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Insulin Dependent Dm Type 1 Immunization for undergraduate students.pdf

Abbas Mushtaq Ali
Abbas Mushtaq Ali

Insulin Dependent Dm Type 1 Immunization for undergraduate students

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Insulin Dependent Dm Type 1
Metabolic Disorder of Hyperglycemia & Ketosis Results From Deficiency of Insulin Production in The Pancreas Most Common Age of Presentation is 5-7Y Then Also in Adolescence Rate in The Developing World Like Most Autoimmune Disease, is on The Rise Pathology Signs & Symptomes A. Early Presentation Weight Loss Fatigue Poly (Uria, Dipsia, Phagia) B. Late Presentation Polyuria Despite Dehydration Delayed Capillary Refill, Dry Mucous Membranes Sweet or Musty Breath Odor (From Ketones) Tachycardia, Tachypnea Confusion / Coma VT/VF (Secondary to Hyperkalemia)
Dx RBS (Random Glucose) > 200 mg/dl + Signs or Symptoms Of IDDM 1 Fasting Glucose Levels > 126 mg/dl (8h Fast) or 2H Post-Glucose Challenge > 200 mg/dl HbA1C > 6.5 % DIABETIC KETOACIDOSIS Dx: Hx. & Clinical Examination Acidosis 1. PH < 7.35 , HCO3 < 15 mEq/dl 2. Pseudohypo-Na & Pseudohyper-K Hyperglycemia (Glucose>300 mg/dl) Ketonuria or Ketonemia (+ve) Low C-Peptide Management: 2 IV Lines 1st Line For Rehydration 2nd Line For Insulin Finally Correct Electrolytes Disturbances Admission to ICU Hx. & Clinical Examination Patient with DM Type 1 Patient with DKI osmolarity = 2 Nat 285-29 -"Short Action 3. ing = 1750
Representative Profiles of Insulin: Traditional Methods for Insulin Delivery (S.C Route ) Daily Requirements: 0.7 unit/kg (Pre-Adolescents) 1 (Adolescents) 1,2 (Post-Adolescents) Regimen 1: 2/3 At Morning (Mixtard 70% LA, 30% SA) 1/3 At Night (Mixtard 70% LA, 30% SA) Regimen 2: 1/2 At Night (LA Glargine) 1/2 Divided For 3 Dose With Each Meal (VSA Aspart & Lispro)
1. Tell Them About Hypoglycemia: Signs & Symptoms (Tremors, Sweating, Palpitations, DLOC, Seizures) Management (Directly Give Something Sweet or Use I.M. Glucagon Injection) 2. Ask The Father to Inform The Teachers About His Child Condition Especially The Hypoglycemia & How Treat it Early 3. Also The child with DM should Avoid Food With High Sugar (Pepsi, chocolateetc) Eat More Than 3 Meals At Day The Diet Should Continue 50-65% CHO, 25-30% Proteins & The Reminder is Fat 4. Allowed to Do Simple Exercises But Not Heavy Exercise 5- Follow up for : Complications (Autoimmune Diseases Vitiligo & Coeliac Disease) Growth & Height Complications of DM Acute (DKA, Hypoglycemia) Chronic (Retinopathy, Neuropathy & Nephropathy) Counselling:
A 7-year-old girl, 30 kg body weight presented to the ER with a 2-week history of being generally unwell. Over the previous 2 days she had been vomiting and that evening she had started to become delirious. On further discussion with the mother, it was found that the girl had been drinking excessively, and unusually she had also been going to the toilet during the night. It was also thought that she had lost some weight. On examination, She was breathing spontaneously but shallowly and at a relatively rapid rate. Auscultation of the chest revealed bilateral air entry. She was noted to be dehydrated with sunken eyes. Her Glasgow Coma Score (GCS) was assessed as 8/15 (E2, M4, V2) as she was only responsive to pain. 1. Past medical history Fit and well Previous admission to hospital for grommets aged 2 years 2. Regular medications None 3. Allergies None known 4. Examination Awake and responsive, but slightly confused Airway clear, face mask oxygen, breath ketotic Chest clear, bilateral air entry, Sats 98% in air Respiratory rate 35 min-l Capillary refill time =4 seconds Temperature 38属C Normal heart sounds, pulse 150 min- 1, BP 95/60 5. Investigations Weight 20 kg CBC (Hb 165 g dI , Plat 445 x 10属 F1, WBC 34,3 x 109 1) U+Es (Na 144 mmol, k+ 4.1 mmol, Urea 13.2 mmol, Creatinine 117 umol) Glucose 65 mmol Venous blood gas (pH 6,82, pCO2 11 mmHg, HCO3 - 5.7 mmol, BE -31.7) Urine dip stick Ketones ++++ Case study

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Insulin Dependent Dm Type 1 Immunization for undergraduate students.pdf

  • 2. Metabolic Disorder of Hyperglycemia & Ketosis Results From Deficiency of Insulin Production in The Pancreas Most Common Age of Presentation is 5-7Y Then Also in Adolescence Rate in The Developing World Like Most Autoimmune Disease, is on The Rise Pathology Signs & Symptomes A. Early Presentation Weight Loss Fatigue Poly (Uria, Dipsia, Phagia) B. Late Presentation Polyuria Despite Dehydration Delayed Capillary Refill, Dry Mucous Membranes Sweet or Musty Breath Odor (From Ketones) Tachycardia, Tachypnea Confusion / Coma VT/VF (Secondary to Hyperkalemia)
  • 3. Dx RBS (Random Glucose) > 200 mg/dl + Signs or Symptoms Of IDDM 1 Fasting Glucose Levels > 126 mg/dl (8h Fast) or 2H Post-Glucose Challenge > 200 mg/dl HbA1C > 6.5 % DIABETIC KETOACIDOSIS Dx: Hx. & Clinical Examination Acidosis 1. PH < 7.35 , HCO3 < 15 mEq/dl 2. Pseudohypo-Na & Pseudohyper-K Hyperglycemia (Glucose>300 mg/dl) Ketonuria or Ketonemia (+ve) Low C-Peptide Management: 2 IV Lines 1st Line For Rehydration 2nd Line For Insulin Finally Correct Electrolytes Disturbances Admission to ICU Hx. & Clinical Examination Patient with DM Type 1 Patient with DKI osmolarity = 2 Nat 285-29 -"Short Action 3. ing = 1750
  • 4. Representative Profiles of Insulin: Traditional Methods for Insulin Delivery (S.C Route ) Daily Requirements: 0.7 unit/kg (Pre-Adolescents) 1 (Adolescents) 1,2 (Post-Adolescents) Regimen 1: 2/3 At Morning (Mixtard 70% LA, 30% SA) 1/3 At Night (Mixtard 70% LA, 30% SA) Regimen 2: 1/2 At Night (LA Glargine) 1/2 Divided For 3 Dose With Each Meal (VSA Aspart & Lispro)
  • 5. 1. Tell Them About Hypoglycemia: Signs & Symptoms (Tremors, Sweating, Palpitations, DLOC, Seizures) Management (Directly Give Something Sweet or Use I.M. Glucagon Injection) 2. Ask The Father to Inform The Teachers About His Child Condition Especially The Hypoglycemia & How Treat it Early 3. Also The child with DM should Avoid Food With High Sugar (Pepsi, chocolateetc) Eat More Than 3 Meals At Day The Diet Should Continue 50-65% CHO, 25-30% Proteins & The Reminder is Fat 4. Allowed to Do Simple Exercises But Not Heavy Exercise 5- Follow up for : Complications (Autoimmune Diseases Vitiligo & Coeliac Disease) Growth & Height Complications of DM Acute (DKA, Hypoglycemia) Chronic (Retinopathy, Neuropathy & Nephropathy) Counselling:
  • 6. A 7-year-old girl, 30 kg body weight presented to the ER with a 2-week history of being generally unwell. Over the previous 2 days she had been vomiting and that evening she had started to become delirious. On further discussion with the mother, it was found that the girl had been drinking excessively, and unusually she had also been going to the toilet during the night. It was also thought that she had lost some weight. On examination, She was breathing spontaneously but shallowly and at a relatively rapid rate. Auscultation of the chest revealed bilateral air entry. She was noted to be dehydrated with sunken eyes. Her Glasgow Coma Score (GCS) was assessed as 8/15 (E2, M4, V2) as she was only responsive to pain. 1. Past medical history Fit and well Previous admission to hospital for grommets aged 2 years 2. Regular medications None 3. Allergies None known 4. Examination Awake and responsive, but slightly confused Airway clear, face mask oxygen, breath ketotic Chest clear, bilateral air entry, Sats 98% in air Respiratory rate 35 min-l Capillary refill time =4 seconds Temperature 38属C Normal heart sounds, pulse 150 min- 1, BP 95/60 5. Investigations Weight 20 kg CBC (Hb 165 g dI , Plat 445 x 10属 F1, WBC 34,3 x 109 1) U+Es (Na 144 mmol, k+ 4.1 mmol, Urea 13.2 mmol, Creatinine 117 umol) Glucose 65 mmol Venous blood gas (pH 6,82, pCO2 11 mmHg, HCO3 - 5.7 mmol, BE -31.7) Urine dip stick Ketones ++++ Case study