DM 1

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Author:
SHIM
ID:
241810
Filename:
DM 1
Updated:
2013-10-21 02:56:41
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DM
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DM
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  1. DM Type 1 Overview
    • - Usually diagnosed in children & YA
    • - AKA "juvenile diabetes" 
    • - Body does not produce insulin (very little, if any insulin) 
    • - Insulin required in order for body to properly use sugar
    • -Insulin = transport for glucose 

    • Insulin's role is to take glucose from blood and carry it into cells where it can be used to provide energy for body to work 
  2. In Depth
    Type 1 usually progressive autoimmune disease disease 

    Beta cells produce insulin, but in DM 1 beta cells that produce insulinare slowly destroyed by body's own immune system
  3. Causes
    Genetics- 10% if first degree relative have DM; father>mother 

    Viruses- Cosackie virus, mumps, rubella 

    Pancreatic damage

    Medications- corticosteroids, BB, and Phenytoin)-- TEMPORARY IDDM
  4. History
    • Polyuria- excessive URINATION
    • May present as nocturia, bedwetting, or incontinence in previously continent child 

    Polydipsia- excessive THIRST 

    Weight Loss- 10-30% 

    Prolonged or recurrent candidal infection

    • Increased fatigue, lethary
    • Muscle cramping
    • Irritability/emotional lability
    • Headaches, abdominal discomfort, nausea
    • Vision changes, such as blurriness 
    • Anxiety attacks
  5. Hyperglycemia
    • Hyperglyceia = predominant "sign" of DM 
    • Chronically uncontrolled, leads to MICROvascular destruction and end organ damage 
    • PVD/PAD 
    • Cause distal neuropathy
  6. DIAGNOSIS
    Fasting glucose >126 mg/dL 

    Random glucose >200 mg/dL in pt with classic symptoms of hyperglycemia

    Oral glucose tolerance test; plasma glucose >20 mg/dL 2 hours after glucose load 

    Glycated hemoglobin (HbA1C) levels >6.5%
  7. Insulin
    ORAL hypoglycemics NOT indicated in DM 1 

    Basal, long-acting insulin once/twice daily
  8. Complications
    Microvascular disease (retinopathy, nephropathy, neuropathy)

    Hyperlipidemia

    Macrovascular disease (coronary and cerebral artery disease) 

    Chronic foot ulcers/amputations, diabetic ketoacidosis, excessive weight gain, increased risk for pre-eclampsia, and preterm delivery, driving mishaps, psychologic problems of chronic disease, HYPOGLYCEMIA
  9. Hypoglycemia
    Defined as plasma glucose less than 70 mg/dL

    • S/S
    • -Diaphoresis (excesive sweating)
    • -Tachycardia
    • -Hunger
    • -Shakiness 
    • -Slurred speech
    • -Altered mental status 
    • -Seizure
    • -Coma
  10. DKA
    • MEDICAL EMERGENCY characterized by:
    • - Hyperglycemia
    • - Ketosis (ketones=acids)
    • - Metabolic acidosis 

    *fruity odor to breath (acetone smell) 

    S/S- HYPOtension, tachycardia, hypothermia, tachypnea, KUSSMAUL respirations, decreased reflexes, abdominal tenderness, dry mucus membranes, poor skin turgor, decreased perspirations, confusion, coma 

    Labs- hyperglycemic, hyponatremic, elevated BUN/Cr, serum ketosis, metoblic acidosis or ABG 

    • **START ISOSTONIC (0.9 % saline) to rehydrate 
    • -Will need supplemental K infusion with IV insulin and sodium bicarbonate to correct acidosis
  11. Rapid Acting
    Insulin lispro (Humalog)

    Insulin aspart (NovoLog) 

    Insulin glulisine (Apidra) 

    • Onset- 1/4-1/2
    • Peak action- "
    • Effective duration- 3-4
    • Max duration- 4-6
  12. Short acting
    • Regular (soluble) 
    • Onset- 1/2-1
    • Peak- 2-3
    • Effective duration- 3-4
    • Max- 6-8
  13. Intermediate-acting
    • NPH (isophane) 
    • Onset- 2-4
    • Peak- 6-10
    • Effective duration- 10-16
    • Max- 14-18
  14. Long-acting
    Insulin glargine (Lantus) 

    Insulin determir (Levemir) 

    • Onset- 3-4 
    • Peak- 8-16 (Lantus) and 6-8 (Levemir, but relatively flat)
    • Effective duration- 18-20 (Lantus) and 14 (Levemir)
    • Max-20-24 (Lantus) and up to 20-24 hours (Levemir)

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