Type 1 Diabetes

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Type I Diabetes Mellitus + DKA seminar

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Type 1 Diabetes

  1. 1. By: Hamza AlGhamdi
  2. 2. Our Roadmap…. Mazen DKA Hamza Diabetes type I
  3. 3. DIABETES INCHILDREN
  4. 4. Types : Other Types
  5. 5. Type I Type IIInsulinopenia Normal or High insulin• Loss of pancreatic • Peripheral insulin function resistance
  6. 6. TYPE I DM
  7. 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. 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. 9. DKAHistory • Nausea and vomiting • Abdominal pain • Tachypnea • Lethargy Common • Polyuria • Polydipsia • Age 5-15 • Weight loss • Blurred vision Uncommon • Comma • Vaginitis • Incidental
  10. 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. 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. 12. MANAGEMENT
  13. 13. Management Insulin Screening for complications Education and Regular psychosocial Follow up support Long term glycemic Monitoring control Diet
  14. 14. Management Goal To keep Glucose level as close to normal as possible More tight with increased age! Without inducing Hypoglycemia
  15. 15. Types of insulin
  16. 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. 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. 18. HYPOGLYCEMIA?
  19. 19. THANK YOU
  20. 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. 21. DKA
  22. 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. 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. 24. Hyperglycemia DKAketosis Acidosis
  25. 25. CausesNew-onset DM1.Known DM1 if : - Insulin injectionsare omitted. - Stress (infections/surgery ).
  26. 26. Management Electrolytes Acidosis Hyperglycemia Rehydration ABC
  27. 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. 28. Management Electrolytes Acidosis Hyperglycemia Rehydration ABC
  29. 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. 30. Management Electrolytes Acidosis Hyperglycemia Rehydration ABC
  31. 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. 32. Cerebral edema.Complications CVA. ATN è ARF. Pancreatitis. Arrhythmia. Bowel ischemia. Pulmonary edema. Peripheral edema.
  33. 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. 34. Treatment of cerebral edema :[1] IV Mannitol.[2] Endotracheal intubation & hyperventilation.
  35. 35. That’s allTHANK YOU

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