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Type 1 Diabetes
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Type 1 Diabetes

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Type I Diabetes Mellitus + DKA seminar

Type I Diabetes Mellitus + DKA seminar

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  • 1. By: Hamza AlGhamdi
  • 2. Our Roadmap…. Mazen DKA Hamza Diabetes type I
  • 3. DIABETES INCHILDREN
  • 4. Types : Other Types
  • 5. Type I Type IIInsulinopenia Normal or High insulin• Loss of pancreatic • Peripheral insulin function resistance
  • 6. TYPE I DM
  • 7. Fatima .. • 7 years old • Saudi girl • From Abha • Came to OPD • Found to have High blood glucose on screening campaign • Concerns about being Diabetic • HOW TO APPROACH ??? is this common presentation ??
  • 8. History• Risk Factors • HLA •1/100.000 in China •DR4-DQ8 •38/100.000 in Finland •DR3-DQ2 •(2) •IN 90% (1) •DR15-DQ6 - protective Genetic Geographic predisposition. region infections Dietary factors •Congenital Rubella •Infant supplementation •(3) with VitD may be •Human Enterovirus protective (5) •(4) •We need further studies to prove
  • 9. DKAHistory • Nausea and vomiting • Abdominal pain • Tachypnea • Lethargy Common • Polyuria • Polydipsia • Age 5-15 • Weight loss • Blurred vision Uncommon • Comma • Vaginitis • Incidental
  • 10. ExaminationGeneral Skin Upper & Eye Others•Look •Ulcers Lower limbs •Retinal •Complete whole•Mental status •Rashes •Ulcers examination for body•Vitals •Infections •Nails retinopathy examination•Dehydration •Injection site •Neuropathy•Growth •feet parameters
  • 11. RBG Random Blood GlucoseDiagnosis • RBG ≥ 200 mg/dLSymptoms + one of thefollowing investigations: FBG Fasting Blood Glucose • FBG ≥ 126 mg/dL OGTT Oral Glucose Tolerance test • 2 –hours post OGTT ≥ 200 mg/dLTo confirm Dx, repeat the HbA1c Glycosylated Hbtest another time. • HbA1c ≥ 6.5%Don’t forget to take Drug Hx
  • 12. MANAGEMENT
  • 13. Management Insulin Screening for complications Education and Regular psychosocial Follow up support Long term glycemic Monitoring control Diet
  • 14. Management Goal To keep Glucose level as close to normal as possible More tight with increased age! Without inducing Hypoglycemia
  • 15. Types of insulin
  • 16. Management Basal Insulin Initial dose : 0.5 – 1 units/kg/day Honeymoon period ??? Premeal correction dose Based on premeal glucose level Amylin analogs To reduce post prandial glucose level
  • 17. Regemin Long Acting Short acting Glargin – once daily Regular – 3-3 times daily NPH – twice daily Detemir – twice daily + Lispro – premeal Aspart – premeal Glulisine – premeal
  • 18. HYPOGLYCEMIA?
  • 19. THANK YOU
  • 20. References• 1- Gillespie, K. M. (2006). Type 1 diabetes: pathogenesis and prevention. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 175(2), 165-70. doi:10.1503/cmaj.060244• 2- Onkamo, P., Väänänen, S., Karvonen, M., & Tuomilehto, J. (1999). Worldwide increase in incidence of Type I diabetes--the analysis of the data on published incidence trends. Diabetologia, 42(12), 1395-403. doi:10.1007/s001250051309• 3- Ginsberg-Fellner, F., Witt, M. E., Fedun, B., Taub, F., Dobersen, M. J., McEvoy, R. C., Cooper, L. Z., et al. (n.d.). Diabetes mellitus and autoimmunity in patients with the congenital rubella syndrome. Reviews of infectious diseases, 7 Suppl 1, S170-6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3890104• 4- Hober, D., & Sauter, P. (2010). Pathogenesis of type 1 diabetes mellitus: interplay between enterovirus and host. Nature reviews. Endocrinology, 6(5), 279-89. doi:10.1038/nrendo.2010.27• 5- Hyppönen, E., Läärä, E., Reunanen, A., Järvelin, M. R., & Virtanen, S. M. (2001). Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet, 358(9292), 1500-3. doi:10.1016/S0140-6736(01)06580- 1
  • 21. DKA
  • 22. • Othman, 6yrs old Saudi boy from Abha • Known case of DM type IMeet our patient • Came to ER complaining of : • Fatigue and malaise • Nausea/vomiting • Abdominal pain • On Examination: Altered mental status Tachycardia Tachypnea or hyperventilation (Kussmaul respirations) low blood pressure Increased capillary refill time Poor perfusion Lethargy and weakness Fever Acetone odor
  • 23. Investigations : Serum glucose • -Hyperglycemia (>200 mg/dl). ABG • -Acidosis (arterial pH < 7.25). Urinalysis • -Ketosis (+ve in urine /serum). ABG • -Serum HCO3 (<15 mEq/l).
  • 24. Hyperglycemia DKAketosis Acidosis
  • 25. CausesNew-onset DM1.Known DM1 if : - Insulin injectionsare omitted. - Stress (infections/surgery ).
  • 26. Management Electrolytes Acidosis Hyperglycemia Rehydration ABC
  • 27. Dehydration[1] IV fluid bolus of glucose- free isotonic solution (NS/ringer`s lactate).[2] The remaining fluid deficit + maintenance fluid: -replaced SLOWELY over 36- 48 hours.* To avoid rapid shifts in serum osmolality: start with 0.9% NaClThen replaced by 0.45% NaCl.
  • 28. Management Electrolytes Acidosis Hyperglycemia Rehydration ABC
  • 29. Hyperglycemia:[1] Fast-acting IV insulin (0.1U/kg/hour).[2] If serum glucose <300 mg/dl , add glucose to IV fluid. Acidosis:* Insulin  increase glucose uptake.  decrease FFAs production.* Avoid HCO3 unless sever acidosis (pH < 7.0).
  • 30. Management Electrolytes Acidosis Hyperglycemia Rehydration ABC
  • 31. Electrolytes imbalance:* potassium should be added to IV fluid , ONLY if adequate urine output is shown. (50% KCl & 50% KPo) at 20-40 mEq/L. Monitoring:[1] Flow-sheet.[2] repeat serum glucose every hour.[3] neurologic & mental status.
  • 32. Cerebral edema.Complications CVA. ATN è ARF. Pancreatitis. Arrhythmia. Bowel ischemia. Pulmonary edema. Peripheral edema.
  • 33. Cerebral edema* 1-5%.* 20-80% mortality rate.* pathogenesis: osmolar shift  increase intracellular compartment fluid & cell swelling.* 6-12 hours after therapy.* signs & symptoms: 1- sever headache. 2- bradycardia, HTN, apnea. 3- dilated pupil, papilledema. 4- seizure.
  • 34. Treatment of cerebral edema :[1] IV Mannitol.[2] Endotracheal intubation & hyperventilation.
  • 35. That’s allTHANK YOU