Pre-existing Diabetes and Auto-Immune Flashcards Preview

Complex Care 2 > Pre-existing Diabetes and Auto-Immune > Flashcards

Flashcards in Pre-existing Diabetes and Auto-Immune Deck (28):
1

Define: Type 1 diabetes mellitus

Also called
- Insulin dependent diabetes or
- Juvenile diabetes.

- Autoimmune destruction of insulin-producing (beta cells) of the pancreas
- Results in total insulin deficiency.

2

Explain: How Insulin works after a meal

- digestion breaks down carbs into sugar molecules inc. glucose/aminoacids

- glucose/aminoacids are absorbed into the blood stream- BGL rise quickly

- rise in BGL trigger beta cells in pancreas to secrete insulin which moves into the blood stream

- Insulin enables glucose to enter the cells in the body particularly the muscle and liver cells

- Here insulin and other hormones determine whether glucose will be burned for energy or stored for future use

3

List causes of Type 1 DM

Autoimmune disease
Genetic (10% chance of aquiring from a direct relative)
Environmental factors (e.g. viral infection)

4

List symptoms of Type 1 DM

Hyperglycemia
Polyuria
Polydipsia
Lipidemia
Polyphagia
Glycosuria
Ketoacidoses
Ketouria
Macular degeneration

5

How is Diabetes diagnosed

Fasting or Random <5.5: diabetes unlikely

Fasting 5.5-6.9 OR Random 5.5-11.0: Diabetes uncertain- Oral GTT

Fasting >7.0 OR Random >11.1: Diabetes likely

6

Describe: Treatment for Type 1 DM

Can deliver Insulin fast, regular, intermediate or slow

Insulin Pump
- catheter directly into abdominal skin
- delivers insulin directly into the system
- controlled by a small digital device that is programmed with the correct doses

7

What are complications/outcomes of Type 1 diabetes

Heart disease
Renal disease
Retinopathy
Vascular disease
Neuropathy
Thyroid disease

Fertility:
Decreased fertility (recurrent yeast infections, decreased lubrication, painful sex)
Delayed menarche (menstruation)
Premature menopause
Male effects

8

What are the effects of Type 1 Diabetes on pregnancy

Miscarriage
Congenital abnormality (brain and neural tube defects, cardiac defects, ambiguous genitalia)
SGA
Preterm birth
Preeclampsia,
Perinatal mortality,
LGA
Key – tight blood sugar control before conception and throughout pregnancy

9

Explain: Diabetes in pregnancy

In pregnancy the woman’s body uses glucose for energy and growth of the fetus

- its production is controlled and regulated by the hormone insulin

- Insulin production increases in pregnancy to manage rising glucose levels and is a normal physiological response to growing a baby and supplying enough energy as well

- when a pregnant woman’s body is less receptive to the regulating effects of insulin it struggles to control the amount of glucose within the blood stream

- which leads to increased glucose levels

This process is intensified when a woman has diabetes prior to pregnancy and increases insulin resistance

10

Explain: Treatment/Management of diabetes in pregnancy

- Pre-conception counselling
- Regulation of HbA1c – good long term glucose control

Pregnancy
- Medical r/v after booking in
- Regular monitoring
- Multi-disciplinary management
- Growth u/s

Labour/Birth
- Delivery plan
- CTG
- Pead if needed

Postnatal
- Check for neonatal hypoglycaemia
- r/v insulin regimne
- BF safe

11

Define: Type 2 Diabetes

Adult onset
- Hyperglyaceamia
- Insulin deficiency
- Insulin resistance
- Innapropriate or excessive glucagon

Family history plays a role in this type of diabetes

12

List risk factors/ causes of Type 2 DM

>45 years of age,
Overweight/obese
Hypertensive
Cardiovascular disease
Had GDM

13

List symptoms of Type 2 diabetes

Polyuria- production of abnormally large volumes of dilute urine
Polydypsia- abnormally great thirst
Polyphagia- excessive hunger or increased appetite and is one of the 3 main signs of diabetes
Weight loss
Recurrent yeast infections
Recurrent UTI
Blurred vision

14

What are the complications/outcomes of Type 2 diabetes

Blindness (retinopathy)
Kidney disease
Nerve damage
Amputation
Cadiovascular disease: stroke, heart attack, loss of circulation in arms and legs

Fertility:
- Links with PCOS
- Alterations to the menstrual cycle
- Anovulatory cycles
- Poor quality blastocysts
- Increased c reactive protein

15

Describe: Treatment/Management of Type 2 DM in Pregnancy

In General:
Lifestyle modification
Weight loss
Exercise
Oral hypoglycaemics
Insulin

Pregnancy
- HbAic
- Physical examination
- BGL monitoring and ongoing strategy
- Medical and diabetic r/v
- U/S
- Growth u/s

Labour/Birth
- BGL monitoring
- diabetes managment
- CTG
- Paed available if needed

16

What are the pregnancy complications of Type 2 diabetes

Miscarriage
Cogential malformations
IUGR
Macrosomia
Polyhydraminos
FDIU

17

Define: Hypothyroidism

Hypothyroidism comprises a lack of thyroid hormones, thyroxine (T4) and tri-iodothyronine (T3).

18

List symptoms of Hypothyroidism

Weight gain
Constipation
Cold intolerance
Alopecia
Dry skin
Hoarseness
Lethargy
Ataxia
Cognitive impairment
Bradycardia

19

Explain: Treatment/Management of Hypothyroidism in Pregnancy

Pregnancy
- treatment immediately upon diagnosis
- if TSH rises: adjust Thyroxine dose
- Check fT4 and TSH at booking and 4-6wkly throughout pregnancy

Labour/Birth
- Treat as normal

Postnatal
- r/v Thyroxine dose
- Neonatal screening required
- BF safe
- Ch fT4 nad TSH 6wks postpartum

20

Define: Thyrotoxicosis

is the clinical syndrome caused by high serum concentrations of thyroid hormones.

Typically caused by Graves disease: an autoimmune condition in which thyrotoxicosis is caused by autoantibodies to the thyroid stimulating hormone receptor (TSHR).

21

List signs and symptoms of Thyrotoxicosis

• Heat intolerance
• Weight loss (despite good appetite)
• Insomnia
• Agitation
• Tremor
• Retraction of the upper eyelid
• Sweating
• Tachycardia and bounding pulse
• Diarrhoea
• Oligo- or amenorrhoea

22

Complications of Thyrotoxicosis

Graves ophthalmopathy
Graves dermopathy

23

Explain: Treatment/Management of Thyrotoxicosis in pregnancy

Pregnancy
- Thyrotoxicosis- increased risk of miscarriage. Diagnosis difficult as symptoms mimicl pregnancy
- Graves disease improves
- U/S
- blood tests

Labour/Birth
- High risk medical management
- Continuous fetal monitoring (fetal tachycardia)
- Paed notified once established

Postnatal
- neonate r/v: may required antithyroid medication
- Encourage BF
- Maternal thyroid hormone levels rechecked at 6wks

24

Define: Systemic Lupus Erythematosus (SLE)

With lupus erythematosus, the body produces autoantibodies against its own connective tissue.

(SLE): the most common variation of lupus affecting the entire body including serous membrane, kidneys, joints, and skin

25

List signs and symptoms of Systemic Lupus Erythematosus (SLE)

Classic ‘butterfly rash’ (malar rash) on cheeks
Weight loss
Fatigue and headaches
Fever with flu-like symptoms
Arthralgia (joint pain without swelling)

26

What are some of the complications of Systemic Lupus Erythematosus (SLE)

Acute and chronic infection
Nausea, vomiting and diarrhoea
Alopecia (hair loss) Photosensitivity Arthritis and sometimes early morning stiffness
and others...

27

Explain: Treatment/Management of Systemic Lupus Erythematosus (SLE)

Pregnancy
- Pregnancy complications are generally reduced if the lupus is mild or stable, particularly at conception
- multidisciplinary care
- Full antenatal bloods for baseline
- record medical history and medications
- Medical r/v

Labour/Birth
- High risk management
- vaginal birth safe if no falre up present
- Teds for LSCS
- Continuous EFM

Postnatal
- increased risk of lupus flare up
- prompt return to maternal drug regimen
- BF NOT safe
- neonate monitoring

28

List complications of Systemic Lupus Erythematosus (SLE) in pregnancy

IUGR
Preterm birth
FDIU
Miscarriage
Congential abnormalities
Increased risk of hypertensive disease
Lupus flare up