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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
4 things that need to be managed in DKA
- dehydration - hyperglycemia - sodium - potassium
26
How do you manage dehydration in DKA
- gradual rehydration with isotonic fluid | - 10mL/kg over 1 hour, max 1000mL
27
How do you manage the hyperglycemia in a patient in DKA
insulin infusion 0.1 units/kg/hour
28
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
29
Why is the sodium levels monitored when a patient is in DKA
as water moves into the cells, the serum sodium will rise
30
What does insulin do to potassium in the body
drives it into the cells which decreases serum K
31
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
32
What other bloodwork should be done once a diagnosis of DM1 is made
- T1D antibodies - thyroid - celiac disease
33
Two things used for medical management of DM1
- insulin to keep glucose levels down | - glucagon to raise glucose levels up
34
What are your prandial insulins
- aspart - glulisine - lispro - regular
35
What are your basal insulins
- detemir - glargine - NPH
36
When should you check ketones in a patient with DM1
- when BGL >300 | - when patient is sick
37
Definition of hypoglycemia
BGL less than 70
38
What are the symptoms of hypoglycemia
- shaky - teeth chattering - dizzy - tired
39
What are the symptoms of hyperglycemia
- irritability - tiredness - thirst - frequent urination - headache - blurred vision - being "zoned out"
40
What is the Dawn phenomenon
a surge of hormones (cortisol) that occur around 4/5 am causes high blood sugar in the morning
41
Treatment of the dawn phenomemon
adjust overnight basal insulin
42
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
43
How many grams of carbs are you supposed to have in a meal
45-60g
44
What is the typical insulin to carbs ratio
1 unit of insulin for every 15/20 carbs
45
Complications of DM
- diabetic retinopathy - peripheral neuropathy - nephropathy - skin complications
46
What is the initial manifestation of diabetic eye disease
non-proliferative retinopathy
47
What causes non-proliferative diabetic retinopathy
dilation of small vessels; vessel closure-->ischemia-->increased permeability
48
Symptoms of non-proliferative retinopathy
none, asymptomatic
49
Signs of non- proliferative diabetic retinopathy
microaneyursm, hemorrhages, "cotton wool" spots, lipid exudates
50
What needs to be done in proliferative diabetic retinopathy
tighter glucose control
51
What kind of neuropathy do diabetics get
symmetrical sensory polyneuropathy
52
Where does diabetic neuropathy start? where does it progress to?
starts in the feet, once it reaches mid calf and starts in the hands
53
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
54
Pathophys behind diabetic nephropathy
mesangial expansion - glomerular basement membrane thickening - podocyte injury - glomerular sclerosis
55
Signs and symptoms of diabetic nephropathy
- albuminuria | - possible hematuria
56
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

ClinMed exam III (7 decks)

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