ENDOCRINE 2 Flashcards
type 1 DM is absolute wat what symptoms risk ix
absolute insulin deficiency
beta cell failure, anti GADI and anti islet ABs
young, polyuria, polydipsia, decrease weight, lean DKA, no evidence of micro dx
Genetic, FH, young
decrease in C peptide, decrease ketones, GAD/islet ABs
treatment of type 1
monster HBA1C 3-6m target 48 mol 6.5%
self monitor on waking 5-7 before meals 4-7
usually BD insulin regime
add metaformin if BMI 25 or over
diabetes Type 2 is relative what
characterised by what
symp
risk factors
insulin deficiency
insulin resistant and beta cell dysfunction
middle age, obese, insidious onset, no/little ketonuria, micro cx in 20%
central obesity, FH, gestational DM, age, ethnicity, PMH of MI/stroke, anti psychotics
ix and dx of type 2 DM HBA1C
fasting
2h OGTT
random
HBA1x 48 or over
- 8 or over
- 1 or over
- 1 or over
pancreatic disease in type 3 DM
endocrine
drug induced
genetic
chronic/recurrent pancreas’s, haemachromatosis, cystic fibrosis
cushings, acromegaly, phaeo, glycoganoma
steroids , diuretics
Cf, turners, myotonic dystrophy
diabetes type 4
gestational - glucose intolerance during pregnancy
IM insulin factors affecting absorption
temperature
site - lipohypertrophy
injection depth
exercise
MODY stands for what what is it in who genetics risk factor ix treatment
maturity onset DM of young
defective glucose sensing in pancreas and/r loss of insulin secretion
<25 ADom
strong FH
assoc features like renal cysts, GAD neg, C peptide pos
SUs
transcription factor mutation v
glucokinase mutation
transcription: young, progressive hyperglcyaemia, 1/3 diet 1/3 OHD 1/3 insulin, cx frequent
glucokinase: onset at birth, stable hyperglycaemia, diet control, rare cx
LADA is what commonly mis dx as what symptoms ix rx
late onset T1DM type 2 slower course of onset, mild, non obese, assoc with other AI disease auto AB pos control on oral agents
neonatal DM diagnosed within first what
transient
permenant
3m of line
dx <1w old, resolves within 12w
dx 0-6w, lifelong treatment w insulin
what is DKA
causes
symptoms
cx adults and kids
absolute/relative insulindefic and increase in counter regulatory hormones
infection, ichaemia, infarction, ignorance
thirst, polyuria, flushed, vom, SOB, and pain
adults: decreased K, aspiration pneumonia, ARD
kids: cerebral oedema
dx of DKA
treatment
ketonaemia >3 or significant ketonuria >2 on sip
BG >11 or known DM
bicarb <15 or venous ph<7.3
increase in amylase, increase WCC, decrease Na, increase lactate, increase Cr
fluids, potassium, insulin 0.1 unit/kg/h when BG 15 switch to infusion of 5% dextrose. can also give phos/bicarb
lactic acidosis lactate originates where normal range symptoms ix rx
RBC, skeletal muscle, brain and renal medullar
0.6-1.2
hyperventillatio, mental confusion, stridor, coma
decrease in bicarb, increased anion gap (normal 10-18), increase glucose and phosphate
fluids, ABs, underlying
type a lactic acidosis
type b lactic acidosis
tissue hyperaemia, infarcted tissue, cariogenic shock, hypovalaemic acid
liver disease, leukaemia states, assoc with DM, metaformin
HHS in who DM often what symp/signs and ix treatment higher what compared to DKA
Type 2 DM, elderly
often known
glucose >30, renal impairment, increased sodium, dehydration, ph>7.3, bicarb >15, increased osmolarity >320
slowly fluids - risk of overload. slowly insulin or none. Na avoid rapid fluctuations, screen for vascular events and LMHW for all
high mortality
IV insulin in who
monitering
free of what
daily what
DKA, HHS, acute insulin
hourly BG monitoring keep 5-12, check ketones if >12
free of hypo
daily U&Es
types of neuropathy
peripheral
autonomic - bowe, bladder, erectile
proximal - thighs, buttocks, hips
focal - one nerve or group of nerves
symptoms of neuropathy
risk factors for neuropathy
numbness tingling. foot ulcers. wasting of muscle. indigestion. N/V. dizzy. urine issues. htn. erectile dysfunction, vaginal dryness
long period of DM, poor glycemic control, type 2>type 1, increased cholesterol, smoking, alcohol
peripheral nerve neuropathy complications
rx
infections/ulcers, deformities, amputations
analgesia, gabapentin/pregablinc, TCAs, opiodes
autonomic neuropathy symptoms
ix
treatment for gatroperesis
gastric slowing, constipation and diarrhoea, gastropereiss, dysphagia, decreased weight, increased sweat, hypoglycaemic unawareness, hypotension, HR stays high
USS of bladder and urinary tract. gastric emptying studies
metoclorpirimide, domperidone, erythromycin
nephropathy risk factors microalbuminaemia dx proteinuria dx treatment for proteinuria why should it be repeated 2/3 times
htn, cholesterol, smoking, glycemic control, albuminuria
ACR<30 PCR <50
ACR<30 PCR>50
ACE/ARB
varies night.day, exercise, protein/water load. false pos: preg, period, UTI, vaginla dc
retinopathy mild NP mod NP severe NP proliferation complicaition ix rx
haem and microaneurysms H, MA and hard exudates H, IRMA, venous beading new vessel formation secondary glaucoma - retinal detachment optic clearance tomography laser, vitrectomy, anti VEGF
erectile dysfunction in how many DM age
RF
50% DM 55%>60
CRF, hepatic failure, MS, depression, spinal cord injuries, pelvic irradtiaon/ surgery, smoking, drugs, alcohol, bicycle riding
treatment of erectile dysfunction
CI to drug
improve glycamic control, decrease alcohol, withdraw causative drugs, viagra levita 4-5h cialus 24-48h
nitrates/nicorandil, recent stroke/MI within 3m, hypotension, severe hepatic failure
