Chapter 1- Diabetes Type 1 Flashcards
What is DKA
Diabetic ketoacidosis:
Not enough insulin made
High glucose but not taken up into cells
Lipolysis forms ketone bodies
Increase acidity of blood (kussmaul respiration and hyperkalaemia)
Respire acetone
Describe a sliding scale/ variable rate IV insulin infusion
1) dissolve 50units (0.5ml) of human actrapid with 49.5ml 0.9% NaCl
2) concentration is 1unit/ml
How might hypoglycaemic state happen?
Too much insulin Skipped meals Alcohol intoxication Night time hypos Exercise without insulin adjustment Liver disease
How can alcohol intoxication cause hypos?
Alcohol can inhibit the livers ability to release glucose into the blood
List signs of DKA
Vomiting Kussmaul respiration Hyperkalaemia Tachycardia Acetone breath Thirst and urination Urinalysis: glucosurea & ketourea
List signs of hypo
Sweating Fatigue Feeling dizzy Hungry Blurred vision Confusion Tachycardia/palpitations Pale/weak Trembling
List 6 treatments for hypos
1) lucozade 150ml
2) 5 glucose tablets 20%
3) IV glucose 25mg infusion
4) monosaccharide carbs if taking alpha glucosidase inhibitor (acarbose)
5) IM glucagon 1mg
6) glucose gel (rub on gums)
In what ways can U100 insulin be administered?
Syringe and vial
Cartridge pen
Disposable pen
In what ways can U200 and U300 be administered
Disposable pen ONLY due to risk of error/overdose if drawn up
What’s the half life of a RBC
3-6months
What is HbA1c?
Refers to glycated haemoglobin, develops when haemoglobin joins with glucose in the blood
If type 1 patients choose to test glucose after meals what plasma glucose should they aim for?
5-9mmol/l at least 90 mins after eating
Name the injection sites in order of quickest absorption
Abdomen
Upper arm
Thigh
Buttocks
During illness should insulin be stopped if eating less
NO - increased insulin requirements during periods of ill health
What is ACR?
Albumin creatinine ratio helps to identify kidney disease in diabetes
What’s the target of ACR?
Male less than 2.5mg/mmol
What is T1DM characterised by?
Destruction of the insulin producing pancreatic beta cells which occurs by either:
1) autoimmune T-cell mediated destruction
2) idiopathic
Is the onset of symptoms in T1 diabetes faster or slower than in T2 diabetes?
Faster in type 1
The age of onset of type 1 diabetes is usually below what?
Below 30
True or false: circulating islet cell antibodies (ICA) are present in more than 70% of those with type 1 at time of diagnosis?
True dat
Appearance of islet cell antibodies (ICA) precedes the onset of diabetes by as much as how many years?
3years
What’s the process of insulin formation in the pancreatic beta cells?
Preproinsulin –> proinsulin –> insulin + C-peptide
True or false: in renal and hepatic disease there is an increase in the rate of insulin clearance
FALSE there is a decrease in rate of clearance (may need dose reduction)
What’s the WHO diagnostic criteria for diabetes
Fasting serum glucose >7mmol/L
Serum glucose >11.1mmol/L 2 hours after 75g anhydrous glucose
Name three acute emergencies associated with diabetes
Hypoglycaemia
Diabetic ketoacidosis
Hyperosmolar hyperglycaemic state
When might individuals not notice hypos?
Alcohol intoxication
Lack of education
Symptoms may not occur due to autonomic neuropathy
If taking drugs that suppress symptoms e.g B-blockers
Recurrent hypos where autonomic symptoms may cease to occur
Serum glucose below 0.5mmol/L can result in what?
Death!! Serious hypo
What is neuroglycopenia
Cerebral malfunction: shortage of glucose in the brain
Why are morning blood glucose readings often high?
Due to nocturnal hypoglycaemia: sustained hypo over night leads to counter-regulatory hormones to raise blood glucose levels
If nocturnal hypos are confirmed what should a patient do?
Have a snack before bed
Reduce evening insulin
Alter timing of administration
Change intermediate acting to peakless analogue
Name 4 precipitating factors for developing DKA in type 1 diabetics
Omission of insulin dose
Acute infection
Trauma
Myocardial infarction
In diagnosing DKA the blood glucose test strip will usually show a blood glucose reading of more than what?
> 22mmol/L
Name two types of long term diabetic complications
Macrovascular: (damage to large vessels)
Microvascular: (damage to smaller vessels)
Macrovascular complications include what?
1) cardiovascular disease:
- hypertension twice as common in diabetes
- risk of stroke and MI
2) peripheral vascular disease:
- often arteries in legs causing intermittent claudication, cramping
- iliac vessels causing buttock pain and erectile dysfunction
Microvaacular complications include what?
1) retinopathy
2) nephropathy (presence detected by albumin in urine)
3) neuropathy
What is the first line hypertensive treatment for type 1 diabetics?
ACEi as Renally protective
When using a pen injection device you must always keep them in the fridge
No NEVER –> there have been reports of devices ‘seizing up’
The patient needs to be fasted for HbA1c
FALSE they don’t have to be
HbA1c may be lower in those with reduced red cell lifespan, name two classes of patient with this?
1) pregnancy
2) advanced renal failure
Serum fructosamine represents what?
Glycation of all serum proteins and gives information about control over the preceding 3 weeks
When should type 1 diabetics monitor their blood glucose?
At least 4 times per day, before meals and before bed
Name the enzyme of the glucose testing strip
Glucose oxidase
