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
