Diabetes type 1 Flashcards by Olivia McConaghie

What level of fasting glucose is needed to diagnose diabetes?

> 7.0 mmol/L

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What random glucose levels are required to diagnose diabetes?

> 11.1 mmol/L

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True or Fale

DKA is more common in type 2 diabetics

False.

DKA is only present in type 1

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What can be seen on histology of an islet in type 1?

Lymphocytes

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What are ICA?

Islet cell antibodies

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What infection can be present in those with type 1?

Candiasis

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What is balanitis?

Inflammation of the head of the penis

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What is the only treatment for type 1?

Insulin (basally and bolus)

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What is the ideal HbA1c range?

Below 59 mmol/L

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What is studied at annual review?

Weight
BP
Bloods- HbA1c, renal, lipids
Retinal screening
foot exam

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True or False

There is often ketonuria in type 2

False.

Present in type 1

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What are children under the age of 6 diagnosed with, rather than type 1?

Monogenic diabetes

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What is type 1.5 diabetes?

Latent onset diabetes of adulthood.
LADA
This is type 1 diabetes.

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What is LADA?

Elevated levels of pancreatic auto-bodies in patients who do not require insulin

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When is LADA suspected?

Young males
Non-obese
Auto-antibodies +ve
Other autoimmune conditions

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True or False

Diabetes is common in cystic fibrosis.

True

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What are the symptoms of Wolfram syndrome?

Diabetes insipidus
DM
optic atrophy
deafness
neurological abnormalities

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What acronym can be used for Wolfram syndrome?

DIDMOAD

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What causes Wolfram syndrome?

Genetic default in the wolfram gene which is present in the pancreas, inner ear and brain

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What are the symptoms for Bardet-Biedl syndrome?

Obese
Polydactyly
Hypogonadal
Visually/audally impaired
Mental retarded
Diabetes

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What makes Bardet-Biedl syndrome more likely?

Parents who are related.

Consanguineous

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In what types of diabetes are antibodies negative?

MODY

Type 2

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Which autoimmune conditions are related to diabetes?

thyroid disease
coeliac
Pernicious anaemia
Addisons

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How common is it to have coeliac disease in type 1?

1:20

Compared to 1% in population

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What antibody is present in coeliac disease?

Anti TTG

What antibodies are present in diabetes type 1?

Anti-GAD | Anti islet

What other GP available tests can be done to exclude diabetes 2?

C peptide

What kind of tumour can cause diabetes?

Glucagonoma

Which drugs can induce diabetes?

Glucocorticoids B blockers Diuretics

What does HbA1c measure?

Control of glucose over the past few months

Which infection of the bone may be present in diabetic neuropathy?

Osteomyelitis

What antibodies may be present in type 1?

IA2 IAA GAD ZnT8

What relation does type 1 have with DVLA?

Must inform DVLA of diagnosis

What HbA1c is ideal for a diagnosed type 1?

48-58 mmol/L

How much does carbohydrate loading need to be changed by when exercising?

1g CHO per kg of body weight per hour exercising.

What is DKA?

Absolute insulin deficiency with an increase in counter-regulatory hormone

What is the danger of a DKA in young children?

Cerebral oedema

What are the four possible regimes for insulin release?

SCII pumps Basal bolus which mimics endogenous release Twice daily Once daily

What factors need to be taken into account when calculating insulin dosages?

Carb intake Pre-meal glucose Anticipated activity

Give an example of rapid acting analogue insulin

Humalog | Novorapid

Give an example of short acting insulin/soluble

Humulin S

Give an example of intermediate acting (isophane)

Insulatard | Humulin I

Give an example of a long acting analogue

lantus

How do rapid-intermediate analogue mixtures work?

Novomix30 - 30% short action. 70% basal insulin

When is a once daily insulin inj. given?

Nursing homes, mental retardation.

What is the standard treatment for T1D?

MDI 3/4 or CSII

What is the target glucose levels pre-meal?

4-7mmol/L

What is the target glucose levels post-meal?

less than 9

What are the education programmes called on insulin management?

DAFNE (dose adjustment for normal eating) | TIM (tayside insulin management)

What can cause DKAs?

``` pregnancy illicit drugs/alcohol infection non-compliance pancreatitis ```

What kind of symptoms can ketone bodies cause?

``` Flushing vomiting abdo pain Kussmaul's breathing Ketones on breath ```

What ketone is tested for in bloods?

Beta-hydroxybutate

What is the normal amount of ketone?

Less than 0.6

Beware! How far can the ketone meter read?

Only to 8 so if above 8 you'd never know.

What is the danger of measuring ketones in urine?

Shows ketones 2 hours previously.

Biochemically, how is lactate produced?

Anaerobically produced from pyruvate

How is lactic acidosis different to hyperlactaemia?

Lactic acidosis involves a high ion gap with low ketone level.

When does type A lactic acidosis occur?

Tissue hypoxaemia e.g. infarcted tissue, hypovolemic shock

When does type B lactic acidosis occur?

Diabetes | Liver disease

What is the equation for working out anion gap?

[Na+ +K+] - [HCO3 + Cl-]

How can endogenous insulin be measured?

Plasma C-peptide

Which antibodies are clinically tested for?

GAD | Anti-islet cells

At what blood glucose level is coma associated?

Less than 2mmol/L

What percent should someones HbA1c be?

Around 6.5% is 48mmol/L

What 3 things must be present to diagnose DKA?

High glucose presence of ketones Acidosis

What is involved in the management of DKA?

IV fluids Potassium Insulin

In what medical procedures should metformin be avoided?

Anything involving contrasts e.g. angiogram

What is hyperglycaemic hyperosmolar syndrome?

Hyperglycaemia but no ketones in blood

What can cause HHS?

Dehydration Diuretics/ steroids Poor glycaemic control

What may precipitate HHS?

Infection | Other illness- MI, stroke

Why are fluids added more slowly in HHS?

Higher risk of cerebral oedema

How is osmolality calculated?

2Na+ + glucose + urea

What is the reference value for osmolality?

275-295

What osmolality is diagnostic of HHS?

>320mosmol/kg

What must blood glucose be to diagnose HHS?

>30mmol/L

What should be given as treatment for HHS?

Saline with potassium

What HbA1c level should be obtained before an elective procedure?

less than 75mmol/L

What is the risk of fluid resuscitation of DKA in children?

Cerebral oedema

What is the target HbA1c in children?

less than 58mmol/L

What is cheriarthropathy?

Thickening of skin over joints

In DKA when should potassium be given?

When serum K falls below 5