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Foundations III > Type 1 Diabetes, Hypoglycemia, HHS, & DKA > Flashcards

Type 1 Diabetes, Hypoglycemia, HHS, & DKA Flashcards

1
Q

Immune-mediated Type 1 DM

A
  • Scandinavia and northern europeans

- Beta cell autoimmunity

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2
Q

Idiopathic Type 1 DM

A

Type 1B

  • Far fewer than type 1-A
  • Asian or African origin
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3
Q

What is an almost certain predictor of clinical hyperglycemia and diabetes in Type 1 ?

A

presence of 2 or more autoantibodies

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4
Q

If you find auto-antibodies, who else needs to be screened?

A
  1. Siblings

2. Adults with atypical features of Type II diabetes

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5
Q

Name the 5 autoimmune markers for Type I diabetes

A
  1. ICA antibody
  2. Glutamic Acid decarboxylase (GAD54)**
  3. Insulin autoantibody
  4. Tyrosine phosphatase (IA-2)
  5. Zinc Transporter 8 (ZnT8) -enzyme specific to beta cells
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6
Q

What do low levels of C-peptide and insulin usually point to?

A

Type 1 diabetes

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7
Q

What is the most sensitive and specific diagnostic lab for type 1 diabetes?

A

Glutamic acid decarboxylase (GAD65)

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8
Q

What happens to antibody levels as disease duration increases?

A

antibody levels decline with time

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9
Q

What develops in almost all patients once they are treated with insulin?

A

anti-insulin antibodies

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10
Q

What is normal A1c?

A

<5.7%

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11
Q

What is prediabetes A1c?

A

5.7 - 6.4%

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12
Q

What should be used to diagnose Type 1 diabetes?

A

blood glucose is best for diagnosing Type 1 Diabetes in symptomatic patients

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13
Q

According to the American Diabetes Association, what should a type 1 diabetic strive to keep their A1c at?

A

<7.5

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14
Q

What are the classic presentation of Type 1 diabetes?

A
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Weight loss

also:
-blurred vision

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15
Q

Type 1 diabetes: essentials of diagnosis

A
  1. Glucose 200mg/dL or more
  2. Fasting plasma glucose >126mg/dL x2 (separate occasions)
  3. Ketoemia, ketouria
  4. Autoantibodies
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16
Q

Clinical presentations that are more common in Type 1 Diabetes

A
  • Lethargy
  • Stupor
  • Smell of acetone**
  • Kussmaul breathing (hyperventilation)
  • N/V/Abdominal pain
  • Nocturnal Enuresis (bedwetting)*
  • Abrupt onset
  • No/Rare micro or macrovascular complications at dx
17
Q

What is the glycemic criteria for Glucose alert value (level 1)?

A

<70mg/dL

18
Q

What is the glycemic criteria for clinically significant hypoglycemia (level 2)?

A

<54 mg/dL

19
Q

Behavioral causes of hypoglycemia

A
  1. Insulin overdose
  2. EtOH abuse (glycogen depletion)
  3. Post exercise
20
Q

Name important medication causes of hypoglycemia

A
  1. Beta blocker
  2. Beta-adrenergic blocking agents
  3. Sulfonylureas
  4. ACE inhibitors
  5. Fluoroquinolones
  6. Salicylates
  7. Pentamidine (pneumocystis jirovecii)
21
Q

What blood test will be high if a patient has an insulinoma?

A

c-peptide

22
Q

Name 2 important other/endrocrine etiologies of hypoglycemia

A
  1. Hypopituitarism

2. Addison disease

23
Q

15:15 Rule

A
  • Give 15 grams of carbohydrates (ex. juice, or glucose tablets)
  • Repeat in 15 mins as needed.
24
Q

What medication can be given in cases of hypoglycemic emergencies?

A

glucagon (if the person is unable to remain conscious)

25
Q

Somogyi effect

A

Nocturnal hypoglycemia

-counter regulatory hormones that produce high blood glucose by 7am (prebreakfast hyperglycemia)

26
Q

Treatment for Somogyi effect

A

eliminate intermediate insulin dose at dinnertime, and give lower dose at bedtime

or

increase food intake at bedtime

27
Q

Which ion is the predominating factor in determining osmolality?

A

sodium (Na+)

28
Q

What 3 ions contribute to serum osmolarity?

A
  1. Sodium
  2. Glucose
  3. Urea (BUN)
29
Q

Hyperglycemic hyperosmolar state more commonly occurs in which type of diabetes?

A

Type II

30
Q

Hyperglycemic Hyperosmolar State

A
  • Type II DM
  • Hyperglycemia (>600mg/dL)
  • Serum osmolality ( >310 and 280 is normal)
  • No acidosis, blood pH is >7.3
  • Minimal ketouria/ketoemia
31
Q

Hyperglycemic Hyperosmolar state: signs and symptoms

A
  • Profound dehydration
  • Non-ketotic
  • polydipsia
  • Polyuria
32
Q

Hyperglycemic Hyperosmolar state: Lab results

A
  1. Plasma glucose: 800- 2400mg/dL!!!

2. Serum Urea nitrogen also very elevated!!

33
Q

Hyperglycemic hyperosmolar state: Tx

A
  1. FLUIDS!!!!!
  2. insulin (IV)
    (keep the glycemic levels between 250-300 to reduce risk of cerebral edema, once stable can give subcutaneously)
  3. K+
  4. Phosphate
34
Q

What is the most common precipitating factor of Diabetic Ketoacidosis?

A

infection**

others: steroids, -itis, EtOH, insuin deficiency, MI

35
Q

In Diabetic ketoacidosis, what other labs with be elevated?

A
  • glucagon
  • cortisol
  • GH
  • epinephrine/norepinephrine
36
Q

What are 2 important initial studies for DKA?

A
  • UA
  • Serum ketones
  • CBC
  • BMP (K+)**
  • ABG= metabolic acidosis
  • EKG
37
Q

What are the main differences with DKA and HHS?

A

DKA: glucose >250, acidotic, ketouria and/or ketoemia

HHS: glucose >600, alkalotic, minimal to no ketones

38
Q

DKA: signs and symptoms

A
  • N/V/abdominal pain
  • hyperventilation (kussmaul breathing)
  • Fruity breath with acetones
  • Possible altered mental status
  • Hypovolemia (tachycardia and orthostasis)

Foundations III (34 decks)

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