Type 1 DM Flashcards
Age distribution of individuals diagnosed with DM1
bimodal
4-6
10-14
What are the risk factors for DM1
- genetics
- environment
- immune system response
What specific environmental factors put someone at risk for DM1
- viral infection
- immunizations
- early intro to cows mild
- obesity
- vit d deficiency
- perinatal factors
Classic signs and symptoms of DM1
- polyuria
- polydipsia
- weight loss
- fatigue
What does insulin do in the body?
- allows for entry of glucose into tissue
- promotes storage of carbs and fat
- promotes synthesis of proteins
- inhibits lipolysis, glycogenolysis and tissue catabolism
Why do we need sugar in our cells
for energy, ATP
What does glucagon do in the body?
- stimulates glycogenolysis
- stimulates gluconeogenesis
Pathophysiology of DM1
- abnormal glucose homeostasis
- relative or absolute reduction in insulin secondary to beta cell dysfunction
Process of glucose homeostasis
serum glucose rises–>insulin released–>serum glucose falls
serum glucose falls–> glucagon released–>serum glucose rises
Why does polyuria happen in DM1
OSMOTIC DIURESIS
-excess glucose being excreted via the kidney, water follows the glucose= more pee
Why does polydypsia happen in DM1
because of the polyuria there is increased serum osmolality and hypovolemia
(need water to correct it)
Why does weight loss occur in DM1
increased catabolism and hypovolemia
Why would someone with DM1 get frequent infections
bacteria loves sugar
Why would someone with DM1 get blurry vision
the increase in blood glucose casues the lens of the eye to swell
What should blood glucose levels be in order to diagnose DM
random blood glucose?
fasting blood glucose?
glucose tolerance test?
random: >200 w/ assoc sx
fasting: >126
tolerance test: >200
When are glucose tolerance tests usually done
during pregnancy
What is the leading cause of morbidity and mortality in children with DM1
diabetic ketoacidosis
What is DKA
- hyperglycemis (>200)
- metabolic acidosis (pH <7.3 or bicarb <15)
- ketosis
Signs and symptoms of DKA
- vomiting
- tachypnea
- abd pain
- SOB
- mental status changes
What does DKA often mimic
GI illness or the flu
What are the vitals on a patient in DKA going to be
- low BP
- weak peripheral pulses
- elevated pulse rate
Why would you need to obtain a weight on a patient in DKA
in order to replenish the 5-10% water deficit that the patient has
Why should you do a neuro exam on a patient in DKA
to look for cerebral edema
What labs would you check for a DKA assesment
- BGL
- ketones
- electrolytes (sodium/potassium)
- ? lactate
- BUN and creatine (kidney function)
- venous pH
- CBC (for infection)
4 things that need to be managed in DKA
- dehydration
- hyperglycemia
- sodium
- potassium
How do you manage dehydration in DKA
- gradual rehydration with isotonic fluid
- 10mL/kg over 1 hour, max 1000mL
How do you manage the hyperglycemia in a patient in DKA
insulin infusion
0.1 units/kg/hour
For a patient in DKA what do you do once the blood usgar falls below 300? Why?
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
Why is the sodium levels monitored when a patient is in DKA
as water moves into the cells, the serum sodium will rise
What does insulin do to potassium in the body
drives it into the cells which decreases serum K
What do you do to treat a patient in DKA that presents with
hyperkalemia?
normokalemia?
hypokalemia?
hyperkalemia: proceed with giving insulin
normokalemia: watch for hypo, give K with the insuilin
hypokalemia: give K first then give insulin
What other bloodwork should be done once a diagnosis of DM1 is made
- T1D antibodies
- thyroid
- celiac disease
Two things used for medical management of DM1
- insulin to keep glucose levels down
- glucagon to raise glucose levels up
What are your prandial insulins
- aspart
- glulisine
- lispro
- regular
What are your basal insulins
- detemir
- glargine
- NPH
When should you check ketones in a patient with DM1
- when BGL >300
- when patient is sick
Definition of hypoglycemia
BGL less than 70
What are the symptoms of hypoglycemia
- shaky
- teeth chattering
- dizzy
- tired
What are the symptoms of hyperglycemia
- irritability
- tiredness
- thirst
- frequent urination
- headache
- blurred vision
- being “zoned out”
What is the Dawn phenomenon
a surge of hormones (cortisol) that occur around 4/5 am causes high blood sugar in the morning
Treatment of the dawn phenomemon
adjust overnight basal insulin
What is the Somogyi effect
patient become hypoglycemic around 2/3am and the body releases hormones which overshoot the correction and cause hyperglycemia in the morning
How many grams of carbs are you supposed to have in a meal
45-60g
What is the typical insulin to carbs ratio
1 unit of insulin for every 15/20 carbs
Complications of DM
- diabetic retinopathy
- peripheral neuropathy
- nephropathy
- skin complications
What is the initial manifestation of diabetic eye disease
non-proliferative retinopathy
What causes non-proliferative diabetic retinopathy
dilation of small vessels; vessel closure–>ischemia–>increased permeability
Symptoms of non-proliferative retinopathy
none, asymptomatic
Signs of non- proliferative diabetic retinopathy
microaneyursm, hemorrhages, “cotton wool” spots, lipid exudates
What needs to be done in proliferative diabetic retinopathy
tighter glucose control
What kind of neuropathy do diabetics get
symmetrical sensory polyneuropathy
Where does diabetic neuropathy start? where does it progress to?
starts in the feet, once it reaches mid calf and starts in the hands
What will a physical exam show in a patient that his diabetic neuropathy
- vibratory sensation loss
- altered propioception
- impaired pain, light touch and temperature
- decreased relfexes
Pathophys behind diabetic nephropathy
mesangial expansion
- glomerular basement membrane thickening
- podocyte injury
- glomerular sclerosis
Signs and symptoms of diabetic nephropathy
- albuminuria
- possible hematuria
What does DM1 cause in pregnancy? why?
macrosomia
-there is more glucose crossing the placenta but no insulin so the baby has to make more
