Problem 7 Flashcards
What are the islet beta auto-antibodies
insulin autoantibodies, antibodies to tyrosine phosphatase IA-2, antibodies to glutamic acid decarboxylase, and others
When does hyperglycemia become apparent
when insulin secretory capacity becomes inadequate to enhance peripheral glucose uptake and to suppress
hepatic and renal glucose production
Why does weight loss occur in diabetes
from the persistent catabolic state and the loss of
calories through glycosuria and ketonuria
What is the classic presentation of diabetes type I
polyuria
polydipsia
polyphagia
weight loss
When can we say the patient has diabetic ketoacidosis
if (1) the arterial pH is below 7.3
(2) the serum bicarbonate level is below 15 mEq/L
and (3) ketones are elevated in serum or urine.
Can diabetic ketoacidosis occur if the patient is treated
yes
if treatment ometted
or insulin injections are not enough because of stress hormones (glucagon, GH, catecholamines, cortisol)
What about the anion gap for ketoacidosis
elevated
What causes vomiting
Vomiting and increased insensible water losses caused
by tachypnea can worsen the dehydration
What causes electrolyte abnormalities in diabetes
occur through a loss of electrolytes in the urine and
transmembrane alterations resulting from acidosis. As hydrogen ions accumulate as a result of ketoacidosis, intracellular potassium is exchanged for hydrogen ions.
What about K concentration
intracellular is depleted
serum levels can be high low or normal depending on how long it has been for ketoacidosis
How is respiration with ketoacidosis
deep kussmaul respiration
What is the most serious DKA treatment complication
cerebral edema and cerebral herniation because of rapid fluid shifts
What is the treatment for DKA
careful replacement of fluid deficits
correction of acidosis and hyperglycemia via insulin administration
correction of electrolyte imbalances
and monitoring for complications of treatment.
What is a dermatological manifestation of hyperinsulinism and insulin resistance
Acanthosis nigricans
presents as hyperkeratotic pigmentation in the nape of the neck and in flexural areas and is noted as a sign in the metabolic syndrome.
Le diagnostic du diabete
Glycémie à jeun ≥7,0 mmol/l
Glycémie ≥11,1 mmol/l, lors d’un test de tolérance au glucose, 2 heures après ingestion de 1,75 g/kg (maximum 75 g) de glucose
Hémoglobine glyquée ≥6,5% (48 mmol/mol)
Glycémie ≥11,1 mmol/l à n’importe quel moment, accompagnée de symptômes classiques d’hyperglycémie
Insuline pour couvrir les besoins de repas
insuline sous forme d’analogue rapide
Insuline pour corriger les glycemies elevees
insuline sous forme d’analogue rapide
Les insulines rapides pour l’enfant
l’insuline lispro (Humalog®)
aspart (Novorapid®)
glulisine (Apidra®)
En plus, l’adjonction de niacinamide et de L-arginine à l’insuline aspart, a permis récemment d’accélérer l’entrée en action de cette dernière et a mené au développement d’une insuline encore plus rapide, la Fiasp
Les symptômes/signes d’hypoglycémies consistent en…
des manifestations adrénergiques telles que des tremblements, sudations, tachycardie
puis de neuroglucopénie avec trouble de la concentration, vision trouble, confusion et changement de l’état de conscience.
Type 2 diabetes
characterized by two underlying defects. The earliest
abnormality is insulin resistance, which initially is compensated for with an increase in insulin secretion. Type 2 diabetes mellitus then develops due to a defect in insulin secretion that prevents such secretion from
matching the increased requirements imposed by the insulin-resistant state.
What is MODY
Maturity-onset diabetes in youth could be considered in an adolescent who has a family history consistent with autosomal dominant inheritance of noninsulin-dependent diabetes with onset in the second or third decade of life
ttt of monogenic diabetes like MODY
oral hypoglycemic agents that stimulate endogenous insulin secretion through binding to the sulfonylurea receptor
What is the honeymoon phase
a time where residual function is present
so insulin requirements often decline temporarily 1 to 3 months after diagnosis.
What are the acute complications of diabetes
acido-cetose
hypoglycemia
