Type 1 diabetes lecture

wasabi's version from 2015-10-18 02:15

diagnostic criteria

Question Answer
OGTT results of GDMfasting 92 or greater, or 1 hr 180 or greater, or 2 hr 153 or greater

Section 1

Question Answer
insulin requirements type one0.5 to 1 unit/kg/daily. start with 0.5 (start low to prevent hypoglycemia)
teenage years may need how much insulin?1.5 units/kg/day
basal options for insulinlantus and levemir.
lantus basalburning sensation due to acidic pH can be bothersome to children. usually dosed at bedtime
levemir basalmany require twice daily dosing! in morning and night.
does one unit of levemir equal one unit lantus?no
bolus insulin optionsrapid acting insulins best any of the three! take when take first bite. cover you for 2 hours.
bolus insulin consists of meal time dose pluscorrection factor if patient doesnt carb count
carb counting is what rule?CHO ratio or 500 rule! used when go beyond daily carb intake usually have
how do carb counting?take total daily insulin dose (basal and bolus) and divide by 500 = 1 unit over X grams. so for every x grams eat must add one unit of bolus insulin
correction factor is what rule?1800 rule. to correct before eat a meal!
how do correction factor?divivde total daily dose divide 1800 by this and this number is insulin sensitivity number. then do (actual glucose- target glucose)/ sensitvity number. this gives you the units of unsulin need bolus
type one wanna see checking glucose at leastpremeal and fasting
type two check moreafter meal
more frequent blood glucose monitoring innewly diagnosed, children, and people with sporadic blood sugars
patients on multiple dose insulin or insulin pump check blood sugar how oftenat least prior to meals and snacks and occasionally postprandially, at bedtime, prior to exercise
check A1c how often?controlled (a1c 7 or below) every 6 months and uncontrolled quarterly

Section 2

Question Answer
insulin pump usually used what insulin?short acting
ideal patient for insulin pumpabsulte insulin def. patient who currently performs 4 or more insulin injections daily and assessess glucose levels 4 or more times daily. is motivated to acheive tighter plasma glucose control and is motivated and intellectually able to account for carb counting and adjustments etc
premixed insulin dosetiwce daily pre breakfast and pre dinner. should be last option. ppl on this not good control just have to accept
candidate for pump afer what age?at least 8

Section 3

Question Answer
is every mother screened at first doctor visit?nope! only if risk factors
if mom diagnosed with diabetes at 2-3 months into pregnancy is this gestational?no had diabetes before.
at what month every mom drink sugary drink check sugar 2 hrs after high = diabetes6-7 months. gestational diabetes then
women with gestational diabetes should have screenign for diabets at leastonce every 3 yrs
history gestational and prediabetes shouldreceive lifestyle interventions or metformin to prevent diabetes
diagnosis gestational fasting, 1 hour, 2 hr post?fasting 92, 1 hr 180, 2 hr 153 (only one abnormal needed)
rapid acting insulin pregnancy cat b?aspart and lispro
basal insulin cat b?levemir, NPH, and reg insulin
preg cat clantus and glulisine. lantus is still widely used

Section 4

Question Answer
symptoms hypoglycemia generally occur when under 60 (assuming blood sugar has been running around normal)
subtle symptoms in children hypoglycemianightmares, restless sleep, headache, confusion, behavior changes on wakening, inconsolable crying
need 15 to 20 grams sugar to help hypoglycemia simple sugarpop. 3 to 4 glucose tabs,
unconscious or cant swallow hypoglycemia do what?glucagon emergency kit, call 911 and if 15 mins no response give another, all pts should have a kit and be aware how to use
exercise dont exercise at night. little snacks before, during, after. check glucose. can affect glucose levels up to 12 hours after
symptoms of diabetic ketoacidosis=polyuria, polydipsia, weight loss, nausea/vomiting, dehydration, mental status change, tachycardia, hypotension, deep labored breathing, poor skin turgor, hypothermia (very prognostic sign)
arterial pH usually7.4
bicarb acidosis mild15-18 (usually 20-22)
ketones for acidosispresent in urine and serum
anion gap acidosis mildgreater than 10 (usually 10 in normal person)
treatment ketoacidos for dehyrdationfluids (saline). eventually dextrose once blood glucose around 200
treatment acidosis for hyperglycemiaregular insulin via cont iv infusion. goal drop 50-75 in first hour
treatment acidosis for electrolytesbicarb only in severe acidosis. potassium usually is high at first then once falls below do supplementation

section 5

Question Answer
A1C goal for toddler/preschooler (0-6)< 8.5%
BG goal before meal for 0-6100-180
BG goal at bedtime/overnight110-200
A1C goal for 6-12 y.o< 8%
BG goal for 6-12 before meal90-180
BG goal bedtime/overnight100-180
A1C goal for 13-19 (adolescent, young adults)< 7.5%
BG goal for adolescent90-130
BG goal bedtime/overnight for adolescent90-150
A1C goal for pregnant women< 6%