Peds - Endo Flashcards
Which type of diabetes is more commonly associated which ketones?
Type I
What markers are associated with Type I Diabetes?
HLA-DR3
HLA-DR4
human leukocyte antigens
What markers are associated with Type II Diabetes?
None
What is the general pathophysiology of Type I Diabetes?
at symptom presentation most of the pancreatic ISLET cells have been destroyed and islet cell ANTIBODIES are detected (AUTOIMMUNE process)
What is the trigger?
infectious or toxic insult to pancreatic cells of genetically predisposed individual
Three P’s which are classic symptoms of Type I Diabetes?
Polydipsia
Polyphagia
Polyuria
seen less commonly in Type II
Other symptoms of Type I Diabetes? (6)
o weight LOSS, with INCREASED hunger o fatigue o weakness o paresthesia o irritability --> coma o nocturnal enuresis
Signs of advanced Type I Diabetes found on physical exam? (3)
EYES, VASCULATURE, NEURO (reflexes)
o ophthalmic exam – microaneurysms or cotton wool spots
o peripheral vascular insufficiency (sensation impaired)
o diminished deep tendon reflexes
Random blood sugar of ____ and what other symptoms indicated the need for fasting studies.
Random blood sugar >/=200 mg/dL AND polydipsia polyuria weight loss
Diagnostic laboratory study for Type I Diabetes?
Fasting blood sugar >/= 126 mg/dL on 2 occasions
Normal A1c?
5.5 to 7 %
target for good diabetic control? 6%
A1c of 4.8% in a diabetic indicates what?
Blood glucose is too tightly controlled
What is IMPAIRED GLUCOSE TOLERANCE and how is it measured?
can be thought of as “pre-diabetes” where fasting BG is elevated, but not to 126 threshold for Diabetes
FBG between 100 and 125 mg/dL
encourage exercise
bring back in 3 - 6 months
What do ketones mean from a management perspective?
patients presenting with ketones must start INSULIN
What is the rule of thumb for initiating insulin?
0.5 units/kg/day with 2/3 in AM and 1/3 in PM
NPH is ___ acting.
short
Somogyi Effect and Dawn Phenomenon both result in:
HYPERglycemia in the morning
Somogyi Effect is characterized by what pattern? What is the cause?
HYPOglycemia around 3 AM and HYPERglycemia by 7 AM
nocturnal hypoglycemia stimulates a surge of counter regulatory hormones that raise blood sugar
(Somogyi is Tsunami - low then high)
Treatment for Somogyi Effect?
reduce or eliminate HS insulin
Dawn Phenomenon is characterized by what pattern? What is the cause?
Blood glucose rises through the night with HYPERglycemia at 7 AM
nocturnal desensitization of tissues to insulin as a result of night surge of growth hormone
(the Dawn slowly rises…)
Treatment for the Dawn Phenomenon?
Increase the dose of insulin at HS
What is often the first sign of Type II Diabetes in females?
recurrent vaginitis
Early disease may be asymptomatic and physical exam unremarkable in Type II Diabetes. If signs and symptoms do occur, what are they?
o acanthosis nigricans o chronic skin infections o pruritis o peripheral neuropathies o recurrent blurred vision
Laboratory diagnostics in Type II Diabetes?
Same as Type I
except do not expect to see ketones in urine or blood
Signs associated with insulin resistance?
o acanthosis nigricans
o hypertension
o dyslipidemia
o polycystic ovarian disease
When should children be screened for Type II Diabetes?
In obese children, starting at the first of age 10 or puberty, and then every 2 years IF two or more of the following are present…
o family history
o minority race
o signs if insulin resistance
Management of Type II Diabetes in children? (1+3)
Refer to endocrine for management and expect the following:
o weight management
o metformin/glucophage
o insulin therapy if severe
How does Metformin work?
reduces gluconeogenesis
What is a potential side effect of Metformin?
significant gastrointestinal upset
however, usually limited to ~2 weeks
T3 is otherwise known as
Triidodthyronine
T4 is otherwise known as
Thyroxine
More important lab in HYPERthyroidism - T3 or T4
T3 / triiodothyronine (INCREASED)
T3 is very important to consider, right after TSH which is DECREASED
Grave’s disease is an example of ____-thyroidism
HYPER
HYPERthyroid is most commonly seen in:
girls between the ages of 12 and 14 years and can be associated with autoimmune diseases
HYPERthyroid common symptoms
Everything is INCREASED/sped up
o heart rate
o nervousness
o metabolism (resulting in weight loss)
FINE HAIR is associated with ____-thyroidism
HYPER
Other than TSH, T3, and T4, what other lab test is elevated in HYPERthyroid?
Serum ANA (antinuclear antibodies) without evidence of lupus
What medication is commonly used to treat the symptoms of HYPERthyroid?
Propranalol
Three potential treatments of HYPERthyroid? (3)
o radioactive iodine
o thyroid surgery
o Lugol’s solution x 10 days to reduce vascularity
WHERE is the problem in HYPOthyroidism? (3)
disease of thyroid itself
or decreased TSH from pituitary
or decreased TRH from hypothalmus (thyrotropin-releasing hormone)
What is the underlying cause of HYPOthyroidism? (4)
o autoimmune most common
o iodine deficiency
o deficient pituitary
o destruction of the gland (surgery, radiation, trauma)
Signs and symptoms of HYPOthyroidism in INFANTS?
o begin after first month of life
o lethargy
o poor feeding
o large fontanels
What is the appearance of the tongue in HYPOthyroid?
thick tongue
What is the appearance of the face in HYPOthyroid?
puffy eyes and face
Diagnostic (thyroid specific) lab work in HYPOthyroidism?
o elevated TSH
o decreased T4
o decreased free T4
“T3 has no role in hypothyroidism”
Other lab values in HYPOthyroid?
o increased serum cholesterol o increased liver enzymes o hyponatremia o hypoglycemia o anemia
Failure to grow more than how many cm per year is a red flag?
4 cm per year
How is a bone age test used to determine if growth hormone therapy is appropriate?
If bone age is consistent with height age then the child should NOT be given growth hormone.
What happens if growth hormone is given when not clinically appropriately?
It speeds the closure of the epiphyseal growth plate, actually thwarting growth
Major side effect of growth hormone
severe headache
Four endocrine diseases that can result in proportional short stature?
o growth hormone deficiency
o hypothyroid
o hypopituitary
o diabetes
What are two conditions that can result in DISproportionate short stature?
o dwarfism
o rickets
With what effect on puberty is constitutional growth delay associated?
delayed onset of puberty
patient and family should be educated
