Diabetes overview and type 1 Flashcards
Diabetes
is a progressive loss of beta cell insulin production and increased glucose
Type 1 screen
not recommended
Type 2 screen
Screen when risk factors or diabetes related illness are present
- >40 yo
- frist degree relative with T2DM
- Prediabetes
- vascular issues (HTN, obesity, hyperlipidemia)
Gestational screen
Confirm with 50g glucose tolerance test at 24-28 weeks
Diabetes diagnosis
Fasting BG >7
A1c >6.5
glucose tolerance test >11.1
random glucose >11.1
A1C targets
<6.5 if patient is at high risk of CKD and low risk of hypoglycaemia (young)
<7 for most adults
7.1-8.5 if limited life expectancy, frail or high risk of hypoglycaemia
symptom avoidance if end of life care
Insulin action
Free insulin binds tyrosine kinase in adipose, muscle and liver tissues. causes conformation shift which leads to GLUT 4 expression and glucose intake, then activates glycogen synthase, protein synthesis and lipogenesis
T1DM presentation
75% get it before 20yo
have polyuria, polydipsia and polyphagia
sudden weight loss
Diabetic ketoacidosis
BG >14
dehydration from water loss
metabolic acidosis
sodium and potassium loss from uria
acetone “fruity” breath
decreased conscious state
T1DM risk factors
family history and genetic markers
Auto antibodies in 90% of cases
Stressful events to body
irregular vaccination schedule
Fetal infection
Nitrosamine products
T1DM genetic markers
human leukocyte antigen (HLA)
T1DM goals of therapy
-Prevent macro and micro vas issues
-Fasting and pre meal glucose of 4-7 or 8
-2 hour PP 5-10
-prevent hypoglycaemia
Honey moon phase
Phase after starting insulin where the beta cells can still produce some insulin and leads to hypoglycaemia if not approached carefully
Insulin starting dose
0.5u/kg to start and then move closer to 1u/kg
-Make regimen easy, 40% basal 20% each meal bolus
Split mixed insulin
not preferred as it limits how much we can change the regimen in response to BG
