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S3 Case 4 - Endocrine > T1DM Acute Care > Flashcards

T1DM Acute Care Flashcards

(74 cards)

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1
Q

What is T1DM?

A

Cell-mediated autoimmune destruction of pancreatic beta cells causing absolute deficiency of endogenous insulin

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2
Q

What are the 4 Ts?

A

Thirst
Tired
Toilet
Thinner

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3
Q

What are other symptoms that may be noticed before diagnosis?

A

Thrush
Cuts/wounds taking longer to heal
Blurred vision

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4
Q

What other autoimmune disorders may lend in the diagnosis?

A

Grave’s disease
Hashimoto’s thyroiditis
Addison’s disease
Celiac

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5
Q

What are the main diagnostic factors?

A

Glucose in urine (6-14 mmol/L)
Nocturia
Increase from habitual levels
Weight loss
Blurred vision

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6
Q

What are the diagnostic tests for auto-antibodies?

A

GAD65
IAA
IA-2A
ZnT8

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7
Q

What is DKA?

A

Diabetic ketoacidosis

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8
Q

What are the 3 things in DKA?

A

Hyperglycaemia
Acidosis = bicarbonate <15mmol/L + pH <7.3
Ketonemia = >3mmol/L
Ketonuria = >++ on urine ketone stick

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9
Q

How does acidosis occur in DKA?

A

Beta-oxidation of free FAs = ketone bodies
= deplete acid buffers
= acidosis

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10
Q

How does hyperglycaemia occur in DKA?

A

Insulin deficient = insulin-mediated uptake of glucose into tissues does NOT happen =hepatic glucose output unchecked
Dysregulation of counter-regulatory hormones = enhances breakdown of triglycerides into FAs = increases rate of gluconeogenesis = hyperglycaemia

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11
Q

What are the symptoms of DKA?

A

Symptoms of hyperglycaemia
Abdominal pain + vomiting
Deep sighing respirations
Sweet smelling
Reduce consciousness

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12
Q

What is the overall goal in management of DKA?

A

Controlled gradual correction of metabolic abnormalities, fluid + electrolyte deficiencies - usually in 24hrs

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13
Q

What is the management of DKA?

A
  1. Confirm diagnosis
  2. Commence 1L NaCl 0.9% over 1hr within 30mins of admission = record time treatment started
  3. Glucose >13mmol/L commence actrapid insulin IV infusion 6 units/hr
    Prescribe 50 units Actrapid insulin in 50ml 0.9% saline to be infused IV 6 units/hr (6mls/hr)
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14
Q

What is the fluid + electrolyte therapy for DKA?

A

0.9% NaCl 15-20ml/kg/hr or 1L/hr
Followed by 250ml/hr after 2-3hrs
IF low in Na must be carefully not to give it back too quickly

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15
Q

What is the IV insulin therapy for DKA?

A

0.1unit/kg/hr as continuous IV infusion
Actrapid insulin + Humulin S

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16
Q

What treatment of other comorbidities of DKA may be present?

A

Infection can precipitate
MI
Stroke
PE
Thrombophlebitis
Acute GI disorder

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17
Q

What monitoring must be down hourly in DKA?

A

Blood glucose
Ketones
Na
K
Renal function
Cardiovascular function
Mental performance

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18
Q

What are the aims of insulin therapy?

A

Match physiological insulin requirements
Optimise any anticipated rise in blood glucose - post-prandial
Should be initiated within 6hrs if in DKA

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19
Q

What are the different types of insulin?

A

Ultra rapid acting
Rapid acting
Short acting
Intermediate acting
Long acting
Ultra long acting
Human mixed insulins
Analogue mixed insulins

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20
Q

What is an example of ultra rapid acting insulin?

A

Fiasp

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21
Q

When do you take ultra rapid acting insulin?

A

Just before, with or up to 20mins after food

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22
Q

What is the onset of ultra rapid acting insulin?

A

2-3mins

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23
Q

What is the peak of ultra rapid acting insulin?

A

30-90mins

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24
Q

What is the duration of ultra rapid acting insulin?

A

Up to 5hrs

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25
What are examples of rapid acting insulin?
NovoRapid Insulin Lispro
26
When do you take rapid acting insulin?
Just before, with or just after food
27
What is the onset of rapid acting insulin?
10-20mins
28
What is the peak of rapid acting insulin?
1-3hrs
29
What is the duration of rapid acting insulin?
2-5hrs
30
What is an example of short-acting insulin?
Actrapid
31
When is short-acting insulin taken?
30 mins before food
32
What is the onset of short-acting insulin?
30-60mins
33
What is the peak of short-acting insulin?
1-5hrs
34
What is the duration of short acting insulin?
5-9hrs
35
What is an example of intermediate acting insulin?
Insuman basal
36
When is intermediate acting insulin taken?
30mins before food or bedtime
37
What is the onset of intermediate acting insulin?
60-90mins
38
What is the peak of intermediate acting insulin?
2-12hrs
39
What is the duration of intermediate acting insulin?
12-24hrs
40
What is an example of long-acting analogue insulin?
Levemir Lantus
41
When do you take long-acting insulin?
Once or twice/day
42
What is the onset of long-acting insulin?
2-4hrs
43
What is the duration of long-acting insulin?
16-20hrs = Levemir Lantus = 20-24hrs
44
What is the risk of Lantus insulin?
Hypo later in the day
45
What are examples of ultra long-acting insulin?
Tresiba Toujeo
46
When is ultra long-acting insulin taken?
OD
47
What is the onset of ultra long-acting insulin?
Toujeo = 6hrs Tresiba = 30-90mins
48
What is the duration of ultra long-acting insulin?
Toujeo = up to 36hrs Tresiba = over 42hrs
49
What is good about Tresiba?
Missed dose = still covered
50
What are examples of analogue mixed insulin?
Novomix Humalog Mix
51
When are analogue mixed insulin taken?
Just before, with or just after food
52
When is the onset of analogue mixed insulin?
10-20mins
53
What is the peak of analogue mixed insulin?
1-4hrs
54
What is the duration of analogue mixed insulin?
Up to 24hrs
55
What is an example of human mixed insulin?
Insuman Comb
56
When is human mixed insulin taken?
30mins before meal
57
What is the onset of human mixed insulin?
30mins
58
What is the peak of human mixed insulin?
1-4hrs
59
What is the duration of human mixed insulin?
12-24hrs
60
What is Humulin R?
500 unit/ml Hospital supply only
61
What does the dose of insulin depend on?
Age Exercise Physical activity Stress Hormonal changes
62
How does multiple daily injections work?
Basal or bolus Basal administered once/twice a day Bolus administered at each main meal
63
How do you initiate + self-manage multiple daily injections?
Insulin 0.3-0.5units/kg = total daily dose = 50% given basal = 50% prandial divided across 3 meals
64
What are the advantages of multiple daily injections regime?
Flexibility Greater dietary freedom Flexibility with dose adjustments
65
What are the disadvantages of multiple daily injections regime?
Greater frequency of injections Regular self monitoring blood glucose
66
What is the "honeymoon" period?
When no insulin or much insulin is required when first starting treatment = can last up till a year
67
What needle length is suitable?
4,5,6mm regardless of BMI
68
At what angle do you inject?
90 degrees
69
What may be needed for slim people?
Need a lifted skin fold
70
What happens if you are using an 8mm needle?
Use lifted skin fold Or give into buttocks
71
What is the fastest sites of absorption when injecting?
Abdomen Back of arm
72
What is the slowest sites of absorption when injecting?
Thighs Arse
73
What must you never do?
Do NOT inject through clothing
74
What is the injection technique?
Clean skin Insert needle Push button Leave in place for 10mins Remove needle

S3 Case 4 - Endocrine (17 decks)

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