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Endocrine > Diabetes Mellitus Type 1 > Flashcards

Diabetes Mellitus Type 1 Flashcards

1
Q

Define Type 1 Diabetes Mellitus?

A

Metabolic Hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production

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2
Q

What is the aetiology of Type 1 Diabetes Mellitus?

A

Caused by destruction of pancreatic insulin-producing beta cells
Autoimmune process
Occurs in genetically susceptible individuals with an environmental trigger

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3
Q

What autoantigens are associated with Type 1 Diabetes Mellitus?

A

Glutamic Acid Decarboxylase (GAD)
Insulin
Insulinoma-associated protein 2
Cation efflux zinc transporter

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4
Q

What is the epidemiology of Type 1 Diabetes Mellitus?

A

0.25% prevalence in the UK

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5
Q

What is the onset of symptoms for Type 1 Diabetes Mellitus?

A

Juvenile onset (<30 yrs)

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6
Q

What are the symptoms and signs of Type 1 Diabetes Mellitus?

A 
Polyuria/nocturia 
Polydipsia
Tiredness
Weight Loss
Diabetic Ketoacidosis Symptoms
Signs of Complications
Signs of Associated autoimmune conditions
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7
Q

What are the Diabetic Ketoacidotic Symptoms?

A 
Nausea and vomiting
Abdominal pain
Polyuria, polydipsia
Drowsiness 
Confusion 
Coma 
Kussmaul Breathing 
Ketotic Breath 
Signs of Dehydration
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8
Q

How do we see the signs of complications in Type 1 Diabetes Mellitus?

A

Fundoscopy - check for diabetic retinopathy
Examine feet for evidence of neuropathy (monofilament test, pulses)
Monitor BP

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9
Q

What are the signs of associated autoimmune conditions in Type 1 Diabetes Mellitus?

A

Vitiligo
Addison’s Disease
Autoimmune thyroid disease

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10
Q

What investigations would you do for Type 1 Diabetes Mellitus?

A 
Blood Glucose 
HbA1c
FBC
U&amp;Es
Lipid Profile 
Urine albumin creatinine ratio 
Urine 
Investigations for DKA
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11
Q

What would you see on the blood glucose for Type 1 Diabetes Mellitus?

A

Fasting blood glucose > 7 mmol/L or random blood glucose > 11.1

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12
Q

What would you look for on an FBC for Type 1 Diabetes Mellitus?

A

MCV

Reticulocytes

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13
Q

Why do we do U&Es for Type 1 Diabetes Mellitus?

A

Monitor for nephropathy and hyperkalaemia

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14
Q

Why do we do a Urine Albumin Creatinine ratio for Type 1 Diabetes Mellitus?

A

Used to detect microalbuminuria

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15
Q

What do we look for in the Urine for Type 1 Diabetes Mellitus?

A

Glycosuria
Ketonuria
MSU

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16
Q

What investigations do we do for DKA and what might we expect?

A

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

17
Q

What are the two parts of the management plan for Type 1 Diabetes Mellitus?

A

Glycaemic Control

DKA management

18
Q

What’s involved in the Glycaemic Control of Type 1 Diabetes Mellitus?

A

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

19
Q

What drugs do we give in Type 1 Diabetes Mellitus?

A

Short-acting insulin (three times daily before meals):

  • Lispro
  • Aspart
  • Glulisine

Long-acting insulin (once daily):

  • Isophane
  • Glargine
  • Determir
20
Q

How do we monitor glycaemic control in Type 1 Diabetes Mellitus?

A

Regular capillary blood glucose tests

HbA1c every 3-6 months

21
Q

How do we treat hypoglycaemia in the management of Type 1 Diabetes Mellitus?

A

If reduced consiousness: 50 ml of 50% glucose IV or 1 mg glucagon IM
If consiousness and cooperative: 50 g oral glucose + starchy snack

22
Q

What is the initial management of DKA in Type 1 Diabetes Mellitus?

A

50 U soluble insulin in 50 mL of normal saline

Use an insulin sliding scale

23
Q

How long do we continue the initial management of DKA in Type 1 Diabetes Mellitus?

A

Continue until:

  • Capillary ketones < 0.3
  • Venous pH > 7.30
  • Venous bicarbonate > 18 mmol/L
24
Q

What do you do after you stop the soluble insulin in DKA management in Type 1 Diabetes Mellitus?

A 
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
25
Q

Why do we have potassium replacement therapy in DKA management of Type 1 Diabetes Mellitus?

A

Insulin drives potassium into cells

26
Q

What do we monitor in DKA management in Type 1 Diabetes Mellitus?

A

Blood Gluocse, capillary ketones and urine output hourly

Also monitor U&Es and venousblood gas

27
Q

When do we give broad spectrum antibiotics in DKA management in Type 1 Diabetes Mellitus?

A

If infection is suspected

28
Q

When do we give an NG tube in DKA management in Type 1 Diabetes Mellitus?

A

If GCS is reduced

29
Q

What are some complications of Type 1 Diabetes Mellitus?

A 
Diabetic Ketoacidosis
Microvascular complications
Macrovascular complicaations
Increased risk of infection 
Complications of treatment
30
Q

What can Diabetic Ketoacidosis be precipitated by?

A

Infection
Errors in management of diabetes
Newly-diagnosed diabetes
Idiopathic

31
Q

What are some Microvascular complications of Type 1 Diabetes Mellitus?

A

Retinopathy
Nephropathy
Neuropathy

32
Q

What are some macrovascular complications of Type 1 Diabetes Mellitus?

A

Peripheral Vascular Disease
Ischaemic Heart Disease
Stroke/TIA

33
Q

What are the complications of treatment of Type 1 Diabetes Mellitus?

A

Weight Gain
Fat hypertrophy at insulin injection sites
Hypoglycaemia

34
Q

What are some of the further complications of Hypoglycaemia?

A 
Personality changes
Fits 
Confusion
Coma 
Pallor 
Sweating 
Tremor 
Tachycardia 
Palpitations
Dizziness 
Hunger 
Focal neurological symptoms
35
Q

What is the prognosis for patients with Type 1 Diabetes Mellitus?

A

Depends on early diagnosis, good glycaemic control and complicance with treatment and screening
Vascular disease and renal failure are the main causes of increased morbidity and mortality

Endocrine (29 decks)

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