P2 AB1 T1DM Clinical Presentation PDF

Classification of diabetes, Type 1 Diabetes Mellitus and Diabetic Ketoacidosis Dr Nithya Sukumar Associate Clinical Professor, Warwick Medical School Consultant Physician in Diabetes and Endocrinology, George Eliot Hospital NHS Tru...

Classification of diabetes, Type 1 Diabetes Mellitus and Diabetic Ketoacidosis Dr Nithya Sukumar Associate Clinical Professor, Warwick Medical School Consultant Physician in Diabetes and Endocrinology, George Eliot Hospital NHS Trust August 2024 Learning outcomes Revise the classification of diabetes Recognise the differences between type 1 and 2 diabetes Revise the pathogenesis of diabetic ketoacidosis (DKA) in T1DM Recognise and describe symptoms and signs in DKA Begin to form basic investigation and management plans for patients with DKA  TYPE Caused by the Diabetes is a autoimmune destruction chronic of the pancreatic beta 1 metabolic cells (which produce insulin) disease Requires insulin for survival characterised Can appear at any age, by high although TYPE Characterised by resistance blood to usually before insulin’s 40 years action and impaired insulin production glucose 2 Strong genetic (familial) levels and propensity caused Unmasked by lifestyle factors by defects in such as obesity and lack of insulin exercise secretion or * Diabetes UK, 2018. Facts and Figures. www.diabetes.org.uk/professionals/position-statements-reports/stati Treatment for Diabetes until 1919 Lock and key strategy The 'oat-cure' (oatmeal) The milk diet The rice cure Potato therapy Opium! Injectable pancreatic extract Diabetes before insulin Insula OR “Island” 1910 - English physiologist Sir Edward Albert Sharpey-Schafer’s study of the pancreas leads him to the discovery of a substance that would normally be produced in non-diabetics: insulin. The name comes from the Latin insula, meaning island, referencing the insulin-producing islets of Langerhans in the pancreas. The discovery of Insulin in 1922 is accredited to Frederick Banting and Charles Best (a medical student), seen above, supervised by J.J.R Macleod and assisted by James Collip. The work was carried out at the University of Toronto. Insulin changed lives Classification of diabetes Difference between type 1 and type 2 diabetes Classification and Diagnosis of Diabetes Table 2.2 Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes - 2021. Diabetes Care 2021;44(Suppl. 1):S15-S33 HbA1c vs glucose for screening and diagnosis of diabetes Clinical Presentation of Type 1 DM Approximately 25-30% of young people with new onset T1DM will present with DKA Antibodies in type 1 DM Clin Exp Immunol, Volume 210, Issue 2, November 2022, Pages 151–162, https://doi.org/10.1093/cei/uxac087 Case 1: Georgette Eliot 44 yr old woman brought into A&E HPC: Fractured humerus after fall while riding a horse PMHx : T1DM, Childhood asthma Drug Hx: Novorapid 8 + 12 + 16 and Lantus 28 units at night. Clinical examination: Systemic examination- BP 130/85mm Hg PR 100 bpm RR 21/min Sats 96% on Room Air GCS 15/15 Cap. Blood glucose 14.2 mmol/l Under T&O, awaiting internal fixation; kept Nil by mouth for 24 hours  ABGs On admission After 24 hours Patient’s Normal Range Patient’s Normal Range Data Data pH 7.58 7.35-7.45 pH 7.2 7.35-7.45 pCO2 3.8 4.7-6.0 pCO2 4.8 4.7-6.0 pO2 11.6 10.5-13.5 pO2 10.9 10.5-13.5 HCO3 24 22-28 HCO3 13 22-28 Gluc 14 Gluc 27 BE 2 BE 2.5 Lac 1.6 Lac 2.1 Clinical Vignette: Georgette Eliot Blood glucose – Hi Blood ketones 5.6 ? Diagnosis Diabetic Ketoacidosis (DKA) due to insulin omission while NBM Definitions and Diagnosis DKA consists of the biochemical triad of ketonaemia (ketosis), hyperglycaemia and acidaemia D known diabetes mellitus or Blood glucose > DIAGNOSIS 11.0mmol/L K Ketonaemia > 3.0mmol/L or significant ketonuria (more than 2+ on standard urine sticks) A Venous pH < 7.3 and/or Bicarbonate (HCO3-) < 15.0mmol/L Diagnosis Establish diagnosis D K A Plasma Glucose Arterial pH 11.1 mmol/l Venous HCO3- 14 > 14 > 14 > 33.3 (mmol/l) pH 7.25 – 7.30 7.00 – 7.25 < 7.00 > 7.30 Serum HCO3- 15 – 18 10 – 15 < 10 Normal (mmol/l) Urine ketones Positive Positive Positive Negative Serum ketones 3–4 4–8 >8 < 0.6 (NR: 320 (mOsm/kg) Anion gap > 10 > 12 > 16 Variable (NR