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S3 Case 4 - Endocrine > Diabetes Pathogenesis Type 1 > Flashcards

Diabetes Pathogenesis Type 1 Flashcards

1
Q

What is the blood glucose with diabetes?

A

> 7mM
(normally between 5-7)

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2
Q

What are the acute symptoms of hypoglycaemia?
(decreased sugar = brain has less glucose)

A

Nervous
Shakey
Dizzy
Confused
Headache
Hunger
Cold clammy skin
Tachycardia
Irritability

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3
Q

What are the acute symptoms of hyperglycaemia?
(increased sugar but cells can’t take it in)

A

Weak
Tired
Frequent urination
Increased thirst
Decreased appetite
Blurry vision
Itchy skin
Breath smells fruity

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4
Q

Describe pathogenesis of Type 1

A

Beta cells destroyed by cytotoxic CD8 T cells
= reactive to peptides complexed with MHC molecules from the beta cell

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5
Q

Describe overall Type 1

A

Failure of insulin secretion
Sudden onset
Childhood onset

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6
Q

What is gestational diabetes?

A

High blood glucose during pregnancy that disappears after birth
= beta cells cannot produce enough insulin to meet extra need

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7
Q

What are the possible consequences of gestational diabetes?

A

Baby grows larger than usual
Premature birth
Jaundice
Pre-eclampsia

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8
Q

What are the symptoms of Type 1?

A

Weight loss
Glucose in urine
Excessive urine
Thirst

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9
Q

Why is there weight loss in Type 1?

A

No insulin
= no glucose utilised at metabolic fuel
= proteins + FAs used
= weight loss

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10
Q

Why is there glucose in the urine, dehydration, excessive urine + thirst in Type 1?

A

High glucose enters glomerular filtrate
= overwhelms glucose capacity of proximal convoluted tubule
= increased fluid osmolarity
= more water secreted
= reabsorption reduced
= increased urine flow

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11
Q

What is the aim of insulin therapy?

A

Artificially regulate blood glucose

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12
Q

What are the problems with repeatedly injecting insulin?
Fat deposition

A

Promote deposition of fate
Cells close to site receive high amounts of insulin
Same site used frequently = lipohypertrophy
= important to change site frequently

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13
Q

What is the problem with repeatedly injecting insulin?
Absorption

A

lead to unpredictable rate of insulin absorption
= poor glycaemic control
= important to change site frequently

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14
Q

What are the forms of insulin used?

A

Animal - STOPPED
Human
Human analogues

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15
Q

What is soluble human insulin?

A

Rapid + short lived
= intravenous emergency

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16
Q

What is isophane human insulin?

A

Intermediate acting

17
Q

What is human insulin zinc suspension?

A

Long acting

18
Q

What is insulin Lispro (Humalog)?
Analogue

A

Modified insulin = switch lysine to proline residue at end of B chain
= very rapid + short-lived = emergency

19
Q

When is insulin Lispro taken?

A

Before a meal

20
Q

What is insulin glargine?
Analogue

A

Mutating Asn-12 in Gly + adding 2 Arg to end of B chain
= long acting + slowly absorbed

21
Q

When is insulin glargine taken?

A

Before a meal in combination with short-acting form

22
Q

What is the first choice for daily treatment for Type 1?

A

Multiple daily injections
= 1 or more separate daily injections of intermediate/long-acting insulin
= multiple injections of short-acting before meals

23
Q

What are the other options for daily treatment of Type 1?

A
  1. Multiple injections per day pf short-acting mixed with intermediate
  2. Insulin pump
24
Q

Who is the insulin pump only available to?

A

Suffering from hypos + hypers without warning
OR glycosylated haemoglobin >69mmol/mol

25
Q

Describe the insulin pump

A

Pre-programmed doses of insulin
= programmed to fit the patten needed for insulin with activity level

26
Q

What are the advantages of an insulin pump?

A

Allows for mealtime boluses to be delivered over a period of time
Insulin action matches carbohydrate absorption
Can deliver very small volumes (0.01-0.05 units)

27
Q

What are the disadvantages of an insulin pump?

A

Worn all the time
Rapid risk of diabetic ketoacidosis if technical failure
Expensive

28
Q

What does insulin pumps allow?

A

Insulin delivery to be closely + conveniently matched to insulin requirement

29
Q

What is a hybrid closed loop technology?

A

Takes readings from a continuous glucose monitor + uses an algorithm to tell an insulin pump how much to deliver

30
Q

Who is the hybrid closed loop technology recommended for?

A

HbA1c of 58mmol/mol or more
OR have disabling hypoglycaemia

31
Q

What is Teplizumab?

A

Ab that blocks CD3 = no signalling = beta cell NOT killed
NEED CD3 to send signal to T cell so it can bind

S3 Case 4 - Endocrine (17 decks)

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