Endocrinology Flashcards
When does a diabetes 1 patient become symptomatic?
When >90% of the beta cells are destroyed
What are the classical sx of diabetes?
Polyuria
Polydipsia
Blurred vision
Weight loss
Glycosuria
Ketonuria
How do you confirm the diagnosis of diabetes in a child?
SYMPTOMATIC PLUS
Fasting glucose >7
OR
2 hour post prandial glucose >11.1
OR
HbA1C>6,5%
How do you confirm Type 1 DM?
Islet antigen 2 antibodies
Glutamic acid decarboxylase antibodies (GAD)
What are the counter-regulatory hormones causing increased glucose?
Catecholamines
Glucagon
Cortisol
Growth hormone
What are clinical features of ketoacidosis?
Acidotic breathing
Nausea
Vomiting
Abdominal pain
Decreased LOC
Coma
What is the biochemical criteria for diabetic ketoacidosis?
hyperglycaemia >11
Venous pH <7.3
Serum bicarbonate <15
Ketonuria
What is Kussmaul breathing?
Abnormal breathing pattern characterised by rapid deep breathing at a constant pace
How do you manage ketoacidosis?
> IV 0,9% saline asap (10-20ml/kg bolus given over 1hr)
Deficit + maintenance replaced over 36-48hrs
> insulin 0,1units/kg/hr -> when glucose drops to less than 11, dextrose fluids added
add potassium to IV fluids when giving insulin
> discontinue fluids when patient stable and improved acidosis and ketonaemia
What are complications of DKA and how is it managed?
Cerebral oedema
>headache
>altered mental status
>vomiting
>HT
>inappropriate bradycardia
Management
>IV mannitol 1-2g/kg
How do you calculate the total daily insulin requirement?
0,5 x total weight in kg
*you can adjust this according to response
What different types of insulin are there?
Rapid
Short
Intermediate
Long
Premixed
What are the advantages of an insulin pump?
> Can adjust according to your schedule of travelling, working, exercise
can deliver in small doses in those extremely sensitive
avoid dawn phenomenon
durable and lasts years
What are the disadvantages of the insulin pump?
> wearing it can be unsettling
expensive costs
higher risk ketoacidosis (long acting insulin not used)
infection of infusion site
requires user input
Describe the Dawn Phenomenon
Normal glucose until +-3am where they become hyperglycaemic due to release of counter-regulatory hormones eg GH and reduced tissue sensitivity to insulin and decreased endogenous insulin release.
Describe the Somogyi effect
Nocturnal hypoglycaemia due to excess amounts of exogenous insulin and then rebound hyperglycaemia due to stimulated counterregulatory hormones. Wake up with hyperglycaemia
What is the dose of insulin needed per day?
Dependent on length of action
>0,5-0,6 units total insulin per kg per day
>long acting = 40-50% of total insulin x1 a day
>short acting = 50-60% divided between meals
What are possible reasons for higher insulin doses?
> illness
less activity
gain in weight
medication that changes insulin sensitivity
emotional stress
puberty
What are possible reasons for less insulin requirements?
> loss of weight
increased activity
exercise
renal impairment
When do you test effects of long acting and short acting insulin?
Long acting = before breakfast
Short acting = 2hrs after meal
Once every 1-2 weeks at 2-3am for Dawn and Somorgi effect
What are the symptoms of hypoglycaemia?
Sweating
Trembling
Dizziness
Mood changes
Hunger
Headaches
Blurred vision
Extreme tiredness and paleness
What are the symptoms of hyperglycaemia?
Dry mouth
Extreme thirst
Polyurea
Drowsiness
Frequent bed wetting
Stomach pain
What is hypoglycaemia and How do you manage hypoglycaemia?
Hypoglycaemia = BG<3
1)give sugar containing drink/snack
2)glucose 10-20g given and glucose rechecked in 10-15mins. Repeat if needed
3) if still not recovered/unconscious = IM or subcut glucagon
What are the long term cx of diabetes?
Micro vascular
>retinopathy
>neuropathy
>neohropathy
>cardiomyopathy
Macro vascular
>stroke
>coronary artery disease
>diabetic myomecrosis
>peripheral vascular disease
Neuropsychological cx
Poor growth
Delayed puberty
Eating disorders
Stress on family
