Endocrine

Question 1

T1DM

Insulin Functions

Lack of insulin causes

Presentation

Antibodies involved

• Also link to

Answer 1

Insulin Functions
1) Converts glucose to glycogen to be stored in muscles + liver
2) Stops gluconeogensis (glucose production in liver)
3)

Lack of insulin causes

1) Hyperglycaemia- Glucose not taken up by liver + muscles
2) Stimulates gluconeogenesis (glycogen to glucose)
3) Production of fatty acids and ketones

Presentation- New presentation

• Polyuria
• Polydypsia
• Weight Loss
• Unusual infections
• DKA
• SOB
• Vom, Abdo pain, Dehydration

Antibodies involved

• GAD Glutamic acid decarboxylase
• ZnT8 Zinc Transporter 8
• IA-2 Islet antigen 2
• Also link to: Hypothryoidism, Addisons, Rheumatoid Arthritis, Downs and Turner Syndromes

Question 2

DKA
What would I see on ABG/ Blood tests?

Injectable Insulin 
- Short acting 
1) 
onset: 
peak time: 
lasts: 

2)

• Long acting
  onset
  lasts

General Rule for boluses?

Answer 2

DKA
What would I see on ABG/ Blood tests?
- pH < 7.3 
> 7.1 mild/ mod but < 7.1 is SEVERE!
- Glucose > 11
- Ketouria
- Dehydration > 5%
- Bicarb >15

It can also cause Cerebral oedema

Injectable Insulin 
- Short acting 
1) Novorapid 
onset: 15mins
peak time: 2hrs
lasts: 3-4hrs

2) Actrapid - used IV in DKA

• Long acting
  1) Degludec
  2) Levimir (Detemin)
  3) Glargine
  onset: 2-4 hrs
  lasts: 24-48 hrs

General Rule for boluses?
Short acting with every meal
Long acting every night

Question 3

Total Daily Dose calculation
>8 yo
<8 yo

Basal Insulin (Degludec)
>8 yo
<8 yo

Carb ratio
>8 yo
<8 yo

ISI sands for?
- ISI =
Blood sugar should be?

Bolus Dose for Novorapid =

Answer 3

Total Daily Dose calculation
>8 = 0.65 units/ kg/ day
<8 = 0.6

Basal Insulin (Degludec) 
>8 yo = 0.35 unit/ kg/ day
<8 yo = 0.3

Carb ratio
>8 yo = 500/ TDD
<8 yo = 300 /TDD

ISI sands for?
- ISI = Insulin Sensitivity Index
Blood sugar should be? 6mmol/L (but depends on time of day and age)

Bolus Dose for Novorapid = Dose for carbs + Correction dose

Question 4

Correction for Hypo (Hypo defind as…)

Short acting (g?)
2 egs

Long acting (g?)
2/7 egs

Answer 4

<4 mmol/L

Short acting  (10-15g)
3-4 glucose tablets (3g each)
120 orange juice 

Long acting (10-15g)
300ml of milk
15g cereal
1 packet of crisps/ apple/ pear/ med slice of bread