Type 1 DM

Question 1

2 types of metabolic acidosis

Answer 1

1. anion gap

2. non-anion

Question 2

DDx for anion gap

Answer 2

MUDPILES
Methanol
Uremia
DKA
Paraldehyde
Isoniazide
Lactic acidosis
Ethyl
Salicylates

Question 3

DDx for non-anion gap (5)

Answer 3

1. hyperalimentation
2. acetozolamide
3. Renal tubular acidosis
4. Diarhhea
5. Sigmoid fistula

Question 4

patho of DKA

Answer 4

1. no insulin
2. increased glucose release from liver
3. osmotic diuresis from high glucose
4. FFA release from liver converted to ketone bodies
5. Ketones cause the gap

Question 5

***diff between T1 and T2 in terms of cause, prevalence, associations, ketoacidosis, pops, age of onset, insulin injections

Answer 5

cause-  insulin def:insulin insensitive
prev- 10%:90
assoc- autoimmunes:metabolic syndromes
ketoacidodiss- yes:seldom
pops- scanidnavian:aboriginal/asian
age- young:old
insulin- always:sometimes

Question 6

presentation of T1DM

Answer 6

• hyperglycemic osmotic diuresis w/ ECFV contraciton
• anion gap
• beta-hydroxybutrate pos

Question 7

5 main principles***

Answer 7

1. prevent hypokalemia
2. restore ECFV contraction
3. correct met. acidosis
4. manage hyperosmolarity
5. ID precipitating cause

Question 8

what is issue with hypokalemia

Answer 8

K deficit in DKA

• giving insulin can cause intracellular shift
• add K to IV

Question 9

**what is major cause of death in DKA

Answer 9

hypokalemia

Question 10

**what is mainstay of glucose control in DKA

Answer 10

fluids, not insulin

Question 11

what are 2 purposes of IV saline

Answer 11

1. restore ECFV

2. osmtotic diuresis of glucose

Question 12

how to correct met. acidosis

Answer 12

IV insulin

• 0.1 unit/kg IV and then drip
• adjust to level of acidosis, not glucose

Question 13

how to manage hyperosmolarity

Answer 13

rapid reduction can lead to cerbral edema, so correct slowly

Question 14

possible precipitating causes

Answer 14

1. new onset T1DM
2. infection
3. MI
4. inadequate insulin

Question 15

what is phsyiological insulin levels like?

Answer 15

boluses after meals and slow release at night as liver releases glucose

Question 16

2 components of insulin protocol

Answer 16

1. basal insulin

2. prandial/bolus

Question 17

2 bolus types

Answer 17

1. rapid - aspart

2. short acting - humulin R

Question 18

2 types of basal insulin

Answer 18

1. intermediate - humulin N

2. long acting - detemir

Question 19

how to allocate daily dose

Answer 19

50% bolus

50% basal

Question 20

what is caveat in switching from IV to SC insulin

Answer 20

IV only last 20 minutes, so need to give SC 4 hour before stop IV

Question 21

how does pump work

Answer 21

enzyme based continuous glucose monitoring