Endo - Type 1 Diabetes Flashcards
What viruses can cause T1DM?
Enterovirus
Coxsackie B virus
What is the normal range for glucose concentration?
4.4 - 6.1 mmol/l
What type of hormone is insulin?
Anabolic hormone
How does insulin lower blood sugar?
Causes cells to absorb glucose from blood
Leads to glycogenesis in muscles and liver
Where is insulin and glucagon produced?
Insulin- beta
Glucagon - alpha
What type of hormone is glucagon?
Catabolic, causes breakdown or glycogen into glucose
Why does ketogenesis occur?
Insufficient supply of glucose and glycogen stores exhausted
When does ketogenesis occur?
Prolonged fasting
T1DM
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
What is characteristic of people in ketosis?
Acetone smell to breath
How do children with T1DM present?
25-50 % with DKA
Remaining with classic triad of hyperglycaemia
- Polyuria
- Polydipsia
- Weight loss (mostly through dehydration)
What are some less typical T1DM presentations?
Secondary enuresis (bedwetting in previously dry child)
Recurrent infections
Symptoms present 1-6 weeks prior to DKA
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
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
Why must insulin injection spots be varied?
Can cause lipodystrophy
Subcutaneous fat hardens and insulin will not be absorbed as well
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
- Glomerulosclerosis
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
