Flashcards in Peds - Endo Deck (52)
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1
Which type of diabetes is more commonly associated which ketones?
Type I
2
What markers are associated with Type I Diabetes?
HLA-DR3
HLA-DR4
human leukocyte antigens
3
What markers are associated with Type II Diabetes?
None
4
What is the general pathophysiology of Type I Diabetes?
at symptom presentation most of the pancreatic ISLET cells have been destroyed and islet cell ANTIBODIES are detected (AUTOIMMUNE process)
What is the trigger?
infectious or toxic insult to pancreatic cells of genetically predisposed individual
5
Three P's which are classic symptoms of Type I Diabetes?
Polydipsia
Polyphagia
Polyuria
seen less commonly in Type II
6
Other symptoms of Type I Diabetes? (6)
o weight LOSS, with INCREASED hunger
o fatigue
o weakness
o paresthesia
o irritability --> coma
o nocturnal enuresis
7
Signs of advanced Type I Diabetes found on physical exam? (3)
EYES, VASCULATURE, NEURO (reflexes)
o ophthalmic exam -- microaneurysms or cotton wool spots
o peripheral vascular insufficiency (sensation impaired)
o diminished deep tendon reflexes
8
Random blood sugar of ____ and what other symptoms indicated the need for fasting studies.
Random blood sugar >/=200 mg/dL
AND
polydipsia
polyuria
weight loss
9
Diagnostic laboratory study for Type I Diabetes?
Fasting blood sugar >/= 126 mg/dL on 2 occasions
10
Normal A1c?
5.5 to 7 %
target for good diabetic control? 6%
11
A1c of 4.8% in a diabetic indicates what?
Blood glucose is too tightly controlled
12
What is IMPAIRED GLUCOSE TOLERANCE and how is it measured?
can be thought of as "pre-diabetes" where fasting BG is elevated, but not to 126 threshold for Diabetes
FBG between 100 and 125 mg/dL
**encourage exercise**
bring back in 3 - 6 months
13
What do ketones mean from a management perspective?
patients presenting with ketones must start INSULIN
14
What is the rule of thumb for initiating insulin?
0.5 units/kg/day with 2/3 in AM and 1/3 in PM
15
NPH is ___ acting.
short
16
Somogyi Effect and Dawn Phenomenon both result in:
HYPERglycemia in the morning
17
Somogyi Effect is characterized by what pattern? What is the cause?
HYPOglycemia around 3 AM and HYPERglycemia by 7 AM
nocturnal hypoglycemia stimulates a surge of counter regulatory hormones that raise blood sugar
(Somogyi is Tsunami - low then high)
18
Treatment for Somogyi Effect?
reduce or eliminate HS insulin
19
Dawn Phenomenon is characterized by what pattern? What is the cause?
Blood glucose rises through the night with HYPERglycemia at 7 AM
nocturnal desensitization of tissues to insulin as a result of night surge of growth hormone
(the Dawn slowly rises...)
20
Treatment for the Dawn Phenomenon?
Increase the dose of insulin at HS
21
What is often the first sign of Type II Diabetes in females?
recurrent vaginitis
22
Early disease may be asymptomatic and physical exam unremarkable in Type II Diabetes. If signs and symptoms do occur, what are they?
o acanthosis nigricans
o chronic skin infections
o pruritis
o peripheral neuropathies
o recurrent blurred vision
23
Laboratory diagnostics in Type II Diabetes?
Same as Type I
except do not expect to see ketones in urine or blood
24
Signs associated with insulin resistance?
o acanthosis nigricans
o hypertension
o dyslipidemia
o polycystic ovarian disease
25
When should children be screened for Type II Diabetes?
In obese children, starting at the first of age 10 or puberty, and then every 2 years IF two or more of the following are present...
o family history
o minority race
o signs if insulin resistance
26
Management of Type II Diabetes in children? (1+3)
Refer to endocrine for management and expect the following:
o weight management
o metformin/glucophage
o insulin therapy if severe
27
How does Metformin work?
reduces gluconeogenesis
28
What is a potential side effect of Metformin?
significant gastrointestinal upset
however, usually limited to ~2 weeks
29
T3 is otherwise known as
Triidodthyronine
30
