DM Type 1

Question 1

Etiology of Dm type 1

Answer 1

• Autoimmune process. Most common is Hashimotos Thyroiditis. Celiac Disease is another associated autoimmune disease. Antibodies destroy insulin producing beta cells of pancreas (islet cells).
• Environmental: Cows milk before 2, Viral infections? Inconclusive

Question 2

What is the most common pediatric endocrine disorder?

Answer 2

DM1

Question 3

Some symptoms of DM1

Answer 3

Multi-organ system involvement: Tiredness, confusion, retinopathy, glaucoma, deep rapid breathing, thirst, vomiting, heart disease, muscle weakness, excessive urine production, weight loss, nerve damage, poor circulation, skin prone to infection

Question 4

Presentation of DKA

Answer 4

Polyuria, Polydipsia, nausea, vomiting, abdominal pain, tachypnea, fruity odor to breath

Question 5

A 12 year old female with DKA. What potential side effect do you want to avoid with treatment?

Answer 5

Cerebral edema- get an endocrinologist involved

Question 6

How to treat dehydration in a DM1 patient

Answer 6

glucose free isotonic solution

Question 7

How to correct hyperglycemia

Answer 7

Fast acting insulin (decrease at 100mg/dl/hr)

Question 8

How to treat acidosis

Answer 8

Should be corrected with insulin- bicarb only in severe cases

Question 9

How to treat electrolyte imbalance

Answer 9

Potassium needs to be replaced

Question 10

Therapy for DM1: Usual starting dose of insulin

Answer 10

0.5U/kg: 50% given to provide basal coverage, 50% divided doses for rapid acting insulins

Question 11

Long acting insulins

Answer 11

Used for basal coverage: Insulin glargine (Lantus), Insulin detimir (Levemir). Not used in pump

Question 12

Rapid acting synthetic insulin

Answer 12

Insulin lispro (Humalog), Insulin aspart (Novolog), Insulin glulisine (Apidra). Completely gone within 3 hours, used in pumps

Question 13

Hypoglycemia results from an ______ of insulin in relation to the serum glucose concentration. Symptoms include: and the Treatment is:

Answer 13

Excess.
Symptoms: Headache, visual changes, confusion, irritability, seizures, tremors, tachycardia, diaphoresis, anxiety.
Treatment: Fast acting glucose- glucose tabs, soda, juice

Question 14

Goal for A1c in a DM1 patient

Answer 14

<7.0%

Question 15

DM1 phenomena: Honeymoon period

Answer 15

Some beta cells still function. See a decrease need of treatment. Occurs in first few weeks of treatment. Can last a few weeks to couple years.

Question 16

Somogyi Phenomenon

Answer 16

Early morning hyperglycemia that is actually caused by hypoglycemia at night.

Question 17

Dawn Phenomenon

Answer 17

Early morning hyperglycemia caused by early dosing of evening insulin and secretion of GH in early morning hours

Question 18

DM1 preventative care

Answer 18

• Hgb A1c every 6 mos.
• Ophthalmologic exams every year
• Urine checked for microalbuminuria every year
• Annual cholesterol measurements
• Monitoring of blood pressures
• Thyroid blood tests every year
• Daily home foot exams and at every visit

Question 19

Decrease in C-peptide plus diabetic symptoms is what type of diabetes?

Answer 19

Type 1

Question 20

Normal C-peptide plus symptoms is what type of diabetes

Answer 20

Type 2

Question 21

Diabetic ketoacidosis occurs in undiagnosed or uncontrolled DM1. DKA is present when Arterial pH is_____ and Bicarb level is ________ and the ketones are _________ in serum or urine

Answer 21

Less than 7.25, <15mEq/L, Elevated