endocrine revision Flashcards
diabetes t1 features vs t2dm
autoimmune destruction of B islet cells
ketoacidosis and sudden onset
Young and thin
low genetic (low concordance)
always need insulin
other AID
t2-
insulin resistance
never ketoacidosis- HHS
Old and thick
high genetics (more inheritable)
action of insulin
signal of a meal
makes glucose into fat, muscle, liver
makes potassium and phosphate go in cell
Diabetes dx
with SX
random has to be above 11.1
fasting above 7 (between 7-6 impaired)
NOT glycosuria
glucose 2h after meal/ogtt over 11.1
between 7-11.1-impaired gluc tolerance
hba1c>48%
DKA mx
Fluid big big, FIXED DOSE
0.1u/kg/h normal rate + basal insulin
Must give potassium EARLY- if not it kills
If pH low- give IV sodium bicarb (care CSF pH go other way-paradox)-but try and avoid
ix of cause- infection often
give dextrose as the glucose drops (to make sure K+, acid and ketocis is corrected)
rememeber you treat the potassium, ketones and the acidosis more than gluc)
high potassium early isnt a sign it isnt severe
give NG tube if not awake
HHS considerations and mx
glucose high af–over 60 for coma (but over 30 usually)
very dry- give big fluids
Sodium very high (over 170)-as lose so much sodium in urine (thats part of the hyperosmolar with gluc), and very dehydrated)-BUT DO NOT CORRECT urgently as cerebral oedema
not acidotic
generally care about fast management-action can be dangerous
sliding scale be good-slower correction
usually dont know they have diabetes-cause it takes YEAR to develop
diabetic retinopathy
common in exam to have ophtalmoscopy– care–look at eyes, and then explain you see its in the eye, and even if the eyes are fine its an early warning sign, and that it means they should improve their control a bit more (nicely), and maybe HTN- easy station
background–stable diabetes pt-common exam. vision is FINE
Venodilation,
microaneurysm (dots)
Hard exudates-yellow spots around
ask about laser treatment
Pre-proliferative-soft exudate/cotton wool spts—fluffy spots
Proliferative=new vessels. Like TONS- usually think eyes are still okay–at that point want to photoburn the rest of macula- make sure vessels CANT grow there-preserve central vision
Hypertensive retinopathy
Grade 1- narrowing of artery-silver lines in artery
2- AV nipping (thinning of vein around)
3- flame heamoraghes (light largeish
4- pappilodema (blurry disc age)
can see infrarct of retinal artery-but thats GCA
there has been pt from neuro stations with papilloedma-and brain cancer
Causes of retinal artery occlusion, and retinal vein occulusion
retinal artery occlude-GCA- why eed treat
Retinal vein-Myeloma
