Diabetes- type 1 Flashcards
Presentation
Signs and symptoms in new diangosis are typically in DKA
Features of DKA
Abdo pain
Polyuria/ polydipsia/ dehydration
Kussmaul respiration
Acetone-smelling breath
Hyperglycaemia
Potassium imbalance
Investigations for diabetes
Urine dip for glucose and ketones
Fasting glucoe and random glucose
HbA1c no useful as may not reflect recent rapid rise in serum glucose
C-peptide levels low in T1DM
Diagnosis
Symptomatic
Fasting glucose >7.0mmol/L
Random glucose>11.0mmol/L
HbA1c monitoring
Every 3-6 months
Target <48mmol
Self-monitoring of blood glucose
Recommend testing at least 4 times a day (before each meal and before bed)
More frequent monitoring if frequent hypoglycaemia, period of illness, before/during/after sport, when planning pregnancy, during pregnancy, breastfeeding
Blood glucose targets
5-7mmol/L on waking
4-7mmol/L before meals and other times of the day
Type of insulin
Multiple injection basal-bolus insulin regimens for all adults
Twice dailt insulin detemir is regime of choice
Rapid acting insulin analogues before meals
Short term complications
Hypoglycaemia (tremor, sweating, irritable, dizzy, pallor, LOC, coma, death)
Hyperglycaemia (lead to DKA)
Macrovascular complications
Coronary artery disease is major cause of death
Peripheral ischaemia causing poor healing, ulcers, diabetic foot
Stroke
HTN
Microvascular complications
Peripheral neuropathy
Retinopathy
Kidney disease (glomerulosclerosis)
Infection related complications
UTI
Pneumonia
Skin and soft tissue infections
Fungal infections (candidiasis)