diabetes type 1 Flashcards

(62 cards)

1
Q

explain the pathology behind type 1 diabetes?

A
  • pancreas stops being able to produce adequate insulin
  • glucose isn’t taken up into cells so they think there’s no glucose available
  • however, glucose levels in blood keep rising causing hyperglycaemia
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2
Q

what does type 1 diabetes present with?

A
  • classical triad of symptoms of hyperglycaemia ( polyuria, polydipsia, weight loss)
  • diabetic ketoacidosis
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3
Q

whats the underlying cause of type 1 diabates?

A

unclear
certain viruses may trigger it

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4
Q

whats the ideal blood glucose concenration?

A

4.4-6.1mmol/L

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5
Q

what process does insulin cause?

A

glycogenesis

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6
Q

what process does glucagon cause?

A

gluconeogenesis

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7
Q

explain the role of glucagon in glucose metabolism?

A
  • alpha cells - islets of langerhans
  • catabolic
  • released in response to low blood glucose and stress
  • tells liver to break down glycogen and releases it into the blood as glucose - glycoenolysis
  • also tells liver to convert proteins and fats into glucose - gluconeogenesis
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8
Q

explain the role of insulin in glucose metabolism?

A
  • hormone
  • beta cells - islets of langerhans
  • anabolic
  • reduces blood sugar in 2 ways
  • causes bodily cells to absorb glucose
  • causes cells to store it as glycogen
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9
Q

explain the role of ketones in metabolism?

A
  • released when low glucose stores
  • made by the liver
  • made from long chain fatty acids
  • water soluble
  • can cross blood-brain barrier
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10
Q

how can ketone levels be measured?

A
  • urine - dipstick test
  • blood - ketone meter
  • acetone smell breath
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11
Q

what is the most common scanario for diabetic ketoacidosis to occur?

A
  • type 1 diabetes
  • type 1 diabetic with other illnesses eg infection
  • type 1 diabetic who isnt sticking to their insulin regeime
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12
Q

what are the 3 key features for diabetic ketoacidosis?

A
  • ketoacidosis
  • dehydration
  • potassium imbalance
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13
Q

the 3 key features of diabetic ketoacidosis are ketoacidosis, dehydration and potassium imbalance, explain why the ketoacidosis is present?

A
  • without insulin body cells dont recognise glucose even tho its there in the blood
  • liver will then start to produce ketones
  • the kidney produces bicarb to buffer these but they get used up making the blood acidic
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14
Q

the 3 key features of diabetic ketoacidosis are ketoacidosis, dehydration and potassium imbalance, explain why the dehydration is present?

A
  • hyperglycaemia overwhelmes the kidneys
  • glucose leaks into the urine
  • this pulls water with it
  • causes polyuria and polydipsia
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15
Q

the 3 key features of diabetic ketoacidosis are ketoacidosis, dehydration and potassium imbalance, explain why the potassium imbalance is present?

A
  • insulin normally drives potassium into cells
  • no insulin so little potassium in cells
  • blood potassium can either be high or normal bc the kidneys balance it
  • however total body potassium is low because it isnt in cells
  • patients develop hypokallaemia v quickly qhich can lead to arrhythmias
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16
Q

what is the pathophysiology of diabetic ketoacidosis?

A
  • hyperglycaemia
  • dehydration
  • ketosis
  • diabetic acidosis (with a low bicarb)
  • potassium imbalance
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17
Q

what are the symptoms of diabetic ketoacidid?

A
  • polyuria
  • polydypsia
  • nausea and vomitting
  • acetone smelling breath
  • dehydration
  • weight loss
  • hypotension
  • altered consciousness
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18
Q

what is the diabetic ketoacidosis diagnosing criteria?

A
  • hyperglycaemia - blood glucose over 11mmol/L
  • ketosis - blood ketones above 3mmol/L
  • acidosis - PH below 7.3
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19
Q

what are the most dangerous parts of diabetic ketoacidosis and therefore what is the treatment priority?

A
  • dangerous - dehydration, potassium imbalance, acidosis
  • priority - fluid resuscitation - insulin infusion
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20
Q

what are the principles of management and whats the nemonic?

A

FIG-PICK
F - fluids - IV fluid with normal saline - 1L in the first hour followed by 1L every 2 hours)
I - insulin - fixed rate insulin infusion
G - glucose - add glucose when less than 14mmol/L
P - potassium - ass potassium to IV
I - infection - treat underlying infections
C - chart fluid balance
K - ketones - monitoe blood ketones, PH and bicarb

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21
Q

what must you ensure is true before stopping the insulin and fluid infusions?

A
  • ketones and acidosis should have resolved
  • they should be eating and drinking
  • they should have started their regular subcutaneous insulin
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22
Q

what are the key complications during treatment?

A
  • hypoglycaemia
  • hypokalaemmia
  • cerebral oedema
  • pulmonary oedema
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23
Q

what can be used to assess if a patient has type 1 or type 2 diabetes?

A

autoantibodies and serum-c peptide

autoantibodies present in a type 1 diabetic are:
- anti-islet cell antibodies
- anti-GAD antibodies
- anti-insulin antibodies

serum-c peptode is a measure of insulin production - if lots then lots

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24
Q

what components are involved in the long-term management of type 1 diabetes?

A
  • subcutaneous insulin
  • monitoring dietary carbohydrate intake
  • monitoring blood sugar levels upon waking, at each meal, and before bed
  • monitoring for and managing complications, both short and long term
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25
what are the different ways of managing insulin artificially?
- basal-bolus reegime - insulin pumps - pancreas/islet transplant - monitoring - closed-loop system
26
explain what the basal-bolus regime is?
combo of: - background, long acting insulin injected once a day - short-acting insulin inhjected 30 mins before consuming carbs
27
what is the issue with always injecting into the same spot?
- lipodystrophy - subcutaneous fat hardens and dont absorb insulin properly - cycle the injection sites
28
explain what an insulin pump is and list the different types?
- pumps that continuously infuse insulin at diff rates to control sugar levels - pushes insulin through a cannula - cannula replaced every 2-3 days types: tethered pump patch pump
29
what are the advantages and disadvantages of insulin pumps?
advantages: - better blood sugar control than basal-bolus - more flexibility with eating - less injections disadvantages: - difficulties learning to use the pump - having it attached all the time - blockage of infusion set - small risk of infection
30
describe the differences between tethered and patch pumps?
tethered pumps: - replacable infusion sets and insulin - attached to patients belt - controls of pump itself patch pumps: - on skin with no tubes visible - replaced when insulin runs out - remote controlled
31
what does a pancreas transplant involve?
- implanting a donor pancreas to produce insulin - original pancreas is left in place to produce digestive enzymes - carries significant risks and life -long immunosuppressio is required to prevent rejection
32
what does islet transplantation involve?
- donor islet cells into patients LIVER - cells will then produce insulin - patients still usually need insulin therapy after
33
whats the role of HbA1c in measuring?
- measures glycated haemoglobin - this is how much glucose is attached to the haemoglobin molecule - reflects the average glucose level over previous 2-3 months - measured every 3-6 months
34
what are the different methods of glucose monitoring?
- capillary blood glucose - flash glucose monitors - continuous glucose monitor
35
what is a capillary blood glucose monitor?
- finger prick test - can be measured using a blood glucose monitor - gives an immediate result - patients with type 1 and type 2 diabetes rely on these - self-monitoring
36
what is the flash glucose monitor?
- sensor on the skin that measures the glucose level of the interstitial fluid in the subcutaneous tissue - 5-min lag - records at short intervals over time - need to swipe mobile phone over sensor - sensor needs replacing every 2 weeks
37
what is the continuous glucose monitor?
- similar to flash glucose monitor - don't need to scan sensor - the results are sent over via bluetooth
38
what is the closed loop system / artificial pancreas?
- combo of continuous glucose monitor and insulin pump - the devices communicate to automatically adjust insulin based off the glucose readings - patients still need to input carb intake and adjust the system for exersize
39
what are the short-term complications to immediate insulin and blood glucose management?
- hyperglycaemia and diabetic ketoacidosis - hypoglycaemia
40
what are the causes of hypoglycaemia?
- too much insulin - not enough carbs
41
what are the symptoms of hypoglycaemia?
- hunger - tremor - sweating - irritability - dizziness - pallor severe: - reduced consciousness - coma - death
42
how is hypoglycaemia treated?
- rapid acting glucose - once it improves they consume slow acting carbs - severe: - IV dextrose and intramuscular glucagon
43
how is hyperglycaemia treated?
- doesnt acc nessasarily need treating - insulin takes a while to take effect and too much can cause hypoglycaemia
44
what are the 3 main catagories of long term complications of chronic high blood sugar and why does this happen?
- chronic high blood glucose causes damage to endothelial cells of blood vessels - causes them to become leaky - makes them unable to regenerate catagories: - macrovascular - microvascular - infection - related
45
what are the macrovascular long-term complications?
- coronary artery disease - peripheral ischemia - stroke - hypertension
46
what are the microvascular long term complications?
- peripheral neuropathy - retinopathy - kidney disease - nephropathy
47
what are the infection-related long term complications?
- urinary tract infections - pnemonia - skin and soft tissue infections, particularly in feet - fungal infections, particularly oral and vaginal candidiasis
48
At what level of Beta cell destruction does hyperglycaemia develop?
80-90%
49
At what level of blood glucose can it no longer be absorbed?
10mmol/L Thirsty and develop polyuria - body attempts to remove excess glucose
50
Diagnosis of T1DM (3)
Random blood glucose ≥11.1mmol/L Fasting blood glucose ≥7mmol/L HbA1c ≥ 48mmol/mol - One abnormal result in symptomatic patients is sufficient - Two abnormal results needed in asymptomatic patients on 2 different days
51
Environmental factors that can increase the risk of developing T1DM (4)
- Diet - Vitamin D deficiency - Early-life exposure to viruses associated with islet inflammation (eg: enteroviruses) - Decreased gut-microbiome diversity
52
Epidemiology of T1DM (4)
- Young (usually between 5-15 years) - Lean - North European descent - 10% of diabetes is type 1
53
First line treatment for T1DM (2)
Basal-Bolus regimen of Insulin Basal - Long acting (either given twice or once daily) Bolus - Short acting before meals
54
How can T1DM be differentiated from Latent Autoimmine Diabetes in Adults (LADA)? (2)
- In LADA age of onset is >30 yrs - Low to normal C-peptide
55
how does type 1 diabetes differ from monogenic diabetes?
In type 1 diabetes: - C-peptide present - Autoantibodies absent
56
How can T1DM be differentiated from Neonatal diabetes?
neonatal occurs in first 6 months of life due to genetic mutation - testing
57
NICE diagnostic criteria for T1DM (6)
- Clinical features and evidence of hyperglycaemia - Ketosis - Rapid weight loss - < 50 years - BMI < 25 kg/m2 - Personal and/or family history of autoimmune disease
58
Other autoimmune conditions that can result from T1DM (most to least common) (6)
- Thyroid disease - Autoimmune gastritis - Pernicious anemia - Coeliac disease - Vitiligo - Addison's disease
59
Signs of T1DM (6)
- BMI < 25kg/m2 - Failure to thrive in children - Glove and stocking sensory loss - Reduced visual acuity - Diabetic retinopathy - Diabetic foot disease
60
What is a Mixed insulin regimen? (3)
- A mixture of short or rapid acting and intermediate-acting insulin - Twice daily - For those who can't tolerate multiple injections for basal bollus
61
what is continuous insulin for?
- If patient has disabling hypoglycaemia - or persistently hyperglycaemic (HbA1c > 69mmol/mol) on multiple injection insulin therapy
62
Which genes are linked with increased risk of developing T1DM? (4)
HLA-DR2 and HLA-DQ3 or HLA-DR4 and HLA-DQ8