Type 1 Diabetes

natalieszabat
Mind Map by natalieszabat, updated more than 1 year ago
natalieszabat
Created by natalieszabat almost 6 years ago
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Description

General overview

Resource summary

Type 1 Diabetes
  1. Characterized by the destruction of pancreatic beta cells
    1. Genetic
      1. Human leukocyte antigen (HLA) types
        1. HLA DR3
          1. HLA DR4
        2. Environmental
          1. Viruses
            1. Toxins
            2. Immunological
              1. Antibodies against islet cells & endogenous insulin
            3. Clinical manifestations
              1. Polyuria
                1. Polydipsia
                  1. Polyphagia
                  2. Assessment & diagnostic findings
                    1. Fasting plasma glucose level (FPG)
                      1. 7.0 mmol/L or more
                      2. A1C lab test
                        1. Normal A1C level is below 5.7 percent
                      3. 5 components of diabetes management
                        1. Nutrition
                          1. Exercise
                            1. Education
                              1. 2 main types
                                1. "Survival skills"
                                  1. In-depth, advanced continuing education
                                2. Monitoring
                                  1. SMBG 4x daily
                                    1. Before meals
                                      1. At bedtime
                                      2. Urine testing for ketones
                                        1. If glucosuria present
                                          1. During illness
                                            1. In pregnancy
                                              1. Persistently elevated glucose levels
                                            2. Pharmacologic therapy
                                              1. Insulin therapy
                                                1. Conventional regimen
                                                  1. Terminally ill
                                                    1. Frail older adult w/ limited self-care capabilities
                                                      1. Patients unwilling to engage in self-management activities
                                                      2. Intensive regimen
                                                        1. Allows for more control over blood glucose levels
                                                          1. Ineligible candidates
                                                            1. Nervous system disorders rendering them unaware of hypoglycemia episodes
                                                              1. Reoccurring severe hypoglycemia
                                                                1. Irreversible diabetic complications
                                                                  1. Blindness
                                                                    1. ESRD
                                                                    2. Cerebrovascular and/or cardiovascular disease
                                                                      1. Ineffective self-care skills
                                                              2. Patient characteristics
                                                                1. Onset any age, but usually young (younger than 30)
                                                                  1. Usually thin at diagnosis
                                                                  2. Complications
                                                                    1. Acute
                                                                      1. Hypoglycemia (insulin reactions)
                                                                        1. Causes
                                                                          1. Too much insulin
                                                                            1. Too many hypoglycemic agents
                                                                              1. Too little food
                                                                                1. Excessive physical activity
                                                                                2. Description
                                                                                  1. Blood glucose falls to <2.7-3.3 mmol/L
                                                                                  2. Clinical manifestations
                                                                                    1. Mild hypoglycemia
                                                                                      1. Sweating
                                                                                        1. Tremor
                                                                                          1. Tachycardia
                                                                                            1. Palpitation
                                                                                              1. Nervousness
                                                                                                1. Hunger
                                                                                                2. Moderate hypoglycemia
                                                                                                  1. Headache
                                                                                                    1. Inability to concentrate
                                                                                                      1. Light-headedness
                                                                                                        1. Confusion
                                                                                                          1. Memory lapses
                                                                                                            1. Slurred speech
                                                                                                              1. Numbness of lips & tongue
                                                                                                                1. Combative behaviour
                                                                                                                  1. Impaired coordination
                                                                                                                    1. Emotional changes
                                                                                                                      1. Double vision
                                                                                                                        1. Drowsiness
                                                                                                                        2. Severe hypoglycemia
                                                                                                                          1. Disoriented behaviour
                                                                                                                            1. Seizures
                                                                                                                              1. Loss of consciousness
                                                                                                                                1. Difficulty arousing from sleep
                                                                                                                              2. Treatment/interventions
                                                                                                                                1. 15g of fast-acting concentrated source of carbohydrate
                                                                                                                                  1. If unconscious/cannot swallow
                                                                                                                                    1. 1mg glucagon administered subcutaneously
                                                                                                                              3. Diabetic ketoacidosis
                                                                                                                                1. Cause
                                                                                                                                  1. Absence or markedly inadequate amount of insulin
                                                                                                                                    1. Decreased or missed dose
                                                                                                                                      1. Illness or infection
                                                                                                                                        1. Undiagnosed/untreated diabetes
                                                                                                                                      2. Main clinical features
                                                                                                                                        1. Hyperglycemia
                                                                                                                                          1. Dehydration & electrolyte loss
                                                                                                                                            1. Acidosis
                                                                                                                                            2. Signs & symptoms
                                                                                                                                              1. Polyuria
                                                                                                                                                1. Polydipsia
                                                                                                                                                  1. Blurred vision
                                                                                                                                                    1. Weakness
                                                                                                                                                      1. Headache
                                                                                                                                                        1. Orthostatic hypotension
                                                                                                                                                          1. Weak, thready pulse
                                                                                                                                                            1. GI symptoms
                                                                                                                                                              1. Anorexia
                                                                                                                                                                1. Nausea
                                                                                                                                                                  1. Abdominal pain
                                                                                                                                                                    1. Vomiting
                                                                                                                                                                    2. Kussmaul respirations
                                                                                                                                                                      1. Low pCO2 level
                                                                                                                                                                        1. 10-30 mm Hg
                                                                                                                                                                      2. Lethargy
                                                                                                                                                                      3. Diagnostic findings
                                                                                                                                                                        1. Low serum bicarbonate
                                                                                                                                                                          1. 0-15 mmol/L
                                                                                                                                                                          2. Low pH
                                                                                                                                                                            1. 6.8-7.3
                                                                                                                                                                          3. Prevention
                                                                                                                                                                            1. Teach "sick day" rules
                                                                                                                                                                            2. Medical management
                                                                                                                                                                              1. Fluid resuscitation
                                                                                                                                                                                1. Avoidance of hypokalemia
                                                                                                                                                                                  1. Insulin administration
                                                                                                                                                                                    1. Avoidance of rapidly falling serum osmolality
                                                                                                                                                                                      1. Search for cause
                                                                                                                                                                                    2. Hyperglycemic hyperosmolar nonketotic syndrome
                                                                                                                                                                                      1. Not common in type I diabetes
                                                                                                                                                                                    3. Chronic
                                                                                                                                                                                      1. Microvascular disease
                                                                                                                                                                                        1. Coronary artery disease
                                                                                                                                                                                          1. Peripheral vascular disease
                                                                                                                                                                                            1. Cerebrovascular disease
                                                                                                                                                                                            2. Microvascular disease
                                                                                                                                                                                              1. Retina
                                                                                                                                                                                                1. Kidneys
                                                                                                                                                                                                2. Neuropathy
                                                                                                                                                                                                  1. Peripheral (sensorimotor) nerves
                                                                                                                                                                                                    1. Autonomic nerves
                                                                                                                                                                                                      1. Spinal nerves
                                                                                                                                                                                                      2. Retinopathy
                                                                                                                                                                                                        1. Nephropathy
                                                                                                                                                                                                      3. Foot & leg problems
                                                                                                                                                                                                        1. Neuropathy
                                                                                                                                                                                                          1. Peripheral vascular disease
                                                                                                                                                                                                            1. Immunocompromise
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