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Clinical 4th Year > Chapter 1- Diabetes Type 1 > Flashcards

Chapter 1- Diabetes Type 1 Flashcards

1
Q

What is DKA

A

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

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2
Q

Describe a sliding scale/ variable rate IV insulin infusion

A

1) dissolve 50units (0.5ml) of human actrapid with 49.5ml 0.9% NaCl
2) concentration is 1unit/ml

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3
Q

How might hypoglycaemic state happen?

A 
Too much insulin 
Skipped meals
Alcohol intoxication 
Night time hypos
Exercise without insulin adjustment 
Liver disease
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4
Q

How can alcohol intoxication cause hypos?

A

Alcohol can inhibit the livers ability to release glucose into the blood

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5
Q

List signs of DKA

A 
Vomiting
Kussmaul respiration 
Hyperkalaemia
Tachycardia 
Acetone breath 
Thirst and urination 
Urinalysis: glucosurea & ketourea
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6
Q

List signs of hypo

A 
Sweating 
Fatigue 
Feeling dizzy 
Hungry 
Blurred vision 
Confusion 
Tachycardia/palpitations 
Pale/weak 
Trembling
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7
Q

List 6 treatments for hypos

A

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)

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8
Q

In what ways can U100 insulin be administered?

A

Syringe and vial
Cartridge pen
Disposable pen

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9
Q

In what ways can U200 and U300 be administered

A

Disposable pen ONLY due to risk of error/overdose if drawn up

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10
Q

What’s the half life of a RBC

A

3-6months

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11
Q

What is HbA1c?

A

Refers to glycated haemoglobin, develops when haemoglobin joins with glucose in the blood

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12
Q

If type 1 patients choose to test glucose after meals what plasma glucose should they aim for?

A

5-9mmol/l at least 90 mins after eating

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13
Q

Name the injection sites in order of quickest absorption

A

Abdomen
Upper arm
Thigh
Buttocks

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14
Q

During illness should insulin be stopped if eating less

A

NO - increased insulin requirements during periods of ill health

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15
Q

What is ACR?

A

Albumin creatinine ratio helps to identify kidney disease in diabetes

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16
Q

What’s the target of ACR?

A

Male less than 2.5mg/mmol

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17
Q

What is T1DM characterised by?

A

Destruction of the insulin producing pancreatic beta cells which occurs by either:

1) autoimmune T-cell mediated destruction
2) idiopathic

18
Q

Is the onset of symptoms in T1 diabetes faster or slower than in T2 diabetes?

A

Faster in type 1

19
Q

The age of onset of type 1 diabetes is usually below what?

A

Below 30

20
Q

True or false: circulating islet cell antibodies (ICA) are present in more than 70% of those with type 1 at time of diagnosis?

A

True dat

21
Q

Appearance of islet cell antibodies (ICA) precedes the onset of diabetes by as much as how many years?

A

3years

22
Q

What’s the process of insulin formation in the pancreatic beta cells?

A

Preproinsulin –> proinsulin –> insulin + C-peptide

23
Q

True or false: in renal and hepatic disease there is an increase in the rate of insulin clearance

A

FALSE there is a decrease in rate of clearance (may need dose reduction)

24
Q

What’s the WHO diagnostic criteria for diabetes

A

Fasting serum glucose >7mmol/L

Serum glucose >11.1mmol/L 2 hours after 75g anhydrous glucose

25
Q

Name three acute emergencies associated with diabetes

A

Hypoglycaemia
Diabetic ketoacidosis
Hyperosmolar hyperglycaemic state

26
Q

When might individuals not notice hypos?

A

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

27
Q

Serum glucose below 0.5mmol/L can result in what?

A

Death!! Serious hypo

28
Q

What is neuroglycopenia

A

Cerebral malfunction: shortage of glucose in the brain

29
Q

Why are morning blood glucose readings often high?

A

Due to nocturnal hypoglycaemia: sustained hypo over night leads to counter-regulatory hormones to raise blood glucose levels

30
Q

If nocturnal hypos are confirmed what should a patient do?

A

Have a snack before bed
Reduce evening insulin
Alter timing of administration
Change intermediate acting to peakless analogue

31
Q

Name 4 precipitating factors for developing DKA in type 1 diabetics

A

Omission of insulin dose
Acute infection
Trauma
Myocardial infarction

32
Q

In diagnosing DKA the blood glucose test strip will usually show a blood glucose reading of more than what?

A

> 22mmol/L

33
Q

Name two types of long term diabetic complications

A

Macrovascular: (damage to large vessels)

Microvascular: (damage to smaller vessels)

34
Q

Macrovascular complications include what?

A

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

35
Q

Microvaacular complications include what?

A

1) retinopathy
2) nephropathy (presence detected by albumin in urine)
3) neuropathy

36
Q

What is the first line hypertensive treatment for type 1 diabetics?

A

ACEi as Renally protective

37
Q

When using a pen injection device you must always keep them in the fridge

A

No NEVER –> there have been reports of devices ‘seizing up’

38
Q

The patient needs to be fasted for HbA1c

A

FALSE they don’t have to be

39
Q

HbA1c may be lower in those with reduced red cell lifespan, name two classes of patient with this?

A

1) pregnancy

2) advanced renal failure

40
Q

Serum fructosamine represents what?

A

Glycation of all serum proteins and gives information about control over the preceding 3 weeks

41
Q

When should type 1 diabetics monitor their blood glucose?

A

At least 4 times per day, before meals and before bed

42
Q

Name the enzyme of the glucose testing strip

A

Glucose oxidase

Clinical 4th Year (9 decks)

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