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Endocrinology 2 > Type 1 Diabetes Mellitus > Flashcards

Type 1 Diabetes Mellitus Flashcards

1
Q

hyperglycaemia in type 1 diabetes is a result of what pathophysiology?

A
  • Autoimmune condition where insulin-producing beta cells in the islets of langerhan in the pancreas are attacked and destroyed by the immune system - results in partial or complete deficiency of insulin production, resulting in hyperglycemia (because insulin causes cells to take up glucose from the blood)
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2
Q

what are the classifications of diabetes mellitus?

A
  • Type 1 - Type 2 - Hybrid - Other eg. MODY/pancreatic injury - Unclassified - During pregnancy - Type 3C - pancreatectomy
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3
Q

what are the combined causes of type 1 diabetes?

A

environmental trigger and genetic risk

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4
Q

what are the combined causes of type 2 diabetes?

A

genetic risk and obesity

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5
Q

what is the name given to autoimmune diabetes that presents later in life?

A

latent autoimmune disease in adults (LADA)

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6
Q

can T2DM present in childhood?

A

yes

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7
Q

can diabetic ketoacidosis be a feature of T2DM?

A

yes

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8
Q

monogenic diabetes can typically present phenotypically as what?

A

type 1 or type 2 diabetes

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9
Q

how do we measure insulin?

A

c-peptide as it is the cleavage product of pro-insulin

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10
Q

how are pancreatic beta cells destroyed?

A
  1. Presentation of auto-antigen by antigen presenting cells to autoreactive CD4+ T lymphocytes
  2. CD4+ activate CD8+ lymphocytes
  3. CD8+ travel to islets and lyse beta cells expressing auto-antigen
  4. This is exacerbated by release of pro-inflammatory cytokines
  5. Defects in regulatory T-cells that fail to suppress autoimmunity
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11
Q

Which allele has the largest effect on risk of type 1 diabetes?

A

HLA-DR allele (human leukocyte antigen)

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12
Q

Give 4 examples of environmental factors that could trigger diabetes type 1

A
  • enteroviral infections
  • cow’s milk protein exposure
  • seasonal variation
  • changes in microbiota
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13
Q

what are the symptoms of type 1 diabetes?

A
  • polyuria
  • nocturia
  • polydipsia
  • blurred vision
  • recurrent infections eg. thrush
  • weight loss
  • fatigue
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14
Q

what are the signs of type 1 diabetes?

A
  • dehydration
  • cachexia
  • hyperventilation
  • smell of ketones
  • glycosuria
  • ketonuria
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15
Q

lack of insulin leads to which processes?

A
  • proteinolysis –> increased amino acids
  • gluconeogenesis –> increased hepatic glucose output
  • lipolysis –> increased NEFAs –> beta oxidation —> ketone bodies
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16
Q

what are the complications of hyperglycaemia?

A

Acute:

  • diabetic ketoacidosis

Chronic:

  • Microvascular –> retinopathy, neuropathy, nephropathy
  • Macrovascular –> ischaemic heart disease, cerebrovascular disease, peripheral vascular disease
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17
Q

what could be the complication of insulin treatment?

A

hypoglycaemia

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18
Q

what are the options for type 1 diabetes management?

A

insulin treatment

dietary support/structured educations

technology

transplantation

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19
Q

what are some examples of short-acting insulin taken with meals?

A

human insulin (actrapid)

insulin analogue (lispro, aspart, glulisine)

20
Q

what are some examples of background/basal insulin?

A
  • bound to zinc or protamine (neutral protamine hagedorn, NPH)
  • Insulin analogue (glargine, determir, degludec)
21
Q

insulin pump therapy involves continuous delivery of which form of insulin? Into which part of the body?

A

short-acting into the subcutaneous space

22
Q

how do you use an insulin pump?

A
  • programme device to deliver fixed units per hour (basal)
  • actively bolus for meals
23
Q

what are the positives of an insulin pump?

A

Variable basal rates

Extended boluses

Greater flexibility

24
Q

what dietary advice should you give to those with type 1 diabetes?

A
  • adjust dose of insulin with carbohydrate content of food
  • train for carbohydrate counting
  • substitute refined carbohydrate foods with complete carbohydrates (low glycaemic index)
25
Q

How does a closed-loop insulin pump work?

A
  • change in glucose
  • real-time continuous glucose sensor
  • algorithm to use glucose to calculate insulin requirement
  • insulin pump delivers calculated insulin
26
Q

what is a hybrid closed loop insulin pump?

A

similar to a closed loop but you must tell it when you want to eat

27
Q

what are the options for transplantation in type 1 diabetes?

A
  • islet cell transplants from pancreas of deceased donor
  • transplant into hepatic portal vein
  • life-long immunosuppression
  • simultaneous kidney and pancreas transplant (better survival when transplanted with kidneys)
  • requires life-long immunosuppression
28
Q

Downsides of transplantation?

A
  • life-long immunosuppression required
  • risk of rejection
  • limited availability of donors
29
Q

which blood tests helps us monitor diabetes control overall?

A

glycated haemoglobin (HbA1c)

30
Q

How do we monitor glucose levels?

A
  • capillary (fingerprick) blood glucose monitoring
  • continuous glucose monitoring (restricted availability)
31
Q

hbA1c reflects what time period of glycaemia?

A

last 3 months

32
Q

what can affect HbA1c?

A
  • erythropoeisis eg. iron, vit B12 deficiency
  • altered haemoglobin
  • glycation problems eg. aspirin, vitamin C and E
  • erythrocyte destruction eg. antiretrovirals, splenectomy, rheumatoid arthritis
33
Q

what is used to guide insulin doses?

A
  • self-monitoring blood glucose results at home
  • HbA1c results every 3-4 months
34
Q

what are 3 acute complications of type 1 diabetes?

A
  1. diabetic ketoacidosis
  2. uncontrolled hyperglycaemia
  3. hypoglycaemia
35
Q

what can cause diabetic ketoacidosis?

A
  • presenting feature of new-onset type 1 diabetes
  • acute illness
  • missed insulin doses
  • inadequate insulin doses
36
Q

what levels of pH, ketones, HCO3- and glucose constitute a diagnosis of diabetic ketoacidosis?

A
  • pH <7.3
  • ketones increased in blood or urine
  • HCO3- less than 15 mmol/L
  • glucose > 11 mmol/L
37
Q

what is the level of glucose that constitutes hypoglycaemia?

A

<3.6mmol/L

38
Q

symptoms of hypoglycaemia

A

Adrenergic

  • tremors
  • palpitations
  • sweating
  • hunger

Neuroglycopaenic

  • somnolence
  • confusion
  • incoordination
  • seizures
  • coma

or NON at all

39
Q

when does someone usually get no symptoms of hypoglycaemia?

A

with recurrent hypoglycaemia, body becomes unreactive

40
Q

how do you relieve hypoglycaemia?

A

glucose administration

41
Q

when are the 4 times hypoglycaemia becomes a problem?

A
  1. excessive frequency
  2. impaired awareness (unable to detect low blood glucose)
  3. nocturnal hypoglycaemia
  4. recurrent severe hypoglycaemia
42
Q

what are the risks of hypoglycaemia?

A
  • seizure/coma/death
  • impacts on driving
  • impacts on emotional well-being
  • impacts on day to day function
  • impacts on cognition
43
Q

risk factors for people with type 1 diabetes for hypoglycaemia?

A
  • exercise
  • missed meals
  • inappropriate insulin regime
  • alcohol intake
  • lower HbA1c
  • Lack of training around dose adjustment for meals
44
Q

list 5 strategies to support problematic hypoglycaemia?

A
  1. indication for insulin-pump therapy
  2. try different insulin analogues
  3. revisit carbohydrate counting/structured education
  4. behavioural psychology support
  5. transplantation
45
Q

what is used for the acute management of hypoglycaemia?

A
  1. carbohydrates and sugary foods
  2. glucogel
  3. 20% glucose IV
  4. IM injection of glucagon

Endocrinology 2 (17 decks)

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