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203: The endocrine system > T1 DM > Flashcards

Flashcards in T1 DM Deck (20)
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1

Epidemiology of DM
- Prevalence
- Peak onset
- Sex
- Race
- Geographical

Prevalence is increasing [6.7% in 16/17]
- T1 only accounts for 10-15% of all diabetes [0.5% prevalence]

Peak onset at adolescence
- Can present from 6 months to 80 [basically any age]

Affects males and females equally
- Slightly more male in UK

White caucasian
- More prevalence in the northern poles

2

Genetic predisposition to T1 DM

Greater predisposition if father has it compared to mother
- As well as sibling

Twin= roughly 35%

HLA regions
- DR3-DQ2
- DR4- DQ8
Can be used to identify individuals at high risk and put interventions in place.
Also used to differentiate T1 and T2 DM [as measures of diagnosing is not very accurate currently]

3

Pathophysiology of T1 DM
- Not completely understood

Autoimmune
- Viral infection causes autoimmune attack
- Selective beta-cell damage

Antibodies against
- Insulin
- GAD [glutamate decarboxylase]

Other antibodies against
- Ia2
- Zn2+ transporter 8

More antibodies= increased change of developing T1 DM

4

Pathological progression of T1 DM

1. Genetic predisposition
- HLA regions etc

Environmental trigger

2. Insulitis

3. Pre-diabetes

4. Diabetes

5

Viral stress of T1 DM

Viral infection [e.g coxsackie]

Triggers autoimmune reaction that destroys beta cells
- ER stress
- Cytokines

6

Associations with T1 DM

Coeliac

Hypothyroidism

Graves'

Addison's

Hypogonadism

Pernicious

Vertiligo

7

Symptoms

Lethargy

Polyuria/ polydipsia

Blurred vision [swelling of lens]

Infections
- Thrush
- Abscesses

Weight loss

Ketosis/ ketoacidosis

Death

Age affects presentation
- Immune attack more brisk in younger patients

8

Ketone bodies

Acetone
Acetoacetate
D-beta-hydroxybutyrate

Metabolised when insulin is deficient and glucose cannot be used.

9

C-peptide

Measurement of insulin production
- Made in 1:1 ratio to insulin

By product of insulin metabolism

10

Insulin treatment

Administered subcutaneously
- Can also be inhaled in US [fear of increased risk of cancer]
- Mucous membrane

11

Insulin pen

Mode of insulin administration
- Contains needle injected subcutaneous

Sites of injection
- Lower abdomen
- Bum
- Upper outer thighs
- Upper outer arms

12

Physiological insulin secretion

Increases just after each meal


13

Basal bolus insulin

Basal insulin
- Long acting background insulin

Then rapid acting insulin given just before a meal
- Bolus


14

Carbohydrate count

Allows insulin calculation according to how much carbohydrate is being consumed

15

Factors that affect the absorption of insulin

Factors that affect blood glucose
- Diet
- Injection site
- Temperature
- Exercise
- Illness
- Stress
- Alcohol
- Menstrual cycle

16

Subcutaneous insulin pump

Administers constant insulin supply throughout the day
- Gives basal insulin
- Allows flexibility
- Can still give bolus pumps

Pump only needs to be changed 2/3 days.

17

Transplantations
- Pancreas
- Islet

Pancreas
- Not commonly done
- Surgery is very invasive [3% mortality], immunosuppressants increase other diseases
- Also not enough pancreases available.
- Only given when already on immunosuppressant and having surgery [SPK, PAK]

Islet cell
- Fusing healthy islet cells into the liver
- Still requires immunosuppressants
- Does not always cure.

18

Glucose monitor

Prick finger
- Place blood on tester at least 4x daily

Glucose sensor [CGMS]
- Gives a constant trace throughout the day

Can also monitor ketone.

19

Freestyle libre CGMS

Does not require pricking finger

Gives constant glucose reading when directed

20

Monitoring HbA1c

Measuring glycated haemoglobin

But affected by shorter red cell life span.