T1DM Flashcards
what are the diabetes mellitus sick day cures?
- monitor blood glucose more frequently- increase to 4 hrly
- encourage fluid intake- 3l in 24hrs
- if unable to eat may need sugary drinks to maintain carb intake
- have a box of sick day supplies they can access if they become unwell
- access to a mobile in case they go into DKA
- continue insulin- corrective dose may be given if BM is too high (total daily dose divided by 6)
why do people become hyponatraemic during a DKA?
body is in a hyperosmolar state because of hyperglycaemia. This leads to a dilution hypernatraemia
hat are features of DKA?
abdominal pain
polyuria, polydipsia, dehydration
Kussmaul respiration (deep hyperventilation)
Acetone-smelling breath (‘pear drops’ smell)
what are the diagnostic criteria for a DKA?
glucose > 11 mmol/l or known diabetes mellitus
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick
what are the values to look for when deciding if DKA has resolved?
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
if these criteria are met and patient is eating and drinking you can switch to Sub cut insulin
how long does the ketonaemia and acidosis take to resolve?
- within 24 hours, if it has not they need review from an endocrinologist
how fluid deplete are patients with DKA?
5-8 litres
what is the management for a DKA?
- insulin infusion 0.1 units/kg/hr and normal saline to compensate for the dehydration
- once blood glucose is <15mmol/l add 5% dextrose
- need to correct electrolyte disturbances, as giving insulin will cause a drop in serum potassium as all potassium rushes into the cells. so give 40mmol potassium in the second bag of saline and give this over 2 hours as you don’t want to correct >20mmol/hr
- if the rate of potassium infusion is >20mmol/hr then cardiac monitoring is required - if already on an insulin regime, long acting insulin should be continued and short acting should be stopped
what are the complications of DKA?
- gastric stasis
- thromboembolism
- arrythmias due to hyper/hypokalaemia
- ARDS
- AKI
- Cerebral oedema, which can be iatrogenic due to incorrect fluid therapy
what does an unrecordable blood glucose suggest?
- usually means the sugars are too high rather than too low
how can you distinguish between type 1 and type 2 diabetes?
C-peptide levels and diabetes-specific autoantibodies are the investigations of choice.
- in type 1 diabetes C peptide will be low
- autoantibodies may also be present
other investigations to suggest type 1?ketosis
rapid weight loss
age of onset below 50 years
BMI below 25 kg/m²
personal and/or family history of autoimmune disease
what are the different antibodies associated with type1 diabetes?
- (anti-GAD):80% of patients with T1DM
- Islet cell antibodies (ICA):Present in around 70-80% of patients with T1DM
- insulin autoantibodies (IAA)- correlates with age, found in >90% of young children with T1DM but only 60% of older patients
what is the HBA1C target for type 1 diabetics?
should be monitored every 3-6 months
adults should have a target of HbA1c level of 48 mmol/mol (6.5%) or lower
how many units of glucose should you treat with in a DKA?
0.1 units/kg
what is maturity onset diabetes of the young? MODY
Maturity-onset diabetes of the young (MODY) is characterised by the development of type 2 diabetes mellitus in patients < 25 years old. It is typically inherited as an autosomal dominant condition.
