Diabetes Mellitus Type 1 Flashcards
Define Type 1 Diabetes Mellitus?
Metabolic Hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production
What is the aetiology of Type 1 Diabetes Mellitus?
Caused by destruction of pancreatic insulin-producing beta cells
Autoimmune process
Occurs in genetically susceptible individuals with an environmental trigger
What autoantigens are associated with Type 1 Diabetes Mellitus?
Glutamic Acid Decarboxylase (GAD)
Insulin
Insulinoma-associated protein 2
Cation efflux zinc transporter
What is the epidemiology of Type 1 Diabetes Mellitus?
0.25% prevalence in the UK
What is the onset of symptoms for Type 1 Diabetes Mellitus?
Juvenile onset (<30 yrs)
What are the symptoms and signs of Type 1 Diabetes Mellitus?
Polyuria/nocturia Polydipsia Tiredness Weight Loss Diabetic Ketoacidosis Symptoms Signs of Complications Signs of Associated autoimmune conditions
What are the Diabetic Ketoacidotic Symptoms?
Nausea and vomiting Abdominal pain Polyuria, polydipsia Drowsiness Confusion Coma Kussmaul Breathing Ketotic Breath Signs of Dehydration
How do we see the signs of complications in Type 1 Diabetes Mellitus?
Fundoscopy - check for diabetic retinopathy
Examine feet for evidence of neuropathy (monofilament test, pulses)
Monitor BP
What are the signs of associated autoimmune conditions in Type 1 Diabetes Mellitus?
Vitiligo
Addison’s Disease
Autoimmune thyroid disease
What investigations would you do for Type 1 Diabetes Mellitus?
Blood Glucose HbA1c FBC U&Es Lipid Profile Urine albumin creatinine ratio Urine Investigations for DKA
What would you see on the blood glucose for Type 1 Diabetes Mellitus?
Fasting blood glucose > 7 mmol/L or random blood glucose > 11.1
What would you look for on an FBC for Type 1 Diabetes Mellitus?
MCV
Reticulocytes
Why do we do U&Es for Type 1 Diabetes Mellitus?
Monitor for nephropathy and hyperkalaemia
Why do we do a Urine Albumin Creatinine ratio for Type 1 Diabetes Mellitus?
Used to detect microalbuminuria
What do we look for in the Urine for Type 1 Diabetes Mellitus?
Glycosuria
Ketonuria
MSU
What investigations do we do for DKA and what might we expect?
FBC (raised WCC without infection in DKA)
U&Es (raised urea and creatinine due to dehydration)
LFT
CRP
Glucose
Amylase
Blood Culture
ABG (metabolic acidosis with high anion gap)
Blood/urinary ketones
What are the two parts of the management plan for Type 1 Diabetes Mellitus?
Glycaemic Control
DKA management
What’s involved in the Glycaemic Control of Type 1 Diabetes Mellitus?
Advice, Patient Education
Drug Treatment
Insulin Pumps
DAFNE courses (dose adjustment for normal eating)
Monitoring
Screening and management of complications
Treatment of hypoglycaemia
Screening and management of cardiovascular risk factors
What drugs do we give in Type 1 Diabetes Mellitus?
Short-acting insulin (three times daily before meals):
- Lispro
- Aspart
- Glulisine
Long-acting insulin (once daily):
- Isophane
- Glargine
- Determir
How do we monitor glycaemic control in Type 1 Diabetes Mellitus?
Regular capillary blood glucose tests
HbA1c every 3-6 months
How do we treat hypoglycaemia in the management of Type 1 Diabetes Mellitus?
If reduced consiousness: 50 ml of 50% glucose IV or 1 mg glucagon IM
If consiousness and cooperative: 50 g oral glucose + starchy snack
What is the initial management of DKA in Type 1 Diabetes Mellitus?
50 U soluble insulin in 50 mL of normal saline
Use an insulin sliding scale
How long do we continue the initial management of DKA in Type 1 Diabetes Mellitus?
Continue until:
- Capillary ketones < 0.3
- Venous pH > 7.30
- Venous bicarbonate > 18 mmol/L
What do you do after you stop the soluble insulin in DKA management in Type 1 Diabetes Mellitus?
Change to SC insulin Don't stop the insulin infusion until 1-2 hrs after the SC insulin has restarted 500mL normal saline over 15-30 mins until SBP > 100 Potassium replacement Monitoring Broad Spectrum Antibiotics Thromboprophylaxis NBM for at least 6 hrs NG tube
