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Year 2 Collin > Endo 15 - T1DM > Flashcards

Endo 15 - T1DM Flashcards

1
Q

Describe the ambiguity between T1DM and T2DM

A
  1. Autoimmune T1DM may present later in life - Latent Autoimmune Diabetes in Adults (LADA)
  2. T2DM may present in childhood
  3. Diabetic ketoacidosis is a feature of T2DM but, more common in T1DM
  4. Monogenic diabetes (strong family history) may present phenotypically as T1DM or T2DM
  5. Diabetes may present following pancreatic damage or other endocrine diseases
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2
Q

Describe T1DM based on aetiology

A

Environmental trigger + genetics causes autoimmune destruction of islet cells –> causes insulin deficiency —> causes hyperglycaemia

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3
Q

Describe T2DM based on aetiology

A

Genetics (stronger influence) + obesity —> insulin resistance —> Beta-cell failure –> hyperglycaemia

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4
Q

Why is the immune basis of T1DM important

A
  1. Increased prevalence of other autoimmune diseases - pernicious anaemia, hyperthyroidism, etc
  2. Risk of autoimmunity in relatives
  3. More complete destruction of beta cells
  4. Autoantibodies can be useful clinically
  5. Immune modulation offers possibility of novel treatments
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5
Q

HLA is located on Cr 6 - which HLA-DRA alleles confer a significant risk for T1DM

A

DR3 and DR4

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6
Q

What markers / antibodies can be measured to affirm whether it is T1DM/T2DM?

A

Most commonly - ICA and GADA antibodies

can also look for IA-2A and insulin antibodies

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7
Q

What are the signs and symptoms of T1DM

A

Symptoms:

  1. Polyuria
  2. Nocturia
  3. Polydipsia
  4. Blurring of vision
  5. Thrush
  6. Weight loss
  7. Fatigue

Signs:

  1. Dehydration
  2. Cachexia
  3. Hyperventilation
  4. Smell of ketones
  5. Glycosuria
  6. Ketonuria
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8
Q

2 things that insulin does?

What does insulin deficiency therefore do?

A
  1. Reduces hepatic glucose output
  2. Increases uptake by muscle cells

Insulin deficiency causes fatty acids to be released by adipocytes –> which are used to produce ketone bodies –> which are detectable in blood/urine

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9
Q

What is a very good way to determine if someone is insulin deficient

A

Ketones

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10
Q

What long term complications may arise from T1DM

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
  4. Vascular disease
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11
Q

How is diet used to treat T1DM

A
  1. Less calories as fat
  2. Less calories as refined carbs
  3. More calories as complex carbs
  4. More soluble fibre

Balanced distribution of food over the day

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12
Q

How do we avoid acute metabolic decompensation in T1DM?

A

Giving exogenous insulin

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13
Q

What are the 2 types of insulin treatment

A
  1. With meals - short acting. human insulin, insulin analogue given (Lispro, etc)
  2. Background - long acting - non-C bound to zinc or protamine - insulin analogy (Glargine)
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14
Q

Explain how/when an insulin pump is used

A

Given in severe diabetes - uncontrolled T1DM or severe hyper

Continuous delivery with preprogrammed basal rate and bolus for meals

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15
Q

When are islet cell transplants given

A

In very severe hypers

Donor beta cells extracted and injected into liver - distributed around body via portal system –> requires major immunosuppression

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16
Q

What are 2 ways to determine if T1DM treatment is successful?

A
  1. Capillary glucose monitoring - measured 2 hours before and after food
  2. Continuous glucose monitor in real time
17
Q

How can HbA1c be used for long term glucose monitoring?

A

Measure glucose levels over 3 months (RBC lifespan = 120 days)

RBCs bind glucose –> irreversible, non-covalent binding - it is affected by RBC lifespan and rate of glycation

Higher HbA1c = higher plasma glucose

Lowering HbA1c = less complications, particularly microvascular complications

18
Q

When may HbA1c not be useful?

A

If they have a haemoglobinopathy, or renal failure, etc

19
Q

Diabetic ketoacidosis is more common in T1DM. It is caused by rapid decompensation of T1DM. What can it cause

A
  1. Hyperglycaemia - due to reduced tissue glucose utilisation and increased hepatic glucose production
  2. The metabolic acidosis is worsened by circulating ketone bodies, osmotic dehydration and poor tissue perfusion
20
Q

Hypoglycaemia may occur in diabetes. Define it

A

Hypoglycaemia = plasma glucose of < 3.6 mmol/l

Severe hypoglycaemia = any hypo requiring help of another person to treat

21
Q

What may severe hypoglycaemia cause

A

Mental processes impaired at <3mmol/l

Consciousness impaired at <2mmol/l

Severe hypoglycaemia - may contribute to arrhythmia and sudden death

Recurrent hypos - result in loss of warnings

22
Q

What is the main risk factor for hypoglycaemia

A

Main RF = quality of glycaemic control – more frequent in patients with low HbA1c

23
Q

When do hypoglycaemic episodes occur

A

Anytime but pre-lunch is common. Nocturnal hypos also very common and not recognised

24
Q

Why might one get a hypoglycaemic episode

A
  1. Unaccustomed exercise
  2. Missed meals
  3. Inadequate snacks
  4. Alcohol
  5. Inappropriate insulin regime
25
Q

What are the signs and symptoms of hypoglycaemia

A

Due to increased autonomic activation - palpitations, tremor, sweating, anxiety

Due to impaired CNS function - drowsiness, confusion, altered behaviour, coma

26
Q

How can hypoglycaemia be treated

A

oral - feed patient (initially simple carbs, then complex)

parenteral (if impaired consciousness) - IV dextrose, glucagon

Year 2 Collin (114 decks)

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