Endo - Diabetes Flashcards
What is T1DM?
Pancreas stops being able to produce insulin causing hyperglycaemia
What is DKA biochemistry?
Hyperglycaemia
Ketones
Metabolic acidosis with raised anion gap
How to classifiy DKA as
mild
moderate
severe?
mild - pH <7.3
moderate - pH <7.2
severe <7.1
What % of new T1DM present in DKA?
25-50%
How does DKA present?
ABDOMINAL PAIN
N+V
Kassmaul respiration
Acetone smelling breath
Dehydration + reduced consciousness
Triad of T1DM symptoms
Polyuria
Polydipsia
Weightloss
What is a urological manifestation of T1DM
Secondaru enuresis - bedwetting in a previously dry child
Blood glucose for T1DM?
Random blood glucose <11
or fasting glucose <7
What 3 types of insulin therapy can be considered?
Multiple daily injection basal bolus
Continuous subcatenous insulin infusions
One, two or three insulin injections per day
How does Multiple injection basal bolus work
This is the one offered from diagnosis
Short acting insulin before meals
1 or more daily injection of long acting insulin
How does continuous subcut insulun infusion work>
This is the insulin pump therapy
What are the monitoring targets for T1DM?
5 capillary glucose tests per day
What is the HbA1c target for T1DM?
48 mmol/L
How to manage DKA overall?
IV fluids
Insulin Infusion
IV potassium chloride
What emergency fluids resus is given for DKA?
10ml/kg 0.9% NaCl bolus over 60 mins
if shocked : 20ml / kg over 15 mins
How to give deficit fluids for DKA?
Replacement over 48 hours:
Mild DKA : 5% fluid deficit
Moderate : 7% fluid deficit
Severe : 10% fluid deficit
Deficit * weight * 10 (- initial bolus)
How to give maintenance fluids for DKA?
Over 24 hours
first 10kg: 100ml/kg/day
next 10kg: +50ml/kg/day
every kg above 20kg: + 20ml/kg/day.
Prescribe deficit and maintenance fluids for:
20kg 6 yr old with a pH of 7.15 in DKA
Recieved 10mL/kg bolus over 60 mins already
Deficit: 7 * 20 = 1400mL (-initial bolus)
Deficit = 1200mL / 48 hours
–> 25mL / hour
Maintenance = (10 * 100) + (10 * 50) = 1500 mL over 24 hours
–> 62mL / hour
Overall = 87mL/ hour
How to go about giving the insulin infusion?
Insulin / dextrose therapy AFTER 1-2 hours of IV fluid
Start 5% dextrose when <14 mmol/L
How is cerebral oedema a complication of fluid therapy?
children will need 1:1 nursing to monitor for neuro-observations
Treat with Mannitol or Hypertonic sodium chloride if there are clinical features e.g. headache, irritability, visual changes, focal neuro
What is DKA resolution defined as?
DKA resolution is defined as:
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
when treating dka patients and giving inulin infusion, do you give fixed rate or variable rate?
** fixed-rate** insulin infusion is preferred over variable-rate due to its more predictable effect on blood glucose levels and ketone bodies. It’s also important to continue long-acting subcutaneous insulin during this time to prevent rebound hyperglycemia once IV insulin is discontinued; short-acting insulins are usually held due to risk of hypoglycemia with concurrent IV and subcutaneous routes.
In t1DM blood glucose targets on waking and before meals?
In type 1 diabetics, blood glucose targets:
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
Patient with dka has been given fluids and insulin infusion at 0,1 units kg/hr
now blood glucose is <14 mmol/L
now what?
once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the 0.9% sodium chloride regime
