T1DM Flashcards

Question

When to screen in T1DM: Nephropathy

Answer 1

Yearly starting age 12y and 5y duration

Answer 2

yearly starting age 15y and 5y duration can go to 2y if good glycemic control

Answer 3

15y and older if poor metabolic control and 5y duration yearly

Answer 4

age 12y and 17y delay after dx until metabolic control if <12y, only screen if BMI> 97th %ile, Fh of dyslipidemia or CVD

Answer 5

all children q6months

Answer 6

Any condition that prolongs the life of the erythrocyte or is associated with decreased red cell turnover iron deficiency vitamin B-12 and folate deficiency anemias asplenia/splenomegaly uremia/chronic renal failure severe hyperTG severe hyper bili chronic alcohol anemia from blood loss pregnancy Vit E ingestion fructosamine

Answer 7

corticosteroids, catecholamines, glucagon, and GH

Answer 8

i) Under the age of 7 (as per ISPAD guidelines) ii) Recurrent severe hypoglycemia iii) Large fluctuation in glucose levels iv) Suboptimal glycemic control (A1C out of range) v) Microvascular complications or risk factors for macrovascular complications vi) Insulin regimen compromises lifestyle vii) Pronounced dawn phenomenon viii) Needle phobia ix) Pregnant adolescents x) Competitive athletes xi) Ketosis prone individuals · Low insulin needs (less than 0.5 units per injection) · Motivation for a pump · Wants flexibility · Gastroparesis · type 2 diabetes who are not meeting glycemic targets with MDI, oral medication, and lifestyle modifications

Answer 9

· Establishment of a basal profile tailored to patient for better overnight and between meals glucose control · Easier to manage glycemic excursions that occur with exercise · Ability to calculate boluses based on glucose reading and carbs easily · Keeps track of time since last bolus and correction – reduces risk of overcorrecting

Answer 10

· Higher risk of DKA due to pump failure given no long-acting insulin · Costly · Time demanded of MD and staff in initiating therapy

Answer 11

i) Sites are getting placed into areas of lipohypertrophy ii) Not changing sites regularly iii) Bolusing after or during eating iv) Missing boluses v) Not giving correction boluses vi) Not putting current BG into pump when bolusing vii) Basal rates require adjustment viii) Extended periods with the pump suspended ix) Outgrown ISF x) Active insulin time is too long

Answer 12

TDD x 0.75 divided 2, then divided by 24 hours

Answer 13

- rise of BG in early morning hours due to spike of counterregulatory hormones - can start ~2AM; often can be managed by increasing basal rate or adding basal about an hour before spike that is higher

Answer 14

-New/worsening headache -Nausea/vomiting -Cushing’s triad (bradycardia, widened pulse pressure, bradypnea/irregular respirations) -loss of consciousness -abnormal pupillary responses -respiratory failure -specific focal neurological defects (posturing, cranial nerve palsy)

Answer 15

One diagnostic criterion, two major criteria, or one major and two minor criteria have a sensitivity of 92% and a false positive rate of only 4%. Diagnostic criteria ● Abnormal motor or verbal response to pain ● Decorticate or decerebrate posture ● Cranial nerve palsy (especially III, IV, and VI) ● Abnormal neurogenic respiratory pattern (eg, grunting, tachypnea, Cheyne-Stokes respiration, apneusis) Major criteria ● Altered mentation, confusion, fluctuating level of consciousness ● Sustained heart rate deceleration (decrease more than 20 beats per minute) not attributable to improved intravascular volume or sleep state ● Age-inappropriate incontinence Minor criteria ● Vomiting ● Headache ● Lethargy or not easily arousable ● Diastolic blood pressure >90 mm Hg ● Age <5 years

Answer 16

-Elevate head of bed/centre head -Reduce fluid rate -Supportive therapy for respiration (ie oxygen) -Mannitol or 3%NaCl

Answer 17

Benign postural proteinuria, diabetes related nephropathy, exercise induced proteinuria, febrile illness, UTI, acutely elevated glucose Decompensated CHF Menstruation Acute severe elevation in BG Acute severe elevation in BP

Answer 18

i) Optimizing glycemic control ii) Blood pressure control (<130/80) iii) Blocking RAAS – ACEi or ARB (independent of BP) iv) SGLT2 inhibitor (also has cardioprotection)

Answer 19

● Thick secretions plug pancreatic ducts causing a chronic pancreatitis like picture and beta cell damage ● Chronic steroid exposure ● High caloric and often carbohydrate intake ● Insulin resistance from chronic hyperglycemia causing down regulation of GLUT4 transporters ● CFTR channel on beta cells may play a role in insulin secretion ● Tube feeding

Answer 20

- 10 yo w OGTT - they don't get microvascular complications

Answer 21

- CFRD - osteoporosis - short stature - male infertility - delayed puberty

Answer 22

Euglycemic Hyperinsulinemic Clamp Test 1. Primed continuous insulin infusion is administered to raise plasma insulin level to a predetermined physiological or pharmacological level 2. Plasma glucose concentration is measured q5min and variable GIR is administered to maintain the plasma glucose concentration constant at the fasting level 3. Given that plasma concentration of insulin is steady, the amount of exogenous glucose administered equals the amount of glucose utilized in response to the hyperinsulinemia and provides a direct measure of whole body sensitivity to insulin; can then predict Insulin Sensitivity Index from this value

Answer 23

1. Homeostasis model of Insulin Resistance (HOMAir): estimates insulin resistance using the formula: a. HOMAir (mmol/LxuU/mL) = fasting BG (mmol/L)x fasting insulinuU/mL/22.5 (higher values means increased insulin resistance) 2. Insulin sensitivity index (ISI) = 10 000/ square root (fasting BGxfasting insulin) x (mean glucose x mean insulin during OGTT) → lower the ISI, the more insulin resistant the subject is

Answer 24

- Shift of K from intracellular to extracellular space in exchange with hydrogen ions that accumulate extracellularly in DKA → shifted K is lost by osmotic diuresis - Administration of insulin, leading to intracellular shift of K - Secondary hyperaldosteronism due to dehydration leading to excretion of K to hold on to Na/fluid for fluid repletion - low total K in body

Answer 25

i) Malignant hyperthermia (mechanism unknown) ii) Rhabdomyolysis due to acute renal failure iii) Altered mental status (reversible) iv) Venous thrombosis associated with central venous cath

Answer 26

· Type 1 diabetes – in honeymoon phase · CFRD – there’s not absolute insulin insufficiency T2DM, acute renal failure (C-peptide is renally cleared)

Answer 27

Has low aqueous solubility at neutral pH; in injection solution, which is pH 4, solution is completely soluble. Acidic solution is neutralized on injection into SC tissue, leading to microprecipitates, from which small amounts of insulin glargine are released. Leads to slow release and a constant (peakless) release over time.

Answer 28

chronic renal failure splenomegaly rheumatoid arthritis use of erythropoietin iron or B12 reticulocytosis chronic liver disease ingestion of aspirin, vit C or Vit E hemoglobinopathy hyperTG assay

Answer 29

encourages lipolysis and ketone production in the liver Binds to receptor on hepatocytes and causes stimulation of glycogen store breakdown maintains gluconeogenesis (production of glucose from amino acids)

Answer 30

1. Consider measuring BG right before driving 2. Keep meter/testing supplies easily accessible 3. Keep rapid glucose available to treat low 4. If driving for long periods, check at least every 4h 5. Consider a CGM so that you can receive alerts 6. Consider checking BG more often if at risk of lows ie if have exercised recently, skipped a meal 7. If recurrent, severe hypoglycemia or hypoglycemia unawareness, must check immediately before driving, at least q2h and/or have a CGM 8. DO NOT start driving if BG<4; if <4, treat with 15g carbs and wait 40min; before driving, should be >5mmol/L 9. If hypoglycemia occurs while driving, pull over in a safe spot and take keys out of ignition. Treat and wait 40min after correction to begin driving again 10. On long journeys, take regular periods for snacks/meals/rest