Practicum III (Peds) Test 2 Diabetes

Question Answer Reason for Type 1 diabetes destruction of pancreatic beta cells (usually by an immune-mediated process) Reason for Type 2 diabetes results from a combination of insulin resistance and a relative deficiency of insulin Metformin works how decreases hepatic glucose production and increases insulin sensitivity to insulin in the peripheral tissues Always included in the management of type 2 diabetes Nutritional therapy The only oral agent approved for use by children in the United States for managment of Diabetes Metformin Always included in the management of type 1 diabetes insulin What effect does trauma/stress have on insulin suppression The primary anabolic hormone that promotes glucose uptake in muscle and adipose tissue while suppressing glucose production (glycogenolysis and gluconeogenesis) by the liver. insulin some anesthetic agents may independently contribute to perioperative hyperglycemia. Which are they? inhalational anesthetics (isoflurane) – inhibit insulin secretion. Hyperglycemia results from impaired glucose uptake AND increased glucose production. What agents actually prevent hyperglycemia epidural analgesia What agents mitigate the hyperglycemic response to surgery? anesthesia with opioids Adverse effects of hyperglycemia impairs wound healing (hinders collagen production), ***T/F – When feasible, children with diabetes should not undergo elective surgery until they are metabolically stable true (no evidence of ketonuria, serum electrolytes are normal, and the HbA1c value is close to or within the ideal range for the child’s age.) preoperative assessment of metabolic control of diabetes should happen at what point before sx no less than 10 days prior What happens if metabolic control of diabetes is poor Sx should be delayed T/F – diabetes cases should be the last cases of the day false – first cases if at all possible The regimen for managing diabetes before, during, and after a surgical or diagnostic procedure that requires the child to fast should aim to maintain blood glucose at what levels? normal (100-200 mg/dl). This range has reduced risk of osmotic diuresis, dehydration, electrolyte imbalance, metabolic acidosis, infection, and hypoglycemia in the sedated child who may be unaware of hypoglycemia or unable to communicate with sta?. T/F – Diabetes patients should be admitted the day prior to surgery false – admit early in the morning T/F – On the morning of sx – patients should not take rapid or short acting insulin true – Unless their BG level is more than 250 mg/dl What happens if the sx is delayed? frequent blood glucose checks must be done to prevent hypo/hyperglycemia Insulin dependent: If the patients blood glucose is above ______ on the morning of sx, what should be done 250mg/dl; Use the childs "correction factor" to administer insulin Correction factor – definition and equation decrease in blood glucose concentration expected after administering 1 unit of rapid acting and short acting insulin. 1500 rule – divide 1500 by the childs daily units of insulin T/F – best to use the childs sliding scale as prescribed to correct hyperglycemia false – use the "correction factor" ***preoperative assessment should include what Endocrine assessment 10 days prior; Assess glycemic control, electrolyte status, ketones (urine or blood), HbA1c; Adjust diabetes treatment as needed to optimize glycemic control, other tests as needed ***Acceptable HgA1C's <6 years: 7.5–8.5%, 6–12 years: <8%, >12 years: <7.5% non-insulin dependent child (but still insulin resistant): If the patients blood glucose is above ______ on the morning of sx, what should be done 250 mg/dl; insulin dose of 0.1 unit/kg of rapid-acting insulin may be administered subcutaneously to correct a blood glucose insulin dependent child: If the patients blood glucose is above ______ on the morning of sx, what should be done 250 mg/dl. Administer insulin based on the child's correction factor For children on split-mixed insulin regimens (insulin given 3x daily), what should be done? 50% of their usual regimen should be given the morning of sx For children whose basal insulin (glargin) is given once a day, what should be done the morning of surgery? No dose the morning of sx IF they took their daily dose the evening before. A full dose should be given if their daily dose is taken in the morning For children whose basal insulin (detemir) is given once a day, what should be done the morning of surgery? No dose the morning of sx IF they took their daily dose the evening before. 75% of normal dose IF they normally take their dose in the morning. Children on an insulin pump: what determines the treatment length of the procedure Children on an insulin pump: what to do if the surgery is < 2 hours keep pt on their basal rate Children on an insulin pump: what to do if the surgery is > 2 hours transfer pt to insulin infusion Children requiring insulin that have major sx – especially those > 2 hours, what should be done usual dose of insulin in the morning, transfer pt to insulin infusion, 10% dextrose in 1/2 normal saline, target rate of 100-200 mg/dL How would you calculate the maintenance rate of 10% dextrose in 1/2 NS 4-2-1 Only _____ (what type) insulin should be used for intravenous infusions regular insulin Ratio of intravenous insulin to intravenous dextrose in PREPUBERTAL children 1 unit to 5 grams of dextrose Ratio of intravenous insulin to intravenous dextrose in ADOLESCENT children 1 unit to 3 grams of dextrose Which medications should be discontinued prior to sx metformin, sulfonureas, thiazolidinediones Surgeries of this duration may not need an insulin infusion? What would be the exception to this <1hr; If the patient is expected to have to fast for a prolonged period of time. What fluids would be used for what? 10% dextrose 1/2 normal saline for maintenance; NS or LR for for insensible losses or blood/body fluid loss. T/F – should generally avoid potassium chloride containing fluids true ***Blood glucose should be monitored how often and maintained to what level? hourly; 100-200 mg/dL When would the patient be discontinued from the dextrose infusion and be resumed on their normal regimen of diabetes management? What is the exception? when the pt is able to resume drinking and eating normally; The exception is children on metformin – this drug should be held for 48 hours and renal function must be normal before reinstitution. Postoperatively, before returning home, what should be done? Children and family should be given appropriate guidelines for monitoring BG and monitoring for signs of problems If the patient is admitted for an overnight stay, what should happen? they should be managed in consultation with endrocrinology Children that need emergent surgery should have what? a full assessment clinically and biochemically (correcting BG and fluid loss is critical); Emergent surgery may override this but correction should happen during surgery. Children with diabetic ketoacidosis require what? close collaboration between anesthesia and endrocrinology

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