T1DM Flashcards
What is the pathophysiology of T1DM?
Autoimmune destruction of Beta Cells causing low insulin levels
This stops glucose being transported into cells leading to high blood glucose
The body believes it is being fasted so adipose tissue and muscles breakdown to provide energy in the form of ketones
Glucagon is released to increase glucose production in the liver via gluconeogenesis
High blood glucose levels leads to decreased glucose reabsorption in the kidneys causing glucose in the urine
Due to osmotic traits of glucose water follows it causing increased urination and therefore increased thirst
Ketones cause acidity of the blood leading to Kussmal breathing and DKA
What are symptoms of diabetes?
Polyuria Polydipsia Weight loss Increased appetite Thrust Fatigue DKA Hyperventilation Ketonuria and glucosuria
How is T1DM investigated?
Urine dip Blood glucose levels -fasting/ random/ oral glucose tolerance test -C-peptide- often low -genetic testing
How is diabetes diagnosed?
Random blood glucose/OGTT >11.1mmol/L
Fasting blood glucose >7mmol/L
What is the general management of T1DM?
Patient education and individualised care plan
Self monitoring of glucose at least 3-4 times a day
-before meals and bed
3-6 monthly monitoring of HbA1c
What are the different types of insulin?
Short/Quick acting
- novorapid or humalog
- onsets within 30mins
- given with or just after food
- peaks at 2.5-3.5hrs
Intermediate acting
- humulin I
- onsets within 1-2hrs
- peaks at 4-12hrs
Long acting
- e.g. glargine or detemir
- onsets within 1hr
- lasts 24hrs
- reaches a continuous minimum level
What are the different insulin regimes that can be used?
Basal-bolus regime
- long or intermediate acting insulin given once (at night) or twice a day
- short/quick acting given at meals
Twice daily dosing
- combination of biphasic insulin e.g. Novomix30
- given in the morning and evenings
- contains intermediate insulin that covers lunch and overnight
What is involved in annual monitoring for diabetes?
Check glycaemic control, whether driving
Assess for macrovascular complications
- BMI
- BP
- Smoking status
- Lipids
- ECG
Assess for microvascular complications
- Foot examination
- Fundoscopy
- Urine dip and creatinine
What are complications of Insulin therapy?
Weight gain Insulin resistance Injection site damage -redness/swelling -can lead to abscesses -lipohypertrophy -must rotate injection site
What are sick day rules in diabetes?
Drink 3L of fluid If not eating then sugary drinks Continue normal insulin regime Check blood glucose every 3-4hrs Check ketones regularly
What should be done to the insulin regime if patient is hypoglycaemic a lot?
Decrease it by 20%
What should be done to the insulin regime if a patient is hyperglycaemic a lot?
Increase it by 10%
