Diabetes Mellitus Type 1 Lecture (Dr. Krila) Flashcards
Characteristics Shared by Both Type 1 and Type 2 without Treatment
INSULIN DEFICIENCY: Absolute (T1DM) or relative
GLUCAGON EXCESS: Absolute (T1DM) or relative
- Volume Depletion
- Mental Status Change
Differential Diagnosis Mental Status Changes
- Mental Status changes also known as “Altered Mental Status” or “UNRESPONSIVE”
AEIOU TIPS: A: Alcohol/ Acidosis E: Epilepsy/ Endocrine/ Exocrine. Encephalopathy I: Infection O: Opioid/ Overdose U: Uremia
T: Trauma
I: Insulin
P: Psychosis
S: Syncope/ Stroke
Diabetic Ketoacidosis (DKA)
- Most commonly seen in Type 1 DM
- Can be seen in Type 2 DM
- May be first presentation in previously unknown Diabetic
Etiology - DKA
1) INADEQUATE INSULIN
2) INFECTION
a) Pneumonia
b) UTI
c) Gastroenteritis
d) Sepsis
3) INFARCTION: Any Location
a) Coronary
b) Cerebral
c) Mesenteric
d) Peripheral
4) SURGERY
5) DRUGS (Cocaine)
Initial Symptoms - DKA
- Anorexia
- Nausea
- Vomiting
- Polyuria
- Thirst
Progression of Symptoms- DKA
- Abdominal Pain
- Altered Mental Function
- Coma
Signs- DKA
- KUSSMAUL Respirations: RAPID/ DEEP
- Acetone (Fruity) Breath Odor (or like Nail Polish remover)
- Dry Mucous Membranes
- Poor Skin Tugor
- Tachycardia
- Hypotension
- Fever
- Abdominal Tenderness
Laboratory - DKA
- Hyperglycemia
- Ketosis
- Metabolic Acidosis
a) !!!!! Calculate Anion Gap (AG): INCREASED in DKA
b) ANION GAP = [Na] - ([Cl] + [HCO3]) : Normal 5 to 16
c) Arterial Blood Gases (ABGs)
d) Change in pH 0.1 (DECREASED) = Change in K+ 0.6 (Number) since ACIDOSIS Causes Potassium to shift out of Cells, so “FALSELY” elevated on Lab Results
High Anion Gap Acidosis “MUDPILES”
- M: METHANOL
- U: UREMIA
- D: DIABETIC KETOACIDOSIS
- P: PARALDEHYDE
- I: ISOPROPYL ALCOHOL, Iron, INH (Isonazied)
- L: LACTIC ACIDOSIS
- E: ETHYLENE GLYCOL
- S: SALICYLATES
Laboratory - DKA cont
- Potassium
a) Serum may be Normal or somewhat High (Result of Acidosis)
b) ACTUALLY TOTAL BODY DEFICIT!!!!!!!
- Hypertriglyceridemia
- Hyperlipoproteinemia
- Hyperamylasemia
a) Can be Salivary
b) Can suggest Acute Pancreatitis - Leukocytosis
Treatment of DKA
INTENSIVE CARE UNIT:
a) Frequent Monitoring of General Status, Vital Signs, Glucose and other labs
- Acid Base Status
- Renal Function
- Potassium and other Electrolytes
Fluid Replacement in DKA
- “1-2-3” Rule is one Method
- 2 to 3 liters NS (Normal Saline) (0.9%) over first 1 to 3 hours (5 to 10 mL/ kg/ hr)
- Then, 1/2 Strength Saline (0.45%) at 150 mL/hr
- When Glucose reaches 250 mg/Dl, switch to D5 1/2 NS (5% Dextrose and 0.45% Saline) at 100 to 200 mL/hr
- Fluid deficit is often 3 to 5 liters
Initial Insulin Administration
REGULAR INSULIN
- 10 to 20 units IV or IM (or 0.15/kg)
- Then, 5 to 10 units/ hr continuous IV (or 0.05 - 0.1/ kg/ hr)
- INCREASE if no response in 1 to 2 hrs: Orders can be Written with Guidelines to Titrate
DKA- Eval for Underlying Causes
- Cultures
- EKG
- CXR
- Drug Screen
- Seek additional History fro Family as available or patient as his/her mental status improves
FYI: Multiple Names for Testing
1) FSG: Fingerstick Glucose
2) BSG: Bedside Glucose
3) “AUCCUCHECK” : 1st Commonly used Monitor
4) Capillary Glucose
5) In Out-Patient Setting:
a) HMG: Home Glucose Monitoring
b) GSM: Glucose Self Monitoring
