Endo - Type 1 Diabetes Flashcards by Nat Perris

What viruses can cause T1DM?

Enterovirus
Coxsackie B virus

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What is the normal range for glucose concentration?

4.4 - 6.1 mmol/l

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What type of hormone is insulin?

Anabolic hormone

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How does insulin lower blood sugar?

Causes cells to absorb glucose from blood

Leads to glycogenesis in muscles and liver

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Where is insulin and glucagon produced?

Insulin- beta
Glucagon - alpha

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What type of hormone is glucagon?

Catabolic, causes breakdown or glycogen into glucose

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Why does ketogenesis occur?

Insufficient supply of glucose and glycogen stores exhausted

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When does ketogenesis occur?

Prolonged fasting
T1DM

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How does ketogenesis occur?

Liver converts fatty acids to ketones

Ketones are water soluble fatty acids and can be used for fuel

Can cross the BBB and be used by brain

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What is characteristic of people in ketosis?

Acetone smell to breath

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How do children with T1DM present?

25-50 % with DKA

Remaining with classic triad of hyperglycaemia
- Polyuria
- Polydipsia
- Weight loss (mostly through dehydration)

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What are some less typical T1DM presentations?

Secondary enuresis (bedwetting in previously dry child)
Recurrent infections

Symptoms present 1-6 weeks prior to DKA

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What should be done when there is a new T1DM diagnosis?

Bloods to exclude other pathology and get a baseline of overall health

FBC
U&Es (for renal profile)
Formal glucose levels
Blood culture if there is fever
HbA1c - picture of blood sugar over last 3 months
TFTs and TPO for associated autoimmune thyroid disease
Anti-TTG
Insulin antibodies, anti-GAD and islet cell antibodies

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How is T1DM managed long-term?

Patient and family education
Subcut insulin regimes
Monitoring dietary carbohydrates
Monitoring blood sugar on waking, before meals and bed
Complication monitoring

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Why must insulin injection spots be varied?

Can cause lipodystrophy

Subcutaneous fat hardens and insulin will not be absorbed as well

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If a patient stops responding to insulin what should you examine for?

Lipodystrophy

Check their injection spots

What is a basal bolus insulin regime?

Basal
Long acting insulin to give constant background insulin during the day

Bolus
Injection of short acting insulin, usually 3 times a day before meals

Also injected according to number of carbohydrates every time patient has snack

What is an insulin pump?

Small device that continuously infuses insulin

Alternative to basal bolus regimes

How do insulin pumps inject insulin?

Pump pushes insulin through cannula

Cannula changed every 2-3 days and insertion sites rotated

How do patients qualify for an insulin pump?

Over 12
Difficulty controlling HbA1c

What are the pros and cons of insulin pumps?

Pros
Better blood sugar control
More flexibility with eating
Less injections

Cons
Difficulties learning to use pump
Attached at all times
Blockages in infusion set
Infection risk

What are the types of insulin pump?

Tethered
Devices with replaceable infusion sets and insulin
Attached to patients belt or around waist
Controls for infusion on pump itself

Patch
Sits directly on skin without tubes
When they run out of insulin entire patch is replaced
Controlled by a separate remote

What are the short term complications of insulin management?

Hypoglycaemia
Hyperglycaemia and DKA

What are the symptoms of hypoglycaemia?

Hunger
Tremor
Sweating
Irritability
Dizziness
Pallor

What can severe hypoglycaemia lead to?

Reduced consciousness Coma Death

How is hypoglycaemia treated initially?

Rapid acting glucose - lucozade Slower acting carbohydrates - biscuits or toast (to maintain blood sugar when rapid is used up)

How can severe hypoglycaemia treated?

IV dextrose IM glucagon

What are some other causes of hypoglycaemia?

Hypothyroidism Glycogen storage disorders GH deficiency Liver cirrhosis Alcohol and fatty acid oxidation defects (MCADD)

What is nocturnal hypoglycaemia?

Common complication Child can be sweaty overnight Morning glucose may be raised

How can nocturnal hypoglycaemia be diagnosed?

Continuous glucose monitoring

How is nocturnal hypoglycaemia managed?

Altering bolus insulin regimes Snacks at bedtime

If a patient is hyperglycaemic why do you need to wait between giving insulin doses?

Can take several hours to work Do not want to cause hypoglycaemia

What are the long-term complications of T1DM?

**Macrovascular** - **Coronary artery disease** - Peripheral ischaemia causing poor healing, ulcers and diabetic foot - Stroke - Hypertension **Microvascular** - Preipheral neuropathy - Retinopathy - Nephropathy - Glomerulo**sclerosis** **Infections** - UTIs - Pneumonia - Skin and soft tissue infections - Fungal infections

Why do you get more frequent infections in T1DM?

High serum sugar causes suppression of the immune system Creates optimal environment for infections

What fungal infections are more common in T1DM?

Oral and vaginal candidiasis

How is T1DM monitored?

**HbA1c** Every 3-6 months Shows glycated haemoglobin over the last 3 months as RBCs have a 3-4 month lifespan **Capillary Blood Glucose** Using a glucose meter **Flash glucose monitoring**

How does flash glucose monitoring work?

Sensor measures glucose in **interstitial fluid** in **subcutaneous tissue** **5 minute lag** behind blood glucose Sensors need replacing every 2 weeks

If hypoglycaemia is suspected in patients with flash monitoring why are capillary blood glucoses still done?

Due to 5 minute delay / lag time from flash monitoring