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Endocrinology > Type 1 diabetes > Flashcards

Type 1 diabetes Flashcards

(63 cards)

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1
Q

What ages are affected by T1DM?

A

Young

Ages 0-4/10-14

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2
Q

What is the BMI of T1DM patients?

A

Normal/Low

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3
Q

What may you find on urinalysis in T1DM?

A

Ketones +++

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4
Q

What is the acute presentation of T1DM?

A

DKA

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5
Q

What antibodies will you look for if unsure of T1DM?

A

GAD65/IA2 Ab

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6
Q

What levels of C-peptide will you have in T1DM at diagnosis?

A

Low (but variable)

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7
Q

What levels of C-peptide will you have in T1DM at 5 years post diagnosis?

A

Absent

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8
Q

Why do levels of C-peptide move from low to absent in T1DM?

A

Natural history and disease progression

Reducing beta cell function

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9
Q

What microvascular complications are present in T1DM?

A

None

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10
Q

What symptoms occur in T1DM?

A 
Weight loss
Polydipsia
Polyuria
Fatigue
Somnolence 
Blurred vision
Candidal infection
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11
Q

What candidal infections occur in T1DM?

A

pruritus vulvae

balantitis

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12
Q

What glucose levels confirm diabetes? a) fasting b) random

A

a) 7+

b) 11.1

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13
Q

What would T1DM islets look like under the microscope histologically?

A

Purple lymphocytes

Attacking islets

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14
Q

What are the anti islet cells antibodies?

A

IA2
GAD65
IAA
ZnT8

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15
Q

What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of IA2 Ab?

A

a) islet antigen 2
b) 60-70%
c) Unknown
d) reduces with age, more males

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16
Q

What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of GAD65 Ab?

A

a) Glutamic acid decarboxylase
b) 70-80%
c) GABA production
d) increases with age (<10), more females

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17
Q

What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of IAA Ab?

A

a) Insulin
b) 50%
c) regulation of glucose
d) more in children M=F

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18
Q

What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of ZnT8 Ab?

A

a) ZnT8 transporter
b) 60-80%
c) Zn function in beta cell
d) more in older population M=F

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19
Q

What is the definition of T1DM?

A

Absolute insulin deficiency from autoimmune attack of beta cells

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20
Q

Which HLA types show increased risk of T1DM?

A

HLA DR3-DQ2

HLA DR4-DQ8

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21
Q

What are the risk factors for pre clinical T1DM?

A

Viral infection!
Vitamin D deficiency
Dietary/environmental

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22
Q

What risk factors can induce T1DM?

A

Puberty (stress hormones)
Weight
Infection
Insulin resistance

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23
Q

What autoimmune conditions can be associated with T1DM?

A 
Thyroid disease
Coeliac 
Pernicious anaemia 
Addison's
IgA Deficiency
Autoimmune polyglandular syndrome
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24
Q

How is T1DM treated?

A

Insulin

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25
What things are monitored in a yearly diabetic review?
``` Weight Blood Pressure HbA1c Retinal screening Foot screening 10 microgram monofilament ```
26
What should be monitored all the time in T1DM management?
``` Blood glucose Ketones CHO estimation Insulin Record of hypos/DKA ```
27
What tools are available for patient monitoring?
Blood glucose at home | Ketones/urinalysis
28
What does HbA1c measure?
Glycalated haemoglobin
29
Why is HbA1c important in diabetes?
Increases in response to prevailing high blood glucose levels
30
What factors can influence HbA1c?
Pregnancy Haemolytic anaemia Chronic/acute blood loss
31
What is the target HbA1c for diabetic patients? Are there any exceptions?
53mmol/mol | Older population may be higher
32
What are the disadvantages of measuring HbA1c?
Only getting brief screenshots, not whole picture
33
What adjunct therapies may patients use in T1DM?
``` Ketone meter (detects early ketone formation) Continuous glucose monitor ```
34
What are the symptoms of hyperglycaemia?
``` Thirst Fatigue Polyuria Blurred vision Nocturia Weight loss Candidiasis Reduced mood Cognitive impairment ```
35
What blood test are needed to diagnose DKA?
Ketones Glucose Bicarbonate
36
What level on ketones would suggest DKA?
>3mmol/l or >2+ urinalysis
37
What level of blood gucose would suggest DKA?
>11 mmol/mol | or known DM
38
What levels of bicarbonate would suggest DKA?
<7.3 (ie acidosis)
39
What are the symptoms of DKA caused by osmotic changes?
Thirst Polyuria Dehydration
40
What are the symptoms of DKA caused by ketone body formation?
``` Flushing Vomiting Abdo pain Kassmaul breathing Smell of ketones ```
41
What causes DKA?
Absolute insulin deficiency | Stress hormones
42
What are the stress hormones?
Cortisol Growth Hormone Glucagon Adrenaline
43
How does acidosis happen in DKA?
Increased lipolysis Increased free fatty acids to liver Increased ketogenesis Leads to acidosis (lactate)
44
Why does hyperglycaemia happen in DKA?
Less glucose utilised Less proteolysis Increased glycogenesis in liver
45
How does hyperosmolarity happen in DKA?
Hyperglycaemia causes glycosuria Electrolyte loss causes dehydration Leads to hyperosmolarity
46
What ketone is found in blood?
Beta-hydroxybutarate
47
What ketone is found in the urine?
Acetoacetate
48
What are the range of glucose levels in DKA?
10-100 | 40 median
49
When would blood glucose be 10 in DKA?
euglycaemic DKA
50
What are the levels of a) creatinine b) lactate c) bicarbonate d) sodium e) potassium in DKA?
a) raised b) raised c) reduced d) reduced e) raised (more than 5.5)
51
How is DKA managed?
Replace losses; fluid (1L saline over 1hr), insulin (6 Units), potassium Address risks; monitor K, prophylactic LMWH
52
What fluids are given in DKA management?
0.9% saline | dextrose when glucose reaches 9-14
53
What are the symptoms of hypoglycaemia?
``` Pallor Sweating Tremor Anxious Palpitations Confusion Nausea Hunger Irritable Post hypo headache ```
54
What blood glucose level does glucagon and adrenaline set in for hypoglycaemia?
3.8 mmol
55
What blood glucose level will symptoms of hypoglycaemia occur?
3.0mmol
56
When will congitive impairment happen in hypoglycaemia?
2.8mmol
57
What can cause reduced hypoglycaemic awareness?
Frequent hypos 3.5mmol - 4.0mmol Long duration of DM Intensively treated T1DM
58
How do you treat a hypoglycaemic attack?
15g of simple CHO Recheck blood glucose in 15 mins Continued low blood sugar then another 15g Small snack if next meal >2hrs away
59
What is equivalent to 15g CHO?
glucose tablets glucose gel tube 1-2 cup fizzy drink (no diet) 1tbsp sugar/honey
60
What should be administered in severe hypo?
1mg glucagon injection into arm/thigh/buttock
61
What may occur when patient recovers from severe hypo?
Nausea and vomiting
62
What is the most common symptom of T1DM in children?
nocturnal enuresis
63
How is management of DKA different in under 16yrs
based on weight careful fluid resuss risk of cerebral oedema insulin commenced 1 hr after IV fluids

Endocrinology (17 decks)

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