Chapter 1- Diabetes Type 1

Question 1

What is DKA

Answer 1

Diabetic ketoacidosis:
Not enough insulin made
High glucose but not taken up into cells
Lipolysis forms ketone bodies
Increase acidity of blood (kussmaul respiration and hyperkalaemia)
Respire acetone

Question 2

Describe a sliding scale/ variable rate IV insulin infusion

Answer 2

1) dissolve 50units (0.5ml) of human actrapid with 49.5ml 0.9% NaCl
2) concentration is 1unit/ml

Question 3

How might hypoglycaemic state happen?

Answer 3

Too much insulin 
Skipped meals
Alcohol intoxication 
Night time hypos
Exercise without insulin adjustment 
Liver disease

Question 4

How can alcohol intoxication cause hypos?

Answer 4

Alcohol can inhibit the livers ability to release glucose into the blood

Question 5

List signs of DKA

Answer 5

Vomiting
Kussmaul respiration 
Hyperkalaemia
Tachycardia 
Acetone breath 
Thirst and urination 
Urinalysis: glucosurea & ketourea

Question 6

List signs of hypo

Answer 6

Sweating 
Fatigue 
Feeling dizzy 
Hungry 
Blurred vision 
Confusion 
Tachycardia/palpitations 
Pale/weak 
Trembling

Question 7

List 6 treatments for hypos

Answer 7

1) lucozade 150ml
2) 5 glucose tablets 20%
3) IV glucose 25mg infusion
4) monosaccharide carbs if taking alpha glucosidase inhibitor (acarbose)
5) IM glucagon 1mg
6) glucose gel (rub on gums)

Question 8

In what ways can U100 insulin be administered?

Answer 8

Syringe and vial
Cartridge pen
Disposable pen

Question 9

In what ways can U200 and U300 be administered

Answer 9

Disposable pen ONLY due to risk of error/overdose if drawn up

Question 10

What’s the half life of a RBC

Answer 10

3-6months

Question 11

What is HbA1c?

Answer 11

Refers to glycated haemoglobin, develops when haemoglobin joins with glucose in the blood

Question 12

If type 1 patients choose to test glucose after meals what plasma glucose should they aim for?

Answer 12

5-9mmol/l at least 90 mins after eating

Question 13

Name the injection sites in order of quickest absorption

Answer 13

Abdomen
Upper arm
Thigh
Buttocks

Question 14

During illness should insulin be stopped if eating less

Answer 14

NO - increased insulin requirements during periods of ill health

Question 15

What is ACR?

Answer 15

Albumin creatinine ratio helps to identify kidney disease in diabetes

Question 16

What’s the target of ACR?

Answer 16

Male less than 2.5mg/mmol

Question 17

What is T1DM characterised by?

Answer 17

Destruction of the insulin producing pancreatic beta cells which occurs by either:

1) autoimmune T-cell mediated destruction
2) idiopathic

Question 18

Is the onset of symptoms in T1 diabetes faster or slower than in T2 diabetes?

Answer 18

Faster in type 1

Question 19

The age of onset of type 1 diabetes is usually below what?

Answer 19

Below 30

Question 20

True or false: circulating islet cell antibodies (ICA) are present in more than 70% of those with type 1 at time of diagnosis?

Answer 20

True dat

Question 21

Appearance of islet cell antibodies (ICA) precedes the onset of diabetes by as much as how many years?

Answer 21

3years

Question 22

What’s the process of insulin formation in the pancreatic beta cells?

Answer 22

Preproinsulin –> proinsulin –> insulin + C-peptide

Question 23

True or false: in renal and hepatic disease there is an increase in the rate of insulin clearance

Answer 23

FALSE there is a decrease in rate of clearance (may need dose reduction)

Question 24

What’s the WHO diagnostic criteria for diabetes

Answer 24

Fasting serum glucose >7mmol/L

Serum glucose >11.1mmol/L 2 hours after 75g anhydrous glucose

Question 25

Name three acute emergencies associated with diabetes

Answer 25

Hypoglycaemia Diabetic ketoacidosis Hyperosmolar hyperglycaemic state

Question 26

When might individuals not notice hypos?

Answer 26

Alcohol intoxication Lack of education Symptoms may not occur due to autonomic neuropathy If taking drugs that suppress symptoms e.g B-blockers Recurrent hypos where autonomic symptoms may cease to occur

Question 27

Serum glucose below 0.5mmol/L can result in what?

Answer 27

Death!! Serious hypo

Question 28

What is neuroglycopenia

Answer 28

Cerebral malfunction: shortage of glucose in the brain

Question 29

Why are morning blood glucose readings often high?

Answer 29

Due to nocturnal hypoglycaemia: sustained hypo over night leads to counter-regulatory hormones to raise blood glucose levels

Question 30

If nocturnal hypos are confirmed what should a patient do?

Answer 30

Have a snack before bed Reduce evening insulin Alter timing of administration Change intermediate acting to peakless analogue

Question 31

Name 4 precipitating factors for developing DKA in type 1 diabetics

Answer 31

Omission of insulin dose Acute infection Trauma Myocardial infarction

Question 32

In diagnosing DKA the blood glucose test strip will usually show a blood glucose reading of more than what?

Answer 32

> 22mmol/L

Question 33

Name two types of long term diabetic complications

Answer 33

Macrovascular: (damage to large vessels) Microvascular: (damage to smaller vessels)

Question 34

Macrovascular complications include what?

Answer 34

1) cardiovascular disease: - hypertension twice as common in diabetes - risk of stroke and MI 2) peripheral vascular disease: - often arteries in legs causing intermittent claudication, cramping - iliac vessels causing buttock pain and erectile dysfunction

Question 35

Microvaacular complications include what?

Answer 35

1) retinopathy 2) nephropathy (presence detected by albumin in urine) 3) neuropathy

Question 36

What is the first line hypertensive treatment for type 1 diabetics?

Answer 36

ACEi as Renally protective

Question 37

When using a pen injection device you must always keep them in the fridge

Answer 37

No NEVER --> there have been reports of devices 'seizing up'

Question 38

The patient needs to be fasted for HbA1c

Answer 38

FALSE they don't have to be

Question 39

HbA1c may be lower in those with reduced red cell lifespan, name two classes of patient with this?

Answer 39

1) pregnancy | 2) advanced renal failure

Question 40

Serum fructosamine represents what?

Answer 40

Glycation of all serum proteins and gives information about control over the preceding 3 weeks

Question 41

When should type 1 diabetics monitor their blood glucose?

Answer 41

At least 4 times per day, before meals and before bed

Question 42

Name the enzyme of the glucose testing strip

Answer 42

Glucose oxidase