DM
autoimmune pancreatic beta-cell destruction
childhood/adolescence
What is the clinical presentation of T1DM
usually presents wtih symptomatic hyperglycemica, may present in DKA
polyuria, polydipsia, catabolism, polyphagia
dehydration, nausea, unexplained weight loss, weakness, irritability, fatigue, blurry vision
what is the honeymoon phase
transient phase of near-normal glucose levels after onset (partial recovery of insulin secretion)
What is the workup of T1DM
random serum glucose
fasting glucose
glucose tolerance testing (OGTT)
(urinalysis)
What is the treatment of a new diagnosis of T1DM
insulin induction (lifetime)
IVF management
electrolyte management
family/patient education (diet/exercise)
consult nutritionist
consult diabetic specialist (endocrinology)
what is the treatment of Existing T1DM
educate and manage:
insulin with endocrine specialist
diet and exercise
comorbidities (ASCVD, HTN, HLD, psychosocial issues)
complication (DKA, hypoglycemia)
What are exercise recommendations with T1DM
ADA: 150 min of aerobic activity 3-4times per week
Surgeon general: 30 minutes of moderate physical activity most days of the week
should be individualized
what is the initiation dose of insulin
0.5 Units/kg/day
what is the maintenance dose of insulin
0.4 - 1.0 U/kg/day
what type of patients require a higher TDI
Puberty, pregnancy and medical issues
what are insulin adverse reactions
Lioatrophy or Hypertrophy and/or Resistance
what is Lioatrophy with insulin
loss of fat at injection site; may allow for incidental intra-muscular injection
what is hypertrophy with insulin
increase in fat mass at site; leads to erratic insulin absorption
what is resistance with insulin
require larger amounts of insulin to get desired effect, due to antibody formation
What are the “I’s” of DKA etiology
Infection -i.e. pneumonia, UTI, appendicitis, cholecysitis
Infarction - CVA or MI
Iatrogenic - insulin/diet/exercise change by pt or provider
Incision - surgery
Intoxication - ETOH or illegal drugs
Initial - initial T1DM diagnosis
Insulin - too little or no insulin administered
What are the diagnostic criteria for DKA
Diabetic: glucose >200mg/dL
Ketonuria: pts may produce both acetoacetate and beta-hydroxybuterate as ketones; ONLY acetoacetat is detected by urine dipstick - order serum beta-hydroxybuterate if necessary
Acidosis: arterial pH <7.3
venous bicarb <15 mmol/L
What is the treatment plan for DKA
step one: fluid replacement: isotonic fluid replacement
step two: electrolyte replacement (correct hypokalemia, potassium, serum sodium)
step three: insulin drip (GO SLOW- 0.05 - 0.1 Units/kg/hour) - once serum glucose < 200mg/dL reduce insulin drip by 50%
what determines DKA resolution
Glucose <200mg/dL
pH >7.3
Bicarbonate level is > 18mEq/L
what are the risk factors for T2DM
age > 45
overweight or obese
sedentary lifestyle
fhx of DM
hx of glucose intolerance
gestational DM or delivery of baby >9 lbs
hx HTN
dyslipidemia
hx CVD
PCOS
black, hispanic, asian american or american indian
what is the clinical presentation of T2DM
may present with symptomatic hyperglycemia but usu asx or “non-complainers”
hyperglycemia: polyuria, polydipsia progress to orthostatic hypotension, dehydration, N/V, weight loss, blurred vision, bacterial/fungal infections
what is the ADA criteria for T2DM diagnosis
one of the following:
-FPG > 126 mg/dL
- random glucose >200mg/dL
- 2hr plasma glucose >200mg/dL
- HbA1c >6.5%
what is the ADA criteria for pre-diabetes
one of the following:
FPG >100-125mg/dL
2hr OGTT plasma glucose of 140-199 mg/dL
HbA1c 5.7-6.4%
What is the preferred medication for T2DM
Metformin
initial: 500mg per day
titrate 500mg per week
maintenance dose 500 or 800mg BID/TID
if a patient has an A1c less than 8 with T2DM what do you think
resistance
if a patient has an A1c greater than 8 with T2DM what do you think
post-prandial
What is MODY
Maturity onset DM of youth
usually seen in adolescents with obesity; peripheral insulin sensitivity 50%
What is HHNK
hyperosmotic hyperglycemia non-ketotic syndrome
metabolic complication characterized by severe hyperglycemia, extreme dehydration, hyperosmolar plasma and altered consciousness
most often occurs in T2DM, usu. in setting of physiologic stress
what is the treatment of HHNK
IV saline solution and insulin
(correct hypokalemia)
what are complications of HHNK
coma, seizure and death
how is HHNK diagnosed
severe hyperglycemia and plasma hyperosmolality and absence of significant ketosis
what is the mean plasma glucose for an A1c of 7
154 mg/dL
what is the mean plasma glucose for an A1c of 10
240 mg/dL
