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ClinMed exam III > Type 1 DM > Flashcards

Type 1 DM Flashcards

1
Q

Age distribution of individuals diagnosed with DM1

A

bimodal
4-6
10-14

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2
Q

What are the risk factors for DM1

A
  • genetics
  • environment
  • immune system response
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3
Q

What specific environmental factors put someone at risk for DM1

A
  • viral infection
  • immunizations
  • early intro to cows mild
  • obesity
  • vit d deficiency
  • perinatal factors
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4
Q

Classic signs and symptoms of DM1

A
  • polyuria
  • polydipsia
  • weight loss
  • fatigue
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5
Q

What does insulin do in the body?

A
  • allows for entry of glucose into tissue
  • promotes storage of carbs and fat
  • promotes synthesis of proteins
  • inhibits lipolysis, glycogenolysis and tissue catabolism
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6
Q

Why do we need sugar in our cells

A

for energy, ATP

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7
Q

What does glucagon do in the body?

A
  • stimulates glycogenolysis

- stimulates gluconeogenesis

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8
Q

Pathophysiology of DM1

A
  • abnormal glucose homeostasis

- relative or absolute reduction in insulin secondary to beta cell dysfunction

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9
Q

Process of glucose homeostasis

A

serum glucose rises–>insulin released–>serum glucose falls

serum glucose falls–> glucagon released–>serum glucose rises

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10
Q

Why does polyuria happen in DM1

A

OSMOTIC DIURESIS

-excess glucose being excreted via the kidney, water follows the glucose= more pee

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11
Q

Why does polydypsia happen in DM1

A

because of the polyuria there is increased serum osmolality and hypovolemia

(need water to correct it)

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12
Q

Why does weight loss occur in DM1

A

increased catabolism and hypovolemia

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13
Q

Why would someone with DM1 get frequent infections

A

bacteria loves sugar

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14
Q

Why would someone with DM1 get blurry vision

A

the increase in blood glucose casues the lens of the eye to swell

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15
Q

What should blood glucose levels be in order to diagnose DM

random blood glucose?
fasting blood glucose?
glucose tolerance test?

A

random: >200 w/ assoc sx
fasting: >126
tolerance test: >200

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16
Q

When are glucose tolerance tests usually done

A

during pregnancy

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17
Q

What is the leading cause of morbidity and mortality in children with DM1

A

diabetic ketoacidosis

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18
Q

What is DKA

A
  • hyperglycemis (>200)
  • metabolic acidosis (pH <7.3 or bicarb <15)
  • ketosis
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19
Q

Signs and symptoms of DKA

A
  • vomiting
  • tachypnea
  • abd pain
  • SOB
  • mental status changes
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20
Q

What does DKA often mimic

A

GI illness or the flu

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21
Q

What are the vitals on a patient in DKA going to be

A
  • low BP
  • weak peripheral pulses
  • elevated pulse rate
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22
Q

Why would you need to obtain a weight on a patient in DKA

A

in order to replenish the 5-10% water deficit that the patient has

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23
Q

Why should you do a neuro exam on a patient in DKA

A

to look for cerebral edema

24
Q

What labs would you check for a DKA assesment

A
  • BGL
  • ketones
  • electrolytes (sodium/potassium)
  • ? lactate
  • BUN and creatine (kidney function)
  • venous pH
  • CBC (for infection)
25
Q

4 things that need to be managed in DKA

A
  • dehydration
  • hyperglycemia
  • sodium
  • potassium
26
Q

How do you manage dehydration in DKA

A
  • gradual rehydration with isotonic fluid

- 10mL/kg over 1 hour, max 1000mL

27
Q

How do you manage the hyperglycemia in a patient in DKA

A

insulin infusion

0.1 units/kg/hour

28
Q

For a patient in DKA what do you do once the blood usgar falls below 300? Why?

A

change the fluid from isotonic fluid to fluids containing sugar

the body still needs sugar to function, cant take it all away with the insulin

29
Q

Why is the sodium levels monitored when a patient is in DKA

A

as water moves into the cells, the serum sodium will rise

30
Q

What does insulin do to potassium in the body

A

drives it into the cells which decreases serum K

31
Q

What do you do to treat a patient in DKA that presents with

hyperkalemia?
normokalemia?
hypokalemia?

A

hyperkalemia: proceed with giving insulin
normokalemia: watch for hypo, give K with the insuilin
hypokalemia: give K first then give insulin

32
Q

What other bloodwork should be done once a diagnosis of DM1 is made

A
  • T1D antibodies
  • thyroid
  • celiac disease
33
Q

Two things used for medical management of DM1

A
  • insulin to keep glucose levels down

- glucagon to raise glucose levels up

34
Q

What are your prandial insulins

A
  • aspart
  • glulisine
  • lispro
  • regular
35
Q

What are your basal insulins

A
  • detemir
  • glargine
  • NPH
36
Q

When should you check ketones in a patient with DM1

A
  • when BGL >300

- when patient is sick

37
Q

Definition of hypoglycemia

A

BGL less than 70

38
Q

What are the symptoms of hypoglycemia

A
  • shaky
  • teeth chattering
  • dizzy
  • tired
39
Q

What are the symptoms of hyperglycemia

A
  • irritability
  • tiredness
  • thirst
  • frequent urination
  • headache
  • blurred vision
  • being “zoned out”
40
Q

What is the Dawn phenomenon

A

a surge of hormones (cortisol) that occur around 4/5 am causes high blood sugar in the morning

41
Q

Treatment of the dawn phenomemon

A

adjust overnight basal insulin

42
Q

What is the Somogyi effect

A

patient become hypoglycemic around 2/3am and the body releases hormones which overshoot the correction and cause hyperglycemia in the morning

43
Q

How many grams of carbs are you supposed to have in a meal

A

45-60g

44
Q

What is the typical insulin to carbs ratio

A

1 unit of insulin for every 15/20 carbs

45
Q

Complications of DM

A
  • diabetic retinopathy
  • peripheral neuropathy
  • nephropathy
  • skin complications
46
Q

What is the initial manifestation of diabetic eye disease

A

non-proliferative retinopathy

47
Q

What causes non-proliferative diabetic retinopathy

A

dilation of small vessels; vessel closure–>ischemia–>increased permeability

48
Q

Symptoms of non-proliferative retinopathy

A

none, asymptomatic

49
Q

Signs of non- proliferative diabetic retinopathy

A

microaneyursm, hemorrhages, “cotton wool” spots, lipid exudates

50
Q

What needs to be done in proliferative diabetic retinopathy

A

tighter glucose control

51
Q

What kind of neuropathy do diabetics get

A

symmetrical sensory polyneuropathy

52
Q

Where does diabetic neuropathy start? where does it progress to?

A

starts in the feet, once it reaches mid calf and starts in the hands

53
Q

What will a physical exam show in a patient that his diabetic neuropathy

A
  • vibratory sensation loss
  • altered propioception
  • impaired pain, light touch and temperature
  • decreased relfexes
54
Q

Pathophys behind diabetic nephropathy

A

mesangial expansion

  • glomerular basement membrane thickening
  • podocyte injury
  • glomerular sclerosis
55
Q

Signs and symptoms of diabetic nephropathy

A
  • albuminuria

- possible hematuria

56
Q

What does DM1 cause in pregnancy? why?

A

macrosomia

-there is more glucose crossing the placenta but no insulin so the baby has to make more

ClinMed exam III (7 decks)

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