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Flashcards in Type 1 diabetes Deck (63):
1

What ages are affected by T1DM?

Young
Ages 0-4/10-14

2

What is the BMI of T1DM patients?

Normal/Low

3

What may you find on urinalysis in T1DM?

Ketones +++

4

What is the acute presentation of T1DM?

DKA

5

What antibodies will you look for if unsure of T1DM?

GAD65/IA2 Ab

6

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

Low (but variable)

7

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

Absent

8

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

Natural history and disease progression
Reducing beta cell function

9

What microvascular complications are present in T1DM?

None

10

What symptoms occur in T1DM?

Weight loss
Polydipsia
Polyuria
Fatigue
Somnolence
Blurred vision
Candidal infection

11

What candidal infections occur in T1DM?

pruritus vulvae
balantitis

12

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

a) 7+
b) 11.1

13

What would T1DM islets look like under the microscope histologically?

Purple lymphocytes
Attacking islets

14

What are the anti islet cells antibodies?

IA2
GAD65
IAA
ZnT8

15

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
b) 60-70%
c) Unknown
d) reduces with age, more males

16

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

17

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

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

18

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

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

19

What is the definition of T1DM?

Absolute insulin deficiency from autoimmune attack of beta cells

20

Which HLA types show increased risk of T1DM?

HLA DR3-DQ2
HLA DR4-DQ8

21

What are the risk factors for pre clinical T1DM?

Viral infection!
Vitamin D deficiency
Dietary/environmental

22

What risk factors can induce T1DM?

Puberty (stress hormones)
Weight
Infection
Insulin resistance

23

What autoimmune conditions can be associated with T1DM?

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

24

How is T1DM treated?

Insulin

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