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T1DM Flashcards

(49 cards)

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1
Q

What percentage of patients who have T1DM, have no family history?

A

85%

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2
Q

When is the peak incidence of T1DM in childhood?

A

6 months - 5 years

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3
Q

At what age are 50% of T1DM diagnosed?

A

> 18 years old

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4
Q

Where is the highest incidence of T1DM in the world?

A

Canada, Saudi Arabia, Sweden, Finland, Norway UK
I.e. Northern Hemisphere

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5
Q

Is T1DM more common in females or males?

A

Males up to the age of 70, then females.

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6
Q

What percentage of people with diabetes in the UK, have T1DM?

A

10-15%

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7
Q

Does genetics affect someones risk of developing T1DM?

A

Yes - monozygotic twin has highest risk at 36%.
Sibling - 6%
Father - 3-6%
Mother - 1-2%
0.5% background risk

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8
Q

Which genes are linked to an increased risk of T1DM?

A

Most on HLA region of Ch 6
HLA DR3-DQ2 + DR4-DQ8

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9
Q

Which genes are linked to a decreased risk of T1DM?

A

HLA-DMA and DQB1

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10
Q

Which genes are linked to insulin deficiency?

A

VNTR
PTPN22
CTLA4
IL2RA

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11
Q

What are the 5 cell types of the pancreas and what do they secrete?

A

Alpha - Glucagon
Beta - Insulin
Delta - Somatostatin
Gamma - Pancreatic polypeptide
Epsilon - Ghrelin

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12
Q

What cells of the pancreas have the highest number of cells?

A

Insulin - 70%

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13
Q

What are Gamma and Epsilon cells involved in?

A

Appetite

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14
Q

Which cells does T1DM affect?

A

Beta cells

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15
Q

What causes T1DM?

A

Autoimmune destruction of the insulin secreting pancreatic B cells –> chronic inflammation of pancreas –> Beta cells cannot produce insulin.

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16
Q

Can beta cells regenerate?

A

no

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17
Q

Which antibodies are associated with T1DM?

A

GAD
IA2
Zn T8

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18
Q

What pancreatic changes occur with T1DM?

A

Decreased weight of the pancreas
Atrophy/hypertrophy
Beta cell loss

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19
Q

What Islet cell changes occur with T1DM?

A

Insulitis
Loss of beta cells through necrosis

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20
Q

What is insulitis?

Study These Flashcards
A

Inflammation of the islet of langerhans

21
Q

What is the honeymoon phase?

Study These Flashcards
A

In pre-diabetes, body is still able to produce small amounts of insulin but decreases over 3-5 years.

22
Q

Do patients with pre-diabetes have diabetic symptoms?

Study These Flashcards
A

Usually day to day - no symptoms.
During stress response - may not be able to produce insulin and therefore symptoms develop.

23
Q

Which conditions are associated with T1DM?

Study These Flashcards
A

Coeliac
Hypothyroidism
Graves disease
Addisons
Hypogonadism
Pernicious anaemia
Vitiligo
Autoimmune polyglandular syndromes

24
Q

What are the commons symptoms of T1DM?

Study These Flashcards
A

Thirst
Polyuria
Lethargy
Weight loss (unintentional)
Recurrent candidiasis
Visual changes - glucose can affect optic disc
Ketone breath
DKA
Coma/death

25
How can insulin levels be measured in T1DM?
Through measuring C-peptide
26
What the three ketone bodies?
Acetoacetate 3 beta hydroxybutyrate (most) Acetone (least)
27
When are ketone bodies produced?
In fasting, exercise + pregnancy. Used peripherally as an energy source if glucose not available.
28
How is C-peptide produced?
End product of proinsulin. Proinsulin --> Insulin --> C-Peptide. If no C-peptide = No insulin production
29
What would C-peptide levels be in T1DM?
Low
30
What would C-peptide levels be in T2DM?
High - means insulin resistance
31
What does an intermediate level of C-peptide mean?
Favours T2DM over T1DM Consider rare genetic forms of diabetes.
32
When can C-peptide levels not be an accurate measure of diabetes?
If measured within 3-5 years of diagnosis, C-peptide levels can still be high/intermediate due to the honeymoon phase. After 3-5 years, there will be no C-Peptides if T1DM.
33
What is the difference between flash and continuous glucose monitoring?
Flash - you need to put device onto sensor every 8 hours. Continuous - Will continually monitor glucose levels and send to device. Both sit in s/c tissue
34
Why is it recommended that when unwell, a patient with diabetes should check their glucose levels via a CBG finger test rather than flash/continuous monitoring?
There can be a delay with flash/continuous monitoring as this sits in the subcutaneous tissue. Lag time now reduced on newer models to 2-3 minutes.
35
What is a glucose management indictor?
A level that can indicate the HBA1C level. Need to make sure it's not an average of lots of highs and lots of lows though.
36
What type of hormone is insulin?
Peptide
37
What is the first line insulin regimen for T1DM?
Basal-bolus
38
What insulin therapy would be offered to someone with disabling hypoglycaemia or high HBA1C with multiple daily injections, aged >12?
Insulin pump
39
Which insulin therapy would not be recommended for those newly diagnosed with T1DM?
Twice daily mixed, basal only or bolus only regimens. As this requires a consistent daily routine that includes three meals a day.
40
When would 'ultra strength' insulin be used?
If there are problems with recurrent DKA, absorption, compliance or insulin stacking.
41
What national educational programme can those with T1DM attend?
DAFNE Dose Adjustment for Normal Eating Teaches about carb counting and how to manage fluctuations and sick day rules etc.
42
How much is a carb portion?
10g = 1 carb point
43
What are the symptoms of hypoglycaemia?
Dizzy Blurred vision Sweaty Weak or tired Upset or nervous Headache Hungry
44
What are the symptoms of hyperglycaemia?
Extreme thirst Hungry Frequent urination Blurred vision Drowsy Wounds healing slow
45
When would someone with T1DM be unable to drive?
If they have an impaired awareness of hypoglycaemia or >1 episode of severe hypoglycaemia (needing third party assistance) within last 12 months. If blood sugar <5.
46
Which questionnaire is used at a diabetics annual review?
DDS - Diabetes distress Score
47
What complications can occur from diabetes?
Microvascular Macrovascular
48
What future treatments could there be for T1DM?
Islet cell transplant Artificial pancreas Cure - whole genome sequencing to prevent autoimmune destruction
49
When does insulin spike in the day?
After meals

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