Endocrine - Type 1 Diabetes

Question 1

What happens in type 1 diabetes?

Answer 1

Autoimmune destruction of beta cells in the islets of Langerhans causing insufficient insulin

Question 2

What viruses can trigger diabetes type 1?

Answer 2

Coxsackie B
Enterovirus

Question 3

What is the classic triad of diabetes type 1?

Answer 3

Polyuria
Polydipsia
Weight loss

Diabetic ketoacidosis

Question 4

What is the normal blood glucose concentration?

Answer 4

4.4-6.1mmol/L

Question 5

What is the function of insulin?

Answer 5

Causes cells to absorb glucose from the blood

Causes muscle and liver cells to absorb glucose and undergo glycogenesis

Question 6

Outline diabetic ketoacidosis

Answer 6

Ketogenesis occurs when there is insufficient glucose supply and glycogen stores are exhausted

Liver converts fatty acids to ketones, fat soluble so can cross the BBB

Normally kidneys buffer but eventually not enough bicarbonate for ketone acids so that the blood becomes acidotic

In diabetes there is extreme ketone production

Acetone smell to their breath

Question 7

What are some common reasons for DKA?

Answer 7

• Initial presentation of T1DM
• T1DM who is unwell with infection
• Not sticking to insulin regime

Question 8

Why do diabetics get dehydrated?

Answer 8

High glucose in blood which is excreted by kidneys

Glucose draws water causing increased urine production leading to dehydration

Dehydration causes polydipsia

Question 9

Why can you develop severe hypokalaemia when treatment of insulin starts?

Answer 9

Insulin normally drives potassium into cells

No insulin means that the kidneys balance blood potassium

Total body potassium is low

When treatment begins patients can develop severe hypokalaemia

Question 10

What signs does DKA present with?

Answer 10

• Ketosis
• Metabolic acidosis (with low bicarbonate)
• Potassium imbalance
• Dehydration
• Hyperglycaemia

Question 11

What symptoms does DKA present with?

Answer 11

Polyuria
Polydipsia
Acetone smell
Nausea and vomiting
Hypotension
Dehydration

Question 12

What criteria must be met to diagnose DKA?

Answer 12

Hyperglycaemia
Ketosis
Acidosis

Question 13

What are the most dangerous aspects of DKA?

Answer 13

Dehydration
Potassium imbalance
Acidosis

This will kill the patient first so must be treated first

Question 14

How is DKA managed?

Answer 14

FIGPICK
Fluids- IV resuscitation
Insulin
Glucose, closely monitor
Potassum- add potassium to IV fluids
Infection- treat any underlying
Chart fluid balance
Ketones-monitor blood pH

Question 15

Why is a central line used during treatment of a DKA?

Answer 15

Potassium infusion is given up to 20 mmol/hour rather than less than 10

Need to carefully monitor arrhythmia risk

Question 16

What are the key complications of treating DKA?

Answer 16

Hypoglycaemia
Hypokalaemia
Cerebral oedema (especially in kids)
Pulmonary oedema (secondary to fluid overload or ARDS)

Question 17

What are the autoantibodies in T1DM?

Answer 17

Anti-islet cell antibodies
Anti-GAD antibodies
Anti-insulin antibodies

Question 18

What is serum C-peptide used for?

Answer 18

Measure of insulin production

Low serum C= Low insulin and vive.

Question 19

How is T1DM managed long-term?

Answer 19

Subcutaneous insulin
Monitoring dietary carbohydrate
Monitoring blood sugar levels

Question 20

What is a basal-bolus regime?

Answer 20

Long-acting insulin injected once a day

+

Short-acting insulin 30 minutes before eating

Question 21

Why do patients need to change locations with insulin injections?

Answer 21

Lipodystrophy

Subcutaneous fat hardens and no longer properly absorbs insulin

Question 22

What are insulin pumps?

Answer 22

Small pump that continuously infuses insulin at different rates to control blood sugar

Pump uses a cannula which is replaced every 2-3 days

Better blood sugar control, more flexibility with eating and fewer injections

Difficult to use pump, having it attached at all times, infection and blockage risk

Question 23

What are the two types of insulin pumps?

Answer 23

Tethered
- Attached to waist

Patch pumps
- Sit directly on the skin
- When they run out patch pump replaced

Question 24

When is a pancreas transplant used?

Answer 24

Patients with severe hypoglycaemic episodes and those having kidney transplants

Old pancreas left for digestive enzyme production

Risks of transplantation e.g. immunosuppression

Islet transplantation can also be used too (insulin still needed)

Question 25

How is T1DM monitored?

Answer 25

HbA1c
Measures glycated haemoglobin
Reflects last 3 months of glucose levels RBC have lifespan of ~4 months

Capillary blood glucose
Immediate result of sugar levels

Flash glucose monitors
Sensory on skin that measures interstitial fluid in subcutaneous tissue
Measures in intervals

Question 26

What is a closed-loop system?

Answer 26

Continuous glucose monitor with an insulin pump

Adjusts insulin automatically

Question 27

What are the short-term complications to insulin?

Answer 27

Hypoglycaemia
Hyperglycaemia and DKA

Question 28

How is severe hypoglycaemia treated?

Answer 28

IV dextrose
IM glucagon

Question 29

What are the long-term complications of high glucose levels in the blood?

Answer 29

High glucose levels damage endothelial cells of blood vessels

Macrovascular
- Coronary artery disease
- Peripheral iscahemia (diabetic foot ulcers)
- Stroke
- Hypertension

Microvascular
- Peripheral neuropathy
- Retinopathy
- Kidney disease (glomerulosclerosis)

Infection-related
- UTI
- Pneumonia
- Skin and soft tissue infection
- Oral and vaginal candidiasis