Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2a- Endocrinology > Type 1 diabetes > Flashcards

Type 1 diabetes Flashcards

1
Q

What are the presenting features of type 1 diabetes?

A
  • Thirst
  • Polyuria
  • Weight loss and fatigue
  • Hunger
  • Pruritis vulvae and balanitis
  • Blurred vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is thirst a presenting feature?

A

osmotic activation of hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why is polyuria a presenting feature?

A

osmotic diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is weight loss and fatigue a presenting feature?

A

lipid and muscle loss due to unrestrained gluconeogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is hunger a presenting feature?

A

Lack of useable energy source

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is pruritis vulvae and balanitis a presenting feature?

A

Because of
- Vaginal candidiasis
- Chest / skin infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is blurred vision a presenting feature?

A

Altered acuity due to uptake of glucose/water into lens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are suggestive features of type 1 diabetes?

A
  • Onset in childhood / adolescence
  • Lean body habitus
  • Acute onset of osmotic symptoms
  • Prone to ketoacidosis
  • High levels of islet autoantibodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What age can type 1 diabetes present?

A

Can occur at any age, the spectrum of presentation depends on the rate of b-cell destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are clinical features of newly diagnosed Type 1 diabetes?

A
  • Weight loss
  • Urinary ketones
  • Moderate or large urinary ketones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How many clinical features of newly diagnosed type 1 diabetes would call for immediate insulin treatment?

A

Any 2 of these three features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are suggestive features of type 2 diabetes?

A
  • Usually presents in over-30s
  • Onset is gradual
  • Almost 100% concordance in identical twins
  • Diet, exercise and oral medication can often control hyperglycaemia; insulin may be required later in the disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What makes diagnosing type 1 and 2 diabetes difficult?

A
  • Type 2 is diagnosed in younger patients, including childhood
  • Type 1 patients can be obese
  • Uncontrolled Type 2 can present with weight loss and ketouria
  • IF IN DOUBT – TREAT WITH INSULIN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What other autoimmune diseases is T1D associated with?

A
  • Hypothyroidism
  • Addisons
  • Coeliac disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does reduced insulin lead to in fat metabolism?

A

leads to fat breakdown and formation of glycerol (a gluconeogenic precursor) and free fatty acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What impact do free fatty acids have on glucose metabolism?

A
  • Impair glucose uptake
  • Are transported to the liver, providing ‘energy’ for gluconeogensis
  • Are oxidised to form ketone bodies (beta hydroxy butyrate, acetoacetate and acetone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What leads to a rise in ketones?

A
  • Absence of insulin and rising counterregulatory hormones leads to increasing hyperglycaemia and rising ketones
  • Glucose and ketones escape in the urine but lead to an osmotic diuresis and falling circulating blood volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do ketones cause?

A

cause anorexia and vomiting

19
Q

What does cycle of increasing dehydration, hyperglycaemia and increasing acidosis eventually lead to?

A

circulatory collapse and death

20
Q

Define Diabetic ketoacidosis (DKA)

A
  • Hyperglycaemia (plasma glucose usually <50 mmol/l)
  • Raised plasma ketones (urine ketones > 2+)
  • Metabolic acidosis – plasma bicarbonate < 15 mmol/l
21
Q

What does DKA cause?

A
  • Intercurrent illness
    • infection
    • myocardial infarct
22
Q

What is the triad of DKA?

A
  • Hyperglycaemia
  • Ketones
  • Acidosis
23
Q

What are symptoms of DKA?

A
  • develop over days
  • polyuria and polydipsia
  • nausea and vomiting
  • weight loss
  • weakness
  • abdominal pain (confused with surgical abdomen)
  • Drowsiness / confusion
24
Q

What are signs of DKA?

A
  • hyperventilation (Kussmaul breathing)
  • dehydration (average fluid loss 5-6 litres)
  • hypotension
  • Tachycardia
  • coma
25
Q

What is the value of hyperglycaemia in diagnosing DKA?

A

<50 mmol/l

26
Q

What is the value of blood ketones in DKA?

A

> 3

27
Q

How do you manage DKA?

A
  • rehydration (3L first 3 hrs)
  • insulin (inhibits lipolysis, ketogenesis, acidosis, reduces hepatic glucose production, increase tissue glucose uptake)
  • replacement of electrolytes (K+)
  • treat underlying cause
  • Treatment must be started without delay
  • Follow DKA protocol in hospital
28
Q

What are complications of DKA?

A
  • cerebral oedema (deterioration in conscious level)
    • children more at risk
  • adult respiratory distress syndrome
  • thromboembolism – venous and arterial
  • aspiration pneumonia (in drowsy/comatose patients)
  • death
29
Q

What are aims of treatment in diabetes type 1?

A
  • Relieve symptoms and prevent ketoacidosis
  • Prevent microvascular and macrovascular complications
30
Q

What are some symptoms of hypoglycaemia?

A
  • Sweating
  • Shaking
  • Dizziness
  • Hunger
  • Fast heartbeat
31
Q

What does acute deprivation of glucose within the brain lead to?

A

cerebral dysfunction (loss of concentration, confusion, coma)

32
Q

What is released in response to hypoglycaemia?

A

glucagon, adrenaline

33
Q

What glucose level inhibits insulin secretion?

A

4.6 mM

34
Q

What glucose level are counter-regulatory hormones released? (glucagon and adrenaline)

A

3.8 mM

35
Q

What glucose level do autonomic symptoms occur?

A

3.8-2.8 mM

36
Q

What are autonomic symptoms?

A

sweating, tremor, palpitations

37
Q

What glucose level do neuroglycopenic symptoms occur?

A

<2.8 mM

38
Q

What are neuroglycopenic symptoms?

A

confusion, drowsiness, altered behaviour, speech difficulty, incoordination

39
Q

What glucose level does
severe neuroglycopenic symptoms occur?

A

<1.5 mM

40
Q

What are severe neuroglycopenic symptoms?

A

convulsions, coma, focal neurological deficit ie. hemiparesis

41
Q

What will setting a higher glucose target in those with T1D reduce the risk of but increase the risk of?

A

will reduce the risk of hypoglycaemia but increase the risk of diabetic complications

42
Q

What will setting a lower glucose target in those with T1D reduce the risk of but increase the risk of?

A

will reduce the risk of complications but increase the risk of hypoglycaemia

43
Q

What are factors making it difficult for people with diabetes to sustain effective self management?

A
  • Risk of hypoglycaemia
  • Too arduous a treatment
  • Risk of weight gain
  • Interference with lifestyle
  • Lack of sufficient training from diabetes teams

2a- Endocrinology (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions