Child Health - Diabetes Flashcards
what, in really basic terms, is the issue with not producing insulin?
without insulin, the cells of the body cant take glucose from the blood and use it for fuel
ie - when there is no insulin, the cells think there is no glucose in the blood and the body is being fasted
the cells cannot use the glucose so it stays in the blood and glucose levels keep increasing in the blood causing hyperglycaemia
normal glucose level?
4.4 - 6.1 (more like 5.6 in real life though)
where is insulin produced?
beta cells in islets of langerhans in the pancreas
what type of hormone is insulin?
anabolic hormone (building hormone)
how does insulin level change?
increases when blood sugars rise so rises after eating
insulin reduces blood glucose levels via what 2 methods?
- causes cells to absorb glucose from blood and use it as fuel
- causes muscle and liver cells to absorb glucose from the blood and store it as glycogen
where is glucagon produced?
alpha cells in islets of langerhans in the pancreas
what type of hormone is glucagon?
catabolic hormone (breaks stuff down)
what does glucagon do?
increases blood glucose levels by telling the liver to break down the stored glycogen into glucose (called glycogenolysis)
also tells liver to convert proteins and fats into glucose (called gluconeogenesis)
when is glucagon released?
released in response to low blood glucose levels and stress
when does ketogenesis occur?
when there is insufficient supply of glucose and glycogen stores are exhausted (eg in prolonged fasting)
what happens in ketogenesis?
liver takes fatty acids and converts them into ketones which can be used as fuel
ketones cross the blood brain carrier and can be used by the brain
is ketogenesis always dangerous?
no
normal and not harmful in healthy patients when under fasting conditions or on a very low carbohydrate, high fat diet
main characteristic of people in ketosis?
acetone smell on breath
how do most kids first present with diabetes?
25-50% present in DKA other present with characteristic symptoms - polyuria - polydipsia - weight loss
other less typical presentations of diabetes in kids?
secondary enuresis (new bedwetting in a previously normal child) recurrent infections
what bloods should be taken in a new diagnosis of type 1 diabetes to rule out other pathology?
baseline bloods (FBC, renal profile, lab glucose etc) blood cultures (if suspected infection) HbA1c TFTs thyroid peroxidase antibodies anti-TTG (coelic) diabetes antibodies
what antibodies are associated with type 1 diabetes?
insulin antibodies
anti-GAD
anti-islet cell
what are the 4 components of long term management of type 1 diabetes?
sub-cut insulin regimes
monitoring daily carbohydrate intake
monitoring blood glucose on waking, at each meal and before bed
monitoring for and managing any complications
most common insulin regime?
basal-bolus
- background long acting insulin given once a day + short acting insulin given 30 mins before carbohydrate intake
insulin can also be given via insulin pump
what is the most common problem with injecting insulin into the same spot repeatedly?
lipodystrophy
- where sub-cut fat hardens and prevents normal absorption of insulin when further doses are injected into this area
(patients should therefore cycle their injection sites)
example of long and short acting insulin?
long acting = lantus
short acting = actrapid
short term complications of type 1 diabetes?
hypoglycaemia
hyperglycaemia (and DKA)
how can hypoglycaemia occur in type 1 diabetes?
too much insulin
not enough carbs for insulin prescription
not processing the carbs properly (eg in malabsorption, diarrhoea, vomiting, sepsis etc)
typical symptoms of hypoglycaemia?
hunger tremor sweating irritability dizziness pallor can lead to reduced consciousness, coma and death in severe cases if not treated
basics of managing hypoglycaemia?
combination of rapid acting glucose and a slower acting carbohydrate to maintain blood sugar level when rapid acting glucose is used up
options for treating hypoglycaemia in someone who is unconscious?
oral glucose not safe
IV dextrose
intramuscular glucagon (doesnt require a cannula)
how can hyperglycaemia (not in DKA) be managed?
may need insulin dose to be increased
patient will get to know their own response to insulin and learn to administer an appropriate dose to keep glucose at good levels
types of long term complications of type 1 diabetes?
macrovascular (CVD, stroke, hypertension etc)
microvascular (peripheral neuropathy, nephropathy, retinopathy)
infection related complications
how do vascular problems develop in type 1 diabetes?
chronic exposure to hyperglycaemia causes damage to endothelial cells of blood vessels
this leads to leaky malfunctioning vessels that are unable to regenerate
how does diabetes increase infection risk?
high glucose levels causes suppression of immune system
high sugar environment is also optimum conditions for organisms to grow
how can type 1 diabetes be monitored?
HbA1c
capillary blood glucose
flash glucose monitoring
how is HbA1c used?
measure of glycated haemoglobin which is how much glucose is attached to the haemoglobin molecules inside RBCs
reflects average blood glucose level over past 3 months (bc RBCs have a lifespan of around 3-4 months)
how often is HbA1c measures?
every 3-6 months
