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56 Cards in this Set

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what age peaks with DM type I
5 years then again at 15 years
what race, body type, comorbidities is most common for type I DM
white
not obese
HTN uncommon - no comorbidities
which type of DM is most common with ketosis or DKA
DM type I - how they present to the ED
break down FAs with dehydration and vomiting
which type of DM is autoimmune
type I DM
what should you do for a child who had symptoms of flu - 1-2 days of vomiting and outside flu season
urine dipstick - rule out glucose
what age peaks for DM type II
teenage or older
what race, comorbidites, body type is most common with DM type II
native americans, hispanics - minority
obesity >90% central
HTN common - must check BP and HR
is ketosis or DKA common in type II DM
no - its a slow progression
what age is most common for AAs to develop DM type II
20-30's not adolescents
what causes DM type I - how is it destroyed
autoimmune destruction of pancreatic beta cells in the islet of lagerhans
what usually happens before developing DM type I
viral illness - 2-3 weeks ago before had URI symptoms - usually a common cold then all of a sudden having symptoms that seem like a bad flu (comes back)
does not make sense, new and progressive
What does insulin deficiency result in
uninhibited gluconeogenesis (form glucose by protein and fat - ketosis) and a blockage of use and storage of circulating glucose
what are common symptoms seen in DM type I
polydipsia - 4-5 gallons water
polyphagia
polyuria

nocturia - new or history
blurred vision - more severe
weight loss - acute, eating a lot
fatigue
what would you see on exam in new onset DM type I
dehydration - most common
weight loss
muscle wasting
tachycardia
slow, labored breathing
flushed cheeks
fruity breath

Monitor cardiac status
Do not want to drop too fast
when someone is diagnosed with DM type I what else should you also test for
other autoimmune diseases - celiac or hypothyroid
what is the goal HgA1c for DM
<6.8 or 6.5 - use to check management
Why would you check a urine to rule out DM
because already eating, if gross protein - quick result if late in the day
What are the diagnostic criteria for DM type I
HgA1C
Random glucose
Fasting glucose
Postprandial
HgA1C >7 - will not be very elevated because its not the time >3 months of high sugars, usually more acute
Random >200 - if unsure time ate last
Fasting >125
Postprandial >200 if >2 hours since eating
What are you looking at for DM with metabolic screening
electrolytes
BUN
Creatnine
when you change medications for DM what lab value do you go by
HgA1C of <6.5
what are the goal for DM managment
**growth and development - muscle growth, bone growth, calcium - relate to kidney function, eye health, neuropathy, skin health, and liver and kidneys

**optimal glycemic control

**minimize acute and chronic complications - acute infections, renal issues

**Psychosocial adjustment - kids want to be normal

**Manage chronic disease
what is the dosage of insulin for DM type I
1 unit/kg/day on average
What is a good regimen for type I DM if they do not want to take insulin in school

what are the disadvantages
Breakfast - short acting with NPH
Dinner - short acting

This is no lunch injection - NPH lasts 8-20 hours so they are covered in school until dinner

timing of meals must stay the same and same amount of carbohydrates must be consumed at meals and snack time - all the time
what medication regimen for DM type I is better for those that are unreliable eaters to match carb intake with insulin
Basal - Lantus at breakfast
Then quick acting before meals and snacks
Best for infants and toddlers
Pump - must be compliant, can clog, must change every 2-3 days
what are the DM type I goals:
<5 years
5-11 years
>12 years
<5 - 100-200mg/dl <8.5%
5-11 - 70-180mg/dl <8%
>12 - 70-150mg/dl <8%
what are some follow up measures you want to address at visits
Emotional/Social adjustment - whole family structure
Physical activity
Eating - nutritionist - yearly a must
PE - growth, puberty, autoimmune diseases
make sure reach milestones
How should meals be spread out for DM type I
Three meals with 2-3 snacks - best for basal and short acting.
What is the percent of protein, carbs, and fat for DM type I
55% carbs
15% protien
<30% fat; <7% saturated fat
what are microvascular complications of DM
retinopathy
nephropathy **** big
Neuropathy
Depression - as get older
what are macrovascular complications of DM
Ischemic heart disease
Arterial obstruction - why loose toes and feet
how is type II DM develop
start with increased tissue resistance to insulin
lead to failure of pancreas and tissue resistance
what are environmental triggers for DM type II
obesity
sedentary lifestyle
high caloric high lipids

increase activity 20 minutes per day - cut DM by 50%
mother of gestational DM
Strong genetic component
what are symptoms of DM type II
polydipsia
polyphagia
polyuria
nocturia** big
blurred vision
obesity
fatigue
Hyperpigemented skin - velvet like, rash - 6-12 months before symptoms start - HgA1C/glucose elevated
tinea - breast folds/yeast
what on exam will you see with DM type II
dehydration - electrolytes will be off
weight gain/obesity
vaginal yeast or thrush
acanthosis nigricans
PCOS - hair growth, weight gain, irregular menses, cystic acne - breast and groin
what medication helps with PCOS
Metformin
why is dehydration status so important with DM
increase SE with dehydration of medication
actos - increase swelling
Metformin - Kidney function worse, nausea and vomiting

increased abnormal electrolytes
what is the gold standard for diagnosis of DM type II
HgA1C >7%
what other tests should you do for DM type II that differs from type I
Lipids - LDL>100 treat with statin
TSH, T4
Baseline LFTs - if statin
UA - protien, glucose, hydration status
Metabolic screen - bun/creatnine, electrolytes
what is the goal for DM type II HgA1C
<6.5%
what are the management goals for DM type II
weight loss**
optimal glucose control
prevent chronic complications - nephrology referral if needed
positive psychosocial adjustment
tight HL control
What medication classes are used for DM type II
Metformin - check kidneys, stop with CT scan with IVP dye

Sulfonylureas - Amaryl
TZD - Avandia, Actos- check LFTs
Meglitinides - Prandin
Biatta - once per week dosage
what is the follow up that you would look at with children with type II DM
physical activity, nutrition**
PE - growth and puberty - delayed
gynacomastia - delayed puberty
if get sugar down then will get better
Menses irregular - fix sugar then will normalize
What nutrition therapy would you prescribe for DM type II
low fat diet
weight maintenance
Changes to family eating patterns
exercise
tobacco cessation
what are microvascular complications of type II DM
retinopathy
nephropathy***
neuropathy
depression
what are other complications for type II DM
Ischemic heart disease - not as bad as type I
Nonalcoholic fatty liver - will see fat on US of liver
what is associated with insulin resistence
DM type II, HTN, HL, Atherosclerosis
Metabolic syndrome - obesity, HTN, HL, and atherosclerosis
PCOS
what is the 2 hour OGTT for diagnosis of DM type I
>200
which DM is the c-peptide elevated
type II
which DM is the insulin elevated in
type II
which type is beta cell dysfunction
type II
how often should DM type I check sugar
4 times per day
what are the quick, rapid, intermediate and long acting insulin
quick - lispro and aspart
rapid - regular
intermediate - NPH
Long - glargin or detemir
how does metformin work
improve control by reeducating hepatic glucose production, increase insulin sensitivity, and reduce intestinal glucose absorption with out increasing insulin secretion
only affective if beta cells are still working
what is the honeymoon phase
after initial diagnosis - reduction of insulin is required, but requirement eventually returns
what are symptoms of hypoglycemia
rapid onset
excessive sweating
faint
HA
trembling or shaking
hunger
irritability
personality change
if child is obese what test should you do to rule out
TSH - hypothyroid