DMT1 Flashcards
How is diabetis Type 1 called that presents in later decancies of life (30,40years)?
latent autoimmune diabetes in adults (LADA)
Diabetic ketoacidosis is a feature of which type of diabetis?
How prevalent is T2DM?
About 6-7%
What are the causes of Type 1 DM?
Not known yet
- Environmental factors?
- Genetic factors?
- –> leading to a autoimmune destruction of the pancreatic ß-cells causing hyperglycaemia
What are the causes for T2DM?
Genetic factors
Environemnt –> obesity
leading to insulin resistance
How could you diagnose T1DM if you are not sure whicht type it is? ?
Autoimmune -anitibodies against ß.cells can be measured
–> leads to an complete destruction of antibodies
What increases your risk for T1DM?
It increases when you or your relatives have Autoimmune diseases –> also the other way around
Which type of genes can put you at risk for or protect you from developing T1DM?
HLA-DR genes on Chromosome 6
Which markes are used to diagnose T1DM?
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
What are the symptoms of someone with Diabetis?
- polyuria
- nocturia
- polydipsia
- blurring of vision
- ‘thrush’
- weight loss
- fatigue
What are the signs of someone with T1 Diabetis?
- dehydration
- cachexia
- hyperventilation
- smell of ketones
- glycosuria
- ketonuria
Which organs are important in glucose regulation?
Liver
Muscle
Adipose tissue
What are the aims of treating someone with T1DM today?
- To prevent them from dying
- To prevent metabolic decompensation
- Prevent long-term complications
- retinopathy
- nepropathy
- neuropathy
- vascular disease
–> via exogenous insulin
What is the diet you sould follow in T2DM?
- low fat
- low refined Carbohydrates
- high complex carbs
- increase soluble fibres
- spread meals (more small meals) over the day
Which drug types are used to treat T1DM?
Normally different forms of insulin:
- Short lasting (with every meal, as required)
- human insulin
- insulin analogue
- Long/intermediate lasting, baseline insulin
- insulin analogue bound to zinc or protamine
–> Tries to mimic natural levels
What are the names of clinically used insulin analogues?
Short acting :Lispro, Aspart, Glulisine
Long acting: Glargine, Determir, Degludec
What is an insulin pump?
How does it work?
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
What are the possibel treatments of T1DM?
- Insulin treatment
- oral/injections
- pump
- Islet cell transplant (rare and expensive)
- onyl in severe cases
- need to be on immunosupressant
How are glucose levels monitored in diabetis?
- 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)
*
What is the advantage and limitations of HbA1C measurements
- 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
What are the acute complication of T1DM?
- Metabolic Ketoacidosis:
- Hyperglycaemia
- severe metabolic acidosis
- Hypoglycaemia
- <3.6 mmol/l
- severe= when assistance is required
What are the problems of hypoglcaemia (acultely and long-term)?
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’
Who is at risk of hypoglycaemia?
- main risk factor is quality of glycaemic control
- in very tight control of levels
- more frequent in patients with low HbA1c
When does hypoglycaemia in T1DM usually occur?
can occur at anytime but often a clear pattern
- pre-lunch + pre-dinner hypos common
- nocturnal hypos very common and often not recognised
Why does hypoglycaemia normally occur?
- unaccustomed exercise
- missed meals –> diabetis skipping (for weightloss)
- inadequate snacks –> forget snacking
- alcohol
- inappropriate insulin regime (given too much, miscalculation)
What are the symptoms of hypoglycaemia?
increased Autonomic effects
- palpitations (tachycardia)
- tremor
- sweating
- pallor / cold extremities
- anxiety
CNS effects:
- drowsiness
- confusion
- altered behaviour
- focal neurology
- coma
How do you treat hypoglycaemia?
- Oral– food
- Dextrose
- complex carbs
- If not able to swallow
- IV glucose
- IM glucagon (might not work when long previous fasting)
