Honey Sweet
What is the typical age of onset for Type I Diabetes?
< 20 years but can occur at any age; peaks at age 4–6 years and 10–14 years (AMBOSS)
How is Insulin excreted from the body?
Urine
Calculate anion gap.
Anion gap = [Na + K] - [HCO3 + Cl]
45.1
What is post prandial hyperglycemia?
Postprandial hyperglycemia is an exaggerated rise in blood sugar following a meal.
(https://www.diabetesselfmanagement.com/diabetes-resources/definitions/postprandial-hyperglycemia/)
Why does the urine sample have a high specific gravity?
Because of glucose in the urine.
Describe the common clinical presentation for Type I Diabetes.
Polydipsia
Polyuria
Polyphagia
Weight loss
What are the labelled indications for therapeutic use of insulin?
Treatment of type 1 diabetes mellitus and type 2 diabetes mellitus to improve glycemic control.
(Lexicomp)
Estimate Mr. Olsen’s osmolarity.
2[Na+] + [BUN]/2.8 + [glucose]/18 = blood osmolarity (mmol/L)
311.2 mmol/L
What are two reasons a diabetic person might have hypoglycemia?
Accidental overdose of insulin.
Decreased insulin clearance (renal failure).
Briefly describe how egophony, increased tactile fremitus, and lung consolidation are related to pneumonia.
Egophony - E to A sound suggests consolidation.
Increased tactile fremitus suggests consolidation
Pneumonia is a common cause of lung consolidation
What are two treatment/management options for patients with Type I Diabetes?
Insulin therapy
Lifestyle modifications
What are 3 target organs that Insulin acts on?
Insulin acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, and fats. Target organs for insulin include the liver, skeletal muscle, and adipose tissue. (Lexicomp)
What is Mr. Olsen’s actual sodium concentration?
mmol/L Na + (glucose – 100)/100 = corrected sodium
135 mmol/L
What are the clinical features of diabetic ketoacidosis?
Clinical signs may progress rapidly and include vomiting, abdominal pain, dehydration, weakness, and lethargy.
Kussmaul respiration (rapid fast deep breathing) in an attempt to decrease Pco2 and compensate for the metabolic acidosis
Ketoacidosis may result in a fruity odor to the breath.
Eventually, when compensatory mechanisms are overwhelmed, children with severe DKA may present with hypotension, shock, and altered mental status.
Why is Mr. Olsen's urine dark yellow?
He is dehydrated.
Describe the pathophysiology of Type 1 Diabetes.
Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors that ultimately lead to immune-mediated destruction of the pancreatic beta cells and insulin deficiency. (Harrison's)
What are two ways insulin can be administered?
IV
IM
Calculate and interpret expected PCO2 with Winter’s formula.
Expected pCO2 = 1.5 * HCO3- + 8 +/- 2
27
Why might an infection precipitate diabetic ketoacidosis?
DKA can occur due to a deficiency in insulin (stress, infection, inadequate insulin intake) in relation to elevated counterregulatory hormone levels (catecholamines, cortisol, glucagon, and growth hormone).
Characterize our patient's HbA1c. What does this finding tell us?
High.
Glycated hemoglobin, which reflects the average blood glucose levels of the prior 8–12 weeks (AMBOSS)
Describe the prognosis of Type I Diabetes if well managed vs. unmanaged.
Type 1 DM is associated with high morbidity and mortality. Close to 50% of patients will develop a serious complication over the lifetime. Some will lose eyesight, and others will develop end-stage renal disease. For those who make it past the first 20 years, the prognosis is good. However, the disease has no cure, and with time, the patient may develop premature coronary artery disease, neuropathy, foot ulcers, and vision loss.
Maintaining euglycemia for a lifetime is associated with severe anxiety and depression; for many patients with type 1 diabetes, the quality of life is poor. (StatPearls)
What is one contraindication for insulin?
Hypersensitivity.
Severe, life-threatening, generalized allergic reactions, including anaphylaxis, may occur. If hypersensitivity reactions occur, discontinue therapy, treat the patient with supportive care and monitor until signs and symptoms resolve.
(Lexicomp)
Explain the science/physiology behind the anion gap.
An anion gap represents the difference between the concentration of unmeasured anions and the concentration of unmeasured cations.
(AMBOSS)
Why is it necessary to add continuous potassium chloride to prevent hypokalemia?
Insulin (especially IV insulin) causes a shift of potassium from the extracellular space to the intracellular space, possibly producing hypokalemia. If left untreated, hypokalemia may result in respiratory paralysis, ventricular arrhythmia, and even death. Use with caution in patients at risk for hypokalemia (eg, loop diuretic use). Monitor serum potassium frequently with IV insulin use and supplement potassium when necessary.
(Lexicomp)
Analyze ABG. What is our patient's acid/base balance?
pH (arterial): 7.13
Pco2 (arterial): 22
Po2 (arterial): 70
Low
Low
Low
In conjunction with other lab analysis suggests: high anion gap metabolic acidosis with respiratory compensation.