Type 1 diabetes

Question 1

Ideal blood glucose concentration

Answer 1

4.4 - 6.1mmol/l

Question 2

What is insulin?

Answer 2

hormone produced by pancreas to reduce blood sugar levels

Question 3

what cells produce insulin?

Answer 3

pancreatic beta cells in islets of langerhans

Question 4

Is insulin a catabolic or anabolic hormone?

Answer 4

anabolic

Question 5

How does insulin reduce blood glucose?

Answer 5

muscle and liver to store glucose as glycogen

causes cells in body to absorb glucose and use as fuel

Question 6

What is glucagon?

Answer 6

hormone produced by pancreas that increases blood sugar levels

Question 7

what cells produce glucagon?

Answer 7

alpha cells in islets of langerhans in pancreas

Question 8

is glucagon a catabolic or anabolic hormone?

Answer 8

catabolic

Question 9

when is glucagon released?

Answer 9

low blood sugar levels and stress

Question 10

actions of glucagon

Answer 10

liver break down glycogen

liver convert fats and protein into glucose

Question 11

glycogenolysis

Answer 11

liver break down stored glycogen into glucose

Question 12

gluconeogenesis

Answer 12

liver convert proteins and fats into glucose

Question 13

When does ketogenesis occur?

Answer 13

insufficient glucose supply and glycogen stores are exhausted
eg prolonged fasting

Question 14

what is ketogenesis?

Answer 14

liver takes fatty acids and converts into ketones

Question 15

what are ketones?

Answer 15

water soluble fatty acids which can be used as fuel

Question 16

can the brain use ketones for energy?

Answer 16

yes - can cross BBB

Question 17

how can ketones be measured?

Answer 17

urine dipstick and blood

Question 18

characteristic smell of ketosis

Answer 18

acetone smell to their breath

Question 19

what is diabetic ketoacidosis?

Answer 19

type 1 DM causes hyperglycaemic ketosis

metabolic acidosis

Question 20

what is type 1 DM?

Answer 20

pancreas stops producing insulin

Question 21

causes of type 1 DM

Answer 21

genetics

viruses eg coxsackie B and enterovirus

Question 22

pathophysiology of type 1 DM

Answer 22

cells cannot take up glucose when no insulin
cells think body is fasted and has no glucose
glucose level in blood keeps rising
hyperglycaemia

Question 23

when does DKA occur?

Answer 23

not producing enough insulin and not injecting enough insulin

Question 24

ketoacidosis in DKA

Answer 24

cells think they are starving so start producing ketones for fuel
higher glucose and ketones

Question 25

ketoacidosis - kidneys

Answer 25

start producing more bicarbonate to maintain pH | overtime blood becomes acidotic

Question 26

DKA - dehydration

Answer 26

glucose in urine draws water out osmotic diuresis polyuria and dehydration

Question 27

excessive thirst?

Answer 27

polydipsia

Question 28

DKA - potassium

Answer 28

insulin drives potassium into cells serum potassium can be high or normal total body potassium low as none in cells when started on insulin can develop hypokalaemia

Question 29

symptoms of DKA

Answer 29

``` polyuria, polydipsia nausea and vomiting acetone smell to breath altered consciousness kussmaul breathing ```

Question 30

priority in DKA

Answer 30

fluid resuscitation | insulin infusion

Question 31

diagnosing DKA

Answer 31

hyperglycaemia >11mmol/l ketosis >3mmol/l acidosis pH <7.3

Question 32

treating DKA (FIG-PICK)

Answer 32

``` IV fluids (saline then potassium) insulin glucose potassium infection? chart fluid balance ketones ```

Question 33

Long term management type 1 DM?

Answer 33

patient education subcut insulin regimes monitor CHO monitor blood sugar

Question 34

insulin regimes

Answer 34

background, long acting insulin once a day and short acting 30 mins before CHO

Question 35

what can injecting into same spot cause?

Answer 35

lipodystrophy

Question 36

Type 1 DM - hypoglycaemia symptoms

Answer 36

``` sweaty tremor irritable dizziness pallor coma ```

Question 37

treating hypoglycaemia

Answer 37

rapid acting glucose eg lucozade slower acting CHO eg biscuits IV dextrose and im glucagon

Question 38

Chronic exposure to hyperglycaemia

Answer 38

damage to endothelial cells of blood vessels | suppression of immune system

Question 39

macrovascular complications

Answer 39

coronary artery disease peripheral ischaemia stroke hypertension

Question 40

microvascular complications

Answer 40

peripheral neuropathy retinopathy glomerulosclerosis

Question 41

Infection related complications

Answer 41

UTI pneumonia skin and soft tissue infections fungal infections

Question 42

HbA1c

Answer 42

glycated haemoglobin average glucose over last 3 months measure every 3-6months

Question 43

capillary blood glucose

Answer 43

immediate result

Question 44

flash glucose monitor

Answer 44

sensor on skin measures glucose of interstitial fluid | 5 min delay behind blood glucose levels