S17C218 - Type 1 diabetes mellitus Flashcards
Type 1 vs type 2 diabetes
- T1 makes up 10% of diabetics
- failure to produce insulin from beta cell destruction
- T2 is a failure to tissues to respond to insulin (insulin resistance) or insulin deficiency or a combo
Insulin
- for the most part it is 100 units/ml (U100)
- there does exist U500 in hospitals
General insulin regimen
- 1/2 of daily requirements for insulin given long acting (basal dosing) - once daily long-acting or twice daily intermediate acting
- 1/2 of daily requirements given prandial dosing (administered 5-30min before a meal)
Some key glucose measurements and their conversions:
126mg/dL = 7 mmol/L 200mg/dL = 11.1 mmol/L
Dx of DM
-fasting plasma glucose >7 (no eating in past 8h)
or
-random plasma glucose >11.1 and symptoms of hyerglycemia (polyuria, polydipsia, wt loss)
or
-2h OGTT >11.1
- all are equal to or greater than
Insulin correction if glucose found to be incidentally high
-give 1 unit of rapid-acting for every 3 mmol/L above target for type 1 diabetics and 1 unit for every 2mmol/L above target for type 2
Signs that insulin has denatured
-frosting on sides of vial (leaves insulin ineffective, can lead to DKA)
Peritoneal dialysis and glucose
-PD will falsely elevate capillary glucose testing therefore it should be done at a central lab with plasma glucose (b/c of the icodextrin)
Causes of hypoglycemia
- inadequate intake
- inaccurate insulin dosing
- infection
- renal failure
- ACS
- stress
Hypoglcyemia: sx
- drowsy, confused, dizzy, tired, inability to concentrate, difficulty speaking
- adrenergic sx: tremor, sweating, anxiety nausea, palpitations, warmth, shivering
- hunger, weakness, blurred vision
Hypoglycemia: tx
- 15-20g PO/PR/IV
- repeat if hypoglycemic after 15mins
- give one amp of d50 (Dextrose 50%) which is 50cc which is 25 grams
- 1mg glucagon IM (takes 10-15mins to take effect)
- other equivalents: 1 cup of juice, 1 tbsp of honey, 2tbsp of icing, 1 can of pop, 4 glucose tabs
