Flashcards in Type 1 diabetes Deck (63):
What ages are affected by T1DM?
What is the BMI of T1DM patients?
What may you find on urinalysis in T1DM?
What is the acute presentation of T1DM?
What antibodies will you look for if unsure of T1DM?
What levels of C-peptide will you have in T1DM at diagnosis?
Low (but variable)
What levels of C-peptide will you have in T1DM at 5 years post diagnosis?
Why do levels of C-peptide move from low to absent in T1DM?
Natural history and disease progression
Reducing beta cell function
What microvascular complications are present in T1DM?
What symptoms occur in T1DM?
What candidal infections occur in T1DM?
What glucose levels confirm diabetes? a) fasting b) random
What would T1DM islets look like under the microscope histologically?
What are the anti islet cells antibodies?
What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of IA2 Ab?
a) islet antigen 2
d) reduces with age, more males
What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of GAD65 Ab?
a) Glutamic acid decarboxylase
c) GABA production
d) increases with age (<10), more females
What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of IAA Ab?
c) regulation of glucose
d) more in children M=F
What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of ZnT8 Ab?
a) ZnT8 transporter
c) Zn function in beta cell
d) more in older population M=F
What is the definition of T1DM?
Absolute insulin deficiency from autoimmune attack of beta cells
Which HLA types show increased risk of T1DM?
What are the risk factors for pre clinical T1DM?
Vitamin D deficiency
What risk factors can induce T1DM?
Puberty (stress hormones)
What autoimmune conditions can be associated with T1DM?
Autoimmune polyglandular syndrome
How is T1DM treated?
What things are monitored in a yearly diabetic review?
Foot screening 10 microgram monofilament
What should be monitored all the time in T1DM management?
Record of hypos/DKA
What tools are available for patient monitoring?
Blood glucose at home
What does HbA1c measure?
Why is HbA1c important in diabetes?
Increases in response to prevailing high blood glucose levels
What factors can influence HbA1c?
Chronic/acute blood loss
What is the target HbA1c for diabetic patients? Are there any exceptions?
Older population may be higher
What are the disadvantages of measuring HbA1c?
Only getting brief screenshots, not whole picture
What adjunct therapies may patients use in T1DM?
Ketone meter (detects early ketone formation)
Continuous glucose monitor
What are the symptoms of hyperglycaemia?
What blood test are needed to diagnose DKA?
What level on ketones would suggest DKA?
>3mmol/l or >2+ urinalysis
What level of blood gucose would suggest DKA?
or known DM
What levels of bicarbonate would suggest DKA?
<7.3 (ie acidosis)
What are the symptoms of DKA caused by osmotic changes?
What are the symptoms of DKA caused by ketone body formation?
Smell of ketones
What causes DKA?
Absolute insulin deficiency
What are the stress hormones?
How does acidosis happen in DKA?
Increased free fatty acids to liver
Leads to acidosis (lactate)
Why does hyperglycaemia happen in DKA?
Less glucose utilised
Increased glycogenesis in liver
How does hyperosmolarity happen in DKA?
Hyperglycaemia causes glycosuria
Electrolyte loss causes dehydration
Leads to hyperosmolarity
What ketone is found in blood?
What ketone is found in the urine?
What are the range of glucose levels in DKA?
When would blood glucose be 10 in DKA?
What are the levels of a) creatinine b) lactate c) bicarbonate d) sodium e) potassium in DKA?
e) raised (more than 5.5)
How is DKA managed?
Replace losses; fluid (1L saline over 1hr), insulin (6 Units), potassium
Address risks; monitor K, prophylactic LMWH
What fluids are given in DKA management?
dextrose when glucose reaches 9-14
What are the symptoms of hypoglycaemia?
Post hypo headache
What blood glucose level does glucagon and adrenaline set in for hypoglycaemia?
What blood glucose level will symptoms of hypoglycaemia occur?
When will congitive impairment happen in hypoglycaemia?
What can cause reduced hypoglycaemic awareness?
3.5mmol - 4.0mmol
Long duration of DM
Intensively treated T1DM
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
What is equivalent to 15g CHO?
glucose gel tube
1-2 cup fizzy drink (no diet)
What should be administered in severe hypo?
1mg glucagon injection into arm/thigh/buttock
What may occur when patient recovers from severe hypo?
Nausea and vomiting
What is the most common symptom of T1DM in children?