Type 1 Diabetes Flashcards
What is the prevalence of diabetes under 18y
1/300-1/400
(second most common chronic illness in childhood)
What is the etiology of T1DM
Autoimmune and genetic features
What are the HbA1C targets (<6y, 6-12y, 13-18y) based on the Canadian Diabetes Association CPG?
What are general blood glucose targets?
<6y - <8% (evidence of poorer cognitive outcomes with tighter control/hypoglycemia)
6-12 - <7.5%
>13 - <7% (or lower if no hypoglycemic episodes)
Glucose targets 4-7
How common is DKA in first presentation Type 1 Diabetes - if not in DKA how do they present?
20-40%
-weight loss, polydipsia, polyuria
What is the cause of mortality in DKA, and how common is it?
Cerebral edema
Happens in <1% of DKA cases, but mortality 25% and morbidity 10-25%
What are the risk factors for development of cerebral edema in DKA?
low bicarb/use of bicarb
low pH
high urea
high glucose
faster administration of fluids/higher rate of rise of Na
What are the symptoms of DKA
fatigue
abdominal pain
nausea/vomiting - ‘gastro symptoms’
tachypnea
intercurrent illness
What are the laboratory findings in DKA
Blood gas - high glucose, low pH, low bicarb, low CO2 (compensation), high lactate
Serum labs (CBC, lytes, AG, glucose, creatinine, urea + labs for etiology of decompensation) - high anion gap
Urine - glucose and ketones
How do you calculate the anion gap?
Na - Cl - HCO3
How do you calculate the effective osmolality?
2Na + sugar + BUN
How do you calculate corrected sodium for glucose?
Na = Na + (glucose - 6) x 0.3
What are your anion gap and bicarb targets for DKA correction?
AG - 12-15
bicarb - >18
What are the signs/symptoms of cerebral edema
altered or fluctuating LOC
Cushing’s triad
headache
What are the signs/symptoms of hypoglycemia
Neuro - altered LOC, confusion, hemiparesis, seizures
CVS - dizziness, syncope
How do you adjust insulin during an intercurrent illness
Remember to continue giving your insulin even if unwell - check sugars to ensure not hypoglycemic
glucose >11 + mod/large ketones or glucose >17 - give 10-20% of total daily insulin as fast acting
What is the start dosing for insulin?
0.5-0.6 u/kg/d
*may need to decrease to 0.2-0.5u/kg/d in honeymoon phase
*adolescents may need >1.5u/kg/d
How is the TID insulin regimen dosed
Start with 0.5-0.7u/kg/d
2/3 of total insulin in AM
- 2/3 intermediate
- 1/3 rapid
1/3 of total insulin in PM
- 2/3 intermediate (give at bedtime)
- 1/3 rapid (give at supper)
How is the basal bolus regimen dosed?
- 5-0.7u/kg/d
- 50% basal, 50% bolus
- breakfast - rapid (1/3)
- lunch - rapid (1/3)
- supper - rapid (13)
- bedtime - long acting
What is the ISF?
Insulin sensitivity factor
ISF = 100/total daily dose
- each unit of rapid insulin will decrease BG by ISF
- helps make a sliding scale
e. g. TDD = 10
ISF = 100/10 = 10
1u of rapid will decrease blood glucose by 10
(actual glucose-target glucose)/ISF = dose
How do you adjust corrections if ketones +
multiply correction by 1.5 if ketones +
How do you do carbohydrate corrections
CHO ratio = 500/ total daily dose of insulin
e.g. 50kg child on 50u insulin daily
500/50 = 10
1 unit of rapid for each 10g CHO ingested
How do you treat hyperglycemia in a T1DM not in DKA
Give 10-20% of TDD as rapid insulin
Or give enough rapid insulin based on ISF to lower to 6-8
What are the microvascular complications of diabetes (3)
nephropathy (microalbuminuria)
retinopathy
neuropathy
What are common comorbidities of type 1 diabetes (6)
psychosocial/psychological disorders
eating disorders
dyslipidemia
hypertension
autoimmune thyroid disease
celiac disease
