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
Quelles sont les complications chroniques du diabete
micro: retinopathie, IR, neuropathie
macro: AVC, infarcts du myocarde, IAMI
How to treat hypoglycemia
glucagon
glucose
What is the recommended diet
50% to 55% carbohydrate calories, 20% protein, and approximately 30% fat.
What is the relation between diabetes and thyroid
increased risk of thyroid auto-immune disease
same for celiac disease
Why does blood cell count increase in keto-acidosis
elevation of the stress hormones epinephrine and cortisol
What are the issues in adolescents
- menstrual irregualrities but normal ovulation
- a bit of delay for menarche
- hypogonadisme hypogonadotrope if uncontrolled
- hyperandrogenism with premenarcheal onsetof T1D and use of multiple insuline doses as risk factors
- increased risk of PCOS because of exogenous insulin
- hyperglycemia may cause early menopause
Contraception and diabetes
In general, adolescents with diabetes duration of less than 20 years without vascular complications are eligible to use any method of contraception
What are the main maternal problems in pregnant patients
A higher incidence of polyhydramnios and hypertensive disorders and progression of diabetes-related chronic complications, even if they have good metabolic control
What are the foetal problems in pregnant patients
preterm delivery, including spontaneous and indicated premature delivery stillbirth and major malformations macrosomie RCIU
Signes cliniques de la deshydratation chez l’enfant
Léthargie ou irritabilité Diminution du pli cutané Sécheresse des muqueuses Enfoncement des globes oculaires Absence de larmes Diminution de la perfusion périphérique Pouls radial rapide et faible Hypotension Oligurie, anurie
Risk factors for ulcers in feet
- Previous foot ulceration
- Neuropathy (loss of protective sensation)
- Foot deformity: pied de charcot
- Vascular disease
- IR et dialyse
Which med to avoid if history of ulceration
SGLT2 inhibitors
What are the autonomic neuropathy symptoms
- Sweating is diminished or absent; as a result, the skin of the feet remains dry and has a tendency to become scaly and cracked, thereby allowing infection to penetrate below the skin.
- Lack of autonomic tone in the capillary circulation causes shunting of blood from arteries directly into veins, bypassing the tissues that need nutrition. This results in a foot that feels warm and has distended veins and bounding pulses.
Quelle est la physiopathologie des ulceres du pied
- les microtraumatismes d’origine mécanique ou sur des zones d’hyperpression passent inaperçus en raison de la neuropathie sensitive. L’artériopathie compromet la cicatrisation. La neuropathie réduit la réponse inflammatoire, et contribue à la déformation de l’architecture du pied
- des callosités, phlyctènes et ulcérations se développent
- ces lésions sont des portes d’entrée à l’infection. L’hyperglycémie entrave le fonctionnement des neutrophiles, et l’artériopathie compromet l’apport d’antibiotiques à la lésion. En raison de l’hyperkératose plantaire dure, l’infection se propage vers l’espace intermétatarsien où la résistance tissulaire est moindre ;
- en cas d’évolution défavorable, l’infection peut perforer le dos du pied , atteindre l’os, se propager dans les tissus (dermo-hypodermite), puis infiltrer le système vasculaire et se disséminer (endocardite, infection d’implant, spondylodiscite).
ttt d’un ulcere du pied diabetique
- retablir les conditions locales: oxygene, nutriments, antibiotiques par chirurgien vasculaire
- attelle ou chaussage par ortho
- soins pedicure-podologue
