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Year 2 LCRS Endocrinology > DMT1 > Flashcards

DMT1 Flashcards

1
Q

How is diabetis Type 1 called that presents in later decancies of life (30,40years)?

A

latent autoimmune diabetes in adults (LADA)

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2
Q

Diabetic ketoacidosis is a feature of which type of diabetis?

A
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3
Q

How prevalent is T2DM?

A

About 6-7%

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4
Q

What are the causes of Type 1 DM?

A

Not known yet

  • Environmental factors?
  • Genetic factors?
    • –> leading to a autoimmune destruction of the pancreatic ß-cells causing hyperglycaemia
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5
Q

What are the causes for T2DM?

A

Genetic factors

Environemnt –> obesity

leading to insulin resistance

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6
Q

How could you diagnose T1DM if you are not sure whicht type it is? ?

A

Autoimmune -anitibodies against ß.cells can be measured

–> leads to an complete destruction of antibodies

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7
Q

What increases your risk for T1DM?

A

It increases when you or your relatives have Autoimmune diseases –> also the other way around

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8
Q

Which type of genes can put you at risk for or protect you from developing T1DM?

A

HLA-DR genes on Chromosome 6

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9
Q

Which markes are used to diagnose T1DM?

A

Different antibodies e.g.

  • Islet cell antibodies (ICA)- grp O human pancreas
  • Insulin antibodies (IAA)
  • Ab against Glutamic acid decarboxylase (GADA) – widespread nuerotransmitter
  • Insulinoma-associated-2 autoantibodies (IA-2A)-receptor like family
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10
Q

What are the symptoms of someone with Diabetis?

A
  • polyuria
  • nocturia
  • polydipsia
  • blurring of vision
  • ‘thrush’
  • weight loss
  • fatigue
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11
Q

What are the signs of someone with T1 Diabetis?

A
  • dehydration
  • cachexia
  • hyperventilation
  • smell of ketones
  • glycosuria
  • ketonuria
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12
Q

Which organs are important in glucose regulation?

A

Liver

Muscle

Adipose tissue

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13
Q

What are the aims of treating someone with T1DM today?

A
  1. To prevent them from dying
  2. To prevent metabolic decompensation
  3. Prevent long-term complications
    • retinopathy
    • nepropathy
    • neuropathy
    • vascular disease

–> via exogenous insulin

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14
Q

What is the diet you sould follow in T2DM?

A
  • low fat
  • low refined Carbohydrates
  • high complex carbs
  • increase soluble fibres
  • spread meals (more small meals) over the day
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15
Q

Which drug types are used to treat T1DM?

A

Normally different forms of insulin:

  1. Short lasting (with every meal, as required)
    • human insulin
    • insulin analogue
  2. Long/intermediate lasting, baseline insulin
    • insulin analogue bound to zinc or protamine

–> Tries to mimic natural levels

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16
Q

What are the names of clinically used insulin analogues?

A

Short acting :Lispro, Aspart, Glulisine

Long acting: Glargine, Determir, Degludec

17
Q

What is an insulin pump?

How does it work?

A

It is a pump that constantly gives Insulin into bloodstream and can also programm bolus wiht food intake

–> Does not measure blood glucose–> no feedback but easier control

18
Q

What are the possibel treatments of T1DM?

A
  1. Insulin treatment
    • oral/injections
    • pump
  2. Islet cell transplant (rare and expensive)
    • onyl in severe cases
    • need to be on immunosupressant
19
Q

How are glucose levels monitored in diabetis?

A
  • Via Caplillary glucose (trens is good, not as acurate as venous)
  • CGM –> continous glucose measuring –> real time reading (can sent of alarm)
  • HbA1c –> long time glucoginated Hb (from last 120 days, livespan of Erythrocytes)
    *
20
Q

What is the advantage and limitations of HbA1C measurements

A
  • Dependant on Erythrocyte lifespan
    • can be less acurate in renal failure
    • or thalassaemia
    • or anaemia = overestimation of HbA1c (more sugar but less cells to bind to)
  • Otherwise can give a good indication of long-term glucose levels and long-term risks
21
Q

What are the acute complication of T1DM?

A
  1. Metabolic Ketoacidosis:
    • Hyperglycaemia
    • severe metabolic acidosis
  2. Hypoglycaemia
    • <3.6 mmol/l
    • severe= when assistance is required
22
Q

What are the problems of hypoglcaemia (acultely and long-term)?

A

Acute

  • most mental processes impaired at <3 mmol/l
  • •consciousness impaired at <2 mmol/l
  • •severe hypoglycaemia may contribute to arrhythmia and sudden death

Long-term

  • •may have long-term effects on the brain
  • •recurrent hypos result in loss of warnings
    • ‘hypoglycaemia unawareness’
23
Q

Who is at risk of hypoglycaemia?

A
  • main risk factor is quality of glycaemic control
    • in very tight control of levels
  • more frequent in patients with low HbA1c
24
Q

When does hypoglycaemia in T1DM usually occur?

A

can occur at anytime but often a clear pattern

    • pre-lunch + pre-dinner hypos common
    • nocturnal hypos very common and often not recognised
25
Q

Why does hypoglycaemia normally occur?

A
  • unaccustomed exercise
  • missed meals –> diabetis skipping (for weightloss)
  • inadequate snacks –> forget snacking
  • alcohol
  • inappropriate insulin regime (given too much, miscalculation)
26
Q

What are the symptoms of hypoglycaemia?

A

increased Autonomic effects

  • palpitations (tachycardia)
  • tremor
  • sweating
  • pallor / cold extremities
  • anxiety

CNS effects:

  • drowsiness
  • confusion
  • altered behaviour
  • focal neurology
  • coma
27
Q

How do you treat hypoglycaemia?

A
  1. Oral– food
    • Dextrose
    • complex carbs
  2. If not able to swallow
    • IV glucose
    • IM glucagon (might not work when long previous fasting)

Year 2 LCRS Endocrinology (15 decks)

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