Type 1 diabetes mellitus (T1DM) Flashcards
What is the pathophysiology in T1DM?
- Pancreas is unable to produce insulin
- Cells of the body therefore are unable to take glucose from the blood and use it as fuel
- Cells think that the body’s being fasted and there’s no glucose, however blood glucose is rising leading to hyperglycaemia
What kind of disease is T1DM?
Autoimmune disorder where the body’s immune system damages the beta cells in the islets of Langerhans in the pancreas
1) Name 2 ways someone with T1DM may present
2) Name 2 ways someone with T1DM in diabetic ketoacidosis may present
1) Thirst, polyuria, weight loss
2) Abdominal pain, vomiting, reduced consciousness
1) There are 4 ways of measuring blood glucose level, name 2 of these
2) What does the HBA1c test measure?
3) Which of these tests can be used to look at average blood glucose over 2-3 months?
4) How does the glucose tolerance test work?
5) Name a scenario/condition where the Hba1c test doesn’t give an accurate measurement
1) Finger prick bedside blood glucose monitor, one-off blood glucose (fasting or non fasting), HBA1c test, glucose tolerance test
2) Glycosylated haemoglobin in the blood
3) HBA1c
4) A fasting blood glucose is taken then a 75g glucose load is taken. After 2 hours a second blood glucose reading is taken
5) Pregnancy, hereditary spherocytosis, G6PD deficiency, sickle cell anaemia, uncommon form of Hb i.e. methaemoglobin, haemodialysis
If a person is symptomatic, a:
- fasting glucose greater than or equal to what
and a:
- random glucose greater than or equal to what
is needed for a diagnosis of T1DM
- 7.0 mmol/l and
- 11.1 mmol/l
1) If a person isn’t symptomatic, what test is used to diagnose diabetes?
2) In this test, a value equal or greater of what results in a diagnosis?
3) What is it called when the result of the test is under the diagnostic value, but not far under?
1) HBA1c
2) 6.5% / 48mmol/L
3) Pre-diabetes
Name 2 aspects of the management of T1DM
- Subcutaneous insulin regimes
- Monitoring dietary carbohydrate intake
- Monitoring blood sugar levels on waking, at each meal and before bed
- Monitoring for and managing complications, both short and long term
1) Insulin is usually prescribed as a combination of which 2 methods once a day?
2) When is short acting insulin given?
1) Background insulin, long acting insulin
2) 30 minutes prior to carbohydrate intake
What are the 2 major short term complications in T1DM?
- Hypoglycaemia
- Hyperglycaemia and DKA
Short term T1DM complications - hypoglycaemia
1) Name 2 symptoms of hypoglycaemia
2) Name a severe symptom of hypoglycaemia
3) What are the 2 aspects of hypoglycaemia treatment?
4) How is severe hypoglycaemia treated (2)?
1) Tremor, sweating, irritability, dizziness and pallor
2) Reduced consciousness, coma, death
3) Rapid acting glucose (i.e. lucozade) and a slow acting carbohydrate (i.e. biscuit)
4) IV dextrose and IM glucagon
Short term T1DM complications - hyperglycaemia
1) If a patient id hyperglycaemic but not in DKA, how would they be treated?
1) Increase insulin dose
Diabetic ketoacidosis (1)
What is the pathophysiology of DKA?
1) Cells in the body think that the body is starved of glucose, therefore they initiate ketogenesis to generate ketones for energy. Now there’s high glucose and high ketones in the blood, but the kidneys counteract the high ketones by producing bicarbonate to maintain a normal pH. Over time, the bicarbonate is all used up leaving ketones to accumulate in the blood and cause the pH to become acidic - ketoacidosis
Diabetic ketoacidosis (2)
Dehydration and potassium imbalance are 2 other problems associated with DKA - explain how both of these problems occur
Dehydration - glucose overwhelms the kidneys and begins to accumulate in the urine. Glucose in the urine draws water out - osmotic diuresis - resulting in increased urination and increased thirst
Potassium imbalance - insulin normally drives K+ into cells, but with no insulin, K+ isn’t stored in cells. Serum K+ can be high or normal as the kidneys continue to balance blood K+ with the K+ excreted in the urine, however total body K+ is low because it isn’t stored in cells. However, when treatment with insulin starts patients can develop severe hypokalaemia quickly which can lead to fatal arrhythmias
Diabetic ketoacidosis (3)
1) Name 3 symptoms DKA can present with
2) What are the 3 things needed for a diagnosis of DKA?
1) Vomiting, thirst, sweet breath (pear drops), polyuria, reduced consciousness
2) Acidosis, ketosis and hyperglycaemia
Diabetic ketoacidosis (4)
The treatment of DKA can be remembered with the mnemonic FIG-PICK - what do each of these letters stand for?
F – Fluids – IV fluid resuscitation with normal saline
I – Insulin – Add an insulin infusion
G – Glucose – Closely monitor blood glucose + add a dextrose infusion if below a certain level
P – Potassium – Closely monitor
I – Infection – Treat underlying triggers
C – Chart fluid balance
K – Ketones – Monitor blood ketones
