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2a Endocrinology > T1 DM > Flashcards

T1 DM Flashcards

1
Q

Type 1 Diabetes is a condition where the _____ stops being able to produce adequate _____

A

pancreas
insulin

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2
Q

Without insulin, the cells of the body cannot absorb ____ from the blood and use it as fuel

A

glucose

Therefore the cells think there is no glucose available.

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3
Q

Whilst the cells think there is no glucose available, the glucose level in the blood keeps rising causing ________

A

hyperglycaemia

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4
Q

Which viruses may trigger T1 DM?

A

Coxsackie B
Enterovirus

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5
Q

What are the triad of symptoms of hyperglycaemia?

A

Polyuria (excessive urine)
Polydipsia (excessive thirst)
Weight loss (mainly through dehydration)

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6
Q

What are some other symptoms of T1DM?

A

Polyphagia (increased hunger)
Glycosuria (glucose in urine)
Fatigue and weakness
Burred vision
Irritability

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7
Q

Where are carbohydrates like glucose absorbed?

A

Small intestine

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8
Q

What is the ideal blood glucose concentration range?

A

4.4 - 6.1 mmol/litre

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9
Q

What is RPG and FPG?

A

Random plasma glucose and Fasting plasma glucose (not eating for at least 8 horus)

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10
Q

What is a normal level of glucose for RPG?

A

Lower than 11.1 mmol/l

(so 11.1 mmol/l or more in T1DM)

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11
Q

What is a normal level of glucose for FPG?

A

Lower than 7.0 mmol/l

(so 7.0 mmol/l or more in T1DM)

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12
Q

Which cell produce insulin?

A

Beta cells in the Islets of Langerhans of the pancreas

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13
Q

True of false: insulin is a catabolic hormone

A

False
Insulin is an anabolic (building) hormone.

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14
Q

Insulin causes cells in the body to absorb glucose and use it as fuel.
It also causes _____ and ____ cells to absorb glucose and store it.

A

muscle and liver

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15
Q

What is glucose stored as in the liver and muscle?

A

Glycogen

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16
Q

What is the process of glucose being stored as glycogen called?

A

Glycogenesis

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17
Q

What hormone is produced by alpha cells in the islets of Langerhans in the pancreas?

A

Glucagon

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18
Q

True or false: glucagon is a catabolic hormone?

A

True, its a breakdown hormone

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19
Q

When is glucagon resleased?

A

In response to low blood sugar levels and stress

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20
Q

True or false: glucagon work to increase blood sugar levels

A

true

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21
Q

Glucagon causes the liver to break down stored glycogen into the blood as glucose in a process called

A

glycogenolysis

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22
Q

Glucagon also instructs the liver to (other than glycogenolysis)…

A

Convert proteins and fats into glucose in the process of gluconeogenesis

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23
Q

When does ketogenesis occur?

A

When there is insufficient glucose supply and the glycogen stores are exhausted (eg prolonged fasting)

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24
Q

What is ketogenesis the conversion of?

A

fatty acids in the liver to ketones

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25
Q

What are properties of ketones?

A

Water-soluble fatty acids that can be used as fuel.
Can cross the BBB and be used by the brain

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26
Q

How can ketone levels be measured?

A

Ketones in urine with dipstick
Ketones in blood with ketone meter

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27
Q

What is a characteristic trait of people in ketosis?

A

Acetone smell to their breath

28
Q

How is the acidity of the ketones in the blood countered?

A

The kidney buffer ketone acids

29
Q

What is the life-threatening metabolic acidosis as a result of extreme hyperglycaemic ketosis called?

A

Diabetic ketoacidosis

30
Q

What can you look for in a T1DM patient to differentiate from T2DM patient?

A

Autoantibodies:
Anti-islet cell antibodies
Anti-GAD antibodies (glutamic acid decarboxylase)
Anti-insulin antibodies

31
Q

How is T1DM managed long-term?

A

Subcutaneous insulin
Monitoring dietary carbohydrate intake
Monitoring blood sugar levels
Monitoring for and managing complications

32
Q

How is insulin delivered?

A

Subcutaneously

(Basal-bolus regime or through pump)

33
Q

When should the blood sugar levels be monitored?

A

Upon waking
At each meal
Before bed

34
Q

What is the basal-bolus regime?

A

Long-acting insulin injected once a day
Short-acting insulin injected 30 mins before consuming carbs (meals)

35
Q

What can happen if insulin is consistently injected at the same spot?

A

Lipodystrophy, where subcutaneous fat hardens, don’t absorb insulin properly.

36
Q

What are insulin pumps?

A

Devices that continuously infuse insulin through a cannular inserted under the skin at different rate to control blood sugar levels. Alternative to basal-bolus regimes. The cannula is replaced every 2-3 days

37
Q

What are advantages of an insulin pump?

A

Better blood sugar control
More flexibility with eating
Fewer injection

38
Q

What are disadvantages of an insulin pump?

A

Difficulties learning to use the pump
Having it attached at all times
Blockages in the infusion set
Small risk of infection

39
Q

True of false: for a pancreas transplant, the diabetic patient’s pancreas is removed in place with a donor’s pancreas to produce insulin

A

False
the original pancreas is left in place to continue producing digestive enzymes, the donor’s pancreas is implanted to produce insulin.

Procedure carries significant risks and life-long immunosuppression to prevent rejection. Therefore, saved for patients having severe hypoglycaemic episodes and kidney transplants.

40
Q

True or false: islet transplantation involves inserting donor islet cell into the patient’s pancreas.

A

False, inserted into patient’s liver. These produce insulin although patients will often still need insulin therapy.

41
Q

What is glycated haemoglobin?

A

Haemoglobin molecule attached to glucose

42
Q

What is the measurement of glycated haemoglobin called and what does it indicate?

A

HbA1c
Reflect the average glucose level over previous 2-3 months.
Measured every 3 to 6 months.

43
Q

What level of HbA1c indicates T1 DM?

A

48 mmol/l or more

44
Q

How can you measure capillary blood glucose?

A

Finger-prick test using blood glucose monitor

45
Q

Flash glucose monitors (eg FreeStyle Libre 2) use a sensor on the skin that measures the glucose level of the ______ ____ in the subcutaneous tissue

A

interstitial fluid

46
Q

What is the time lag for flash glucose monitors?

A

5 minutes
Sensor records glucose readings at short intervals. Can be read by using phone.
Sensor need replacing every 2 weeks.

47
Q

What does an artificial pancreas of closed-loop system refer to?

A

Combination of continuous glucose monitor and insulin pump. Devices communicate automatically to adjust insulin based on glucose readings. Still need to input carbohydrate intake and adjust for strenuous exercise.

48
Q

H____glycaemia may be caused by too much insulin

A

Hypoglycaemia

49
Q

What other factors may lead to hypoglycaemia?

A

Not consuming enough carbs, malabsorption, diarrhoea, vomiting.

50
Q

What are symptoms of hypoglycaemia?

A

Hunger, tremor, sweating, irritability, dizziness and pallor

Severe: reduced consciousness, coma and death

51
Q

How do you treat hypoglycaemia

A

Rapid-acting glucose (eg high sugar content drink)
Then slower-acting carbohydrates (eg biscuits).

If severe: IV dextrose, intramuscular glucagon

52
Q

Too much or too little insulin can cause hyperglycaemia?

A

Too little insulin
Insulin injections can take several hours to take effect and repeated doses may lead to hypoglycaemia.
Exclude DKA!

53
Q

Chronic high blood glucose levels can cause damage to…

A

endothelial cells of blood vessels = leaky vessels that are unable to regenerate

Also cause immune system dysfunction and create optimal environment for infectious organisms to thrive.

54
Q

What are microvascular complications from diabetes?

A

Coronary artery disease
Peripheral ischaemia
Diabetic foot ulcers (due to peripheral neuropathy)
Stroke
Hypertension

Due to hyperglycaemia (which activates RAAS system resulting in hypertension), inflammation and dyslipidaemia contributing to atherosclerosis

55
Q

What are microvascular complication from diabetes?

A

Peripheral neuropathy (nerve damage)
Retinopathy (hyperglycaemia damages blood vessels in retina)
Kidney disease eg glomerulosclerosis (due to hyperglycaemia)

56
Q

What are some infection-related complications?

A

UTIs
Pneumonia
Skin and soft tissue infections
Fungal infections eg oral or vaginal candidiasis

57
Q

In retinopathy, hyperglycaemia can damage the small blood vessel in the retina causing them to leak fluid or bleed. This can result in _____ of the retina and formation of abnormal blood vessels, impacting vision

A

swelling

58
Q

What kind of hypersensitivity is T1DM?

A

Type 4 hypersensitivity, autoimmune destruction of pancreatic beta cells

59
Q

T1DM is an ______ insulin deficiency, though to be triggered by an _____ factor eg virus

A

absolute
environmental

60
Q

What is the aetiology of T1 DM?

A

Young, lean, North European descent (Finland)

61
Q

What are risk factors for T1 DM?

A

HLA DR2DQ3
HLA DR2DQ8
Other autoimmune conditions
environmental infection

62
Q

What is transported with glucose into cells in response to insulin?

A

Potassium

63
Q

In insulin deficiency the potassium levels may become…

A

elevated (hyperkalaemia)
No insulin to stimulate uptake of K+ into cell

64
Q

Persistent hyperglycaemia can lead so o_____ d____, where glucose is excreted in urine, dragging water and electrolytes like potassium with it, potentially causing h____

A

Osmotic diuresis
hypokalaemia

65
Q

DKA is increased ketone bodies due to breakdown of fatty acids. As ketone bodies are excreted, they carry potassium ions with them, potentially leading to…

A

hypokalaemia

66
Q

How can excessive insulin impact potassium?

A

Can cause shift of k+ into cells causing hypokalaemia

67
Q
A

2a Endocrinology (26 decks)

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