Diabetes and Thyroid Problems Flashcards by tcarlso 3

What is the most common type of DM below age 40? Above?

Below = DM I
Above = DM II

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What is maturity onset diabetes of youth (MODY)?

DM occurring before 18 yo

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What are the HLA haplotypes that are associated with DM I?

HLA-DRB1 and DQB1

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What are the environmental factors that can cause DM I in susceptible individuals?

Viral disease
Chemicals
Early cow’s milk

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What is the rate of DM I in an identical sibling if the other has it?

35-50%

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What is the drug that may be able to preserve beta islet cells in newly diagnosed pts with DM I?

Cyclosporine

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What are the histological characteristics of islet cells of DM I?

WBCs, insulin auto-antibodies

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Which is the more common presentation: DKA or polydipsia/polyphagia

Polydipsia/polyphagia

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What is the fasting glucose level that is diagnostic for DM?

More than 126 mg/dL (200 for him)

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What is the random glucose measurement that is diagnostic of DM?

More than 300 mg/dL

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What are the two most important factors of the prognosis for kids with DM I?

Parental and pt education

Stress management

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What should happen to insulin doses with emesis?

May need to tone back d/t loss of sugar

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What, generally, is the dosing scheme for insulin?

2/3 daily dose NPH in AM, 1/3 regular before dinner

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What foods should be avoided with DM I pts?

High salt
Fatty
High protein
High cholesterol
Pure sugar

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What type of food should be increased in the diets of DM I pts?

Fibrous

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What is the role of regular aerobic exercise with DM I?

Increases insulin sensitivity

Improves circulation

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What role does stress play in DM I?

Need to avoid d/t BG elevation that can occur

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In general, how often should BG be measured with DM I?

twice daily, but more if sick

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What is the target BG level for 0-4, 5-12, and 13+ two hours after a meal?

0-4 = 100-200
5-12 = 80-180
13+ = 70-150

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When should urine ketone monitoring be performed? (3)

Illness
Emesis
BG above 250 mg/dL

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HbA1C level below what value are associated with reduced risk of renal/retinal complications?

10%

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What are the ssx of hypoglycemia?

Hunger, weakness, drowsiness, HA, confusion

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What are the components of preventing hypoglycemia? (4)

Consistent eating schedules
Insulin dosing
BG monitoring
Edu

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What are the two criteria for DKA?

BG more than 200

VBG with pH less than 7.3 or HCO3 less than 15

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What other common medical condition leads to low HCO3 levels?

Emesis

What are the IVF goals with DKA?

Correct shock and/or ~15 ml/kg of NS or LR

What is the problem with bolusing fluids too fast with DKA?

Too much will start to pool fluids in the brain d/t the slower diffusion of glucose through the BBB

How is insulin administered to patients in DKA?

IV insulin at 0.1 nits/kg/hr until 100 mg/dL. Add D5 to IVF when BG is less than 300 mg/dL, to ensure a slow decline in BG

What happens to K with acidosis?

H+ is exchanged for K in an attempt to bring pH of the blood back up.

What type of fluids should be used for DKA: NS or LR?

NS initially to prevent hyperkalemia, then switch to LR once urine output is adequate to maintain K levels

What is the effect of insulin on the acidosis of DKA?

Reduces ketone body production, and thus acidosis

When should HCO3 be used with DKA?

iff severely acidotic. Otherwise will overshoot and cause a rapid fall in K

True or false: all pts with DKA have some degree of cerebral edema

True

How do you prevent the cerebral edema with treating DKA?

Close monitoring, and administer NS then LR slowly

How do you prevent the long term complications from DM? (3)

- HbA1C less than 10% - BP less than 90th - no nicotine

What week of gestation is the thyroid capable of hormone synthesis?

14 weeks

True or false: maternal and fetal pituitary-thyroid axes are dependent on one another

False--totally independent

Can anti-thyroid hormones like PTU and methimazole cross the placenta?

Yes

How can hyperthyroid mothers cause thyrotoxicosis in their fetuses?

Human specific thyroid stimulator immunoglobin can cross the placenta, and produce thyrotoxic newborns

What are the proteins that bind T3/T4 in the serum? Which binds more readily?

Thyrobinding hormone | T4 binds more readily

What is the most accurate measure of thyroid function? What is the situation in which this is not true?

TSH Not true if there is a pituitary problem

True or false: if there is a normal TSH level, then the patient does not have thyroid issues

True

What should be added to the orders if TSH is high?

Free T4 to evaluate for hypothyroidism

What should be added to the orders if TSH is low?

Free T3 and T4 to determine degree of hyperthyroidism

What is the most common cause of acquired hypothyroidism?

Chronic lymphocytic thyroiditis (Hashimoto's)

What are the ssx of hypothyroidism in children?

Growth retardation Sluggishness Poor perfusion Macroglossia

What is the classic x-ray finding of hypothyroidism in children?

Epiphyseal stippling

What type of anemia is usually found with hypothyroidism, assuming there is not dietary uptake issues 2/2 to it?

Normocytic

What happens to cholesterol and carotene levels with hypothyroidism?

Increased

What happens to CrCl with hypothyroidism?

Decreased

What are the three major congenital thyroid issues?

Aplasia Hypoplasia Maldescent

What is the inheritance pattern of inborn errors of thyroid hormone metabolism?

What are the lab values that should be followed with Levothyroxine administration?

Free T4 and TSH

What is acute suppurative thyroiditis?

TTP thyroid in a toxic appearing child d/t infection with GAS or Staph Aureus

What are the TFTs like with acute suppurative thyroiditis?

Normal

What is the treatment for acute suppurative thyroiditis?

Abx

What causes the exophthalmos and pretibial myxedema in hypothyroidism and Grave's disease?

TSH receptors on fibroblasts in these areas. - If hypothyroid, elevated TSH - If graves, autoantibodies stimulate these receptors

What are the ssx of hyperthyroidism in children?

- premature closure of suture lines | - Advanced bone age

What is the cause of congenital hyperthyroidism?

Placental passage of TSI IgG from a thyrotoxic mother, causing hyperthyroidism in the infant

What is the short and long term prognosis with congenital hyperthyroidism?

``` Short = significant death rate Long= will be normal ```

In whom does idiopathic hyperthyroidism usually occur?

12-14 yo with a 5:1 female to male ratio

What is the natural history of idiopathic hyperthyroidism?

Cyclic spontaneous exacerbations and remissions

Diabetes and Thyroid Problems Flashcards

(62 cards)