Endocrine - Type 1 Diabetes Flashcards
What happens in type 1 diabetes?
Autoimmune destruction of beta cells in the islets of Langerhans causing insufficient insulin
What viruses can trigger diabetes type 1?
Coxsackie B
Enterovirus
What is the classic triad of diabetes type 1?
Polyuria
Polydipsia
Weight loss
Diabetic ketoacidosis
What is the normal blood glucose concentration?
4.4-6.1mmol/L
What is the function of insulin?
Causes cells to absorb glucose from the blood
Causes muscle and liver cells to absorb glucose and undergo glycogenesis
Outline diabetic ketoacidosis
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
What are some common reasons for DKA?
- Initial presentation of T1DM
- T1DM who is unwell with infection
- Not sticking to insulin regime
Why do diabetics get dehydrated?
High glucose in blood which is excreted by kidneys
Glucose draws water causing increased urine production leading to dehydration
Dehydration causes polydipsia
Why can you develop severe hypokalaemia when treatment of insulin starts?
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
What signs does DKA present with?
- Ketosis
- Metabolic acidosis (with low bicarbonate)
- Potassium imbalance
- Dehydration
- Hyperglycaemia
What symptoms does DKA present with?
Polyuria
Polydipsia
Acetone smell
Nausea and vomiting
Hypotension
Dehydration
What criteria must be met to diagnose DKA?
Hyperglycaemia
Ketosis
Acidosis
What are the most dangerous aspects of DKA?
Dehydration
Potassium imbalance
Acidosis
This will kill the patient first so must be treated first
How is DKA managed?
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
Why is a central line used during treatment of a DKA?
Potassium infusion is given up to 20 mmol/hour rather than less than 10
Need to carefully monitor arrhythmia risk
What are the key complications of treating DKA?
Hypoglycaemia
Hypokalaemia
Cerebral oedema (especially in kids)
Pulmonary oedema (secondary to fluid overload or ARDS)
What are the autoantibodies in T1DM?
Anti-islet cell antibodies
Anti-GAD antibodies
Anti-insulin antibodies
What is serum C-peptide used for?
Measure of insulin production
Low serum C= Low insulin and vive.
How is T1DM managed long-term?
Subcutaneous insulin
Monitoring dietary carbohydrate
Monitoring blood sugar levels
What is a basal-bolus regime?
Long-acting insulin injected once a day
+
Short-acting insulin 30 minutes before eating
Why do patients need to change locations with insulin injections?
Lipodystrophy
Subcutaneous fat hardens and no longer properly absorbs insulin
What are insulin pumps?
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
What are the two types of insulin pumps?
Tethered
- Attached to waist
Patch pumps
- Sit directly on the skin
- When they run out patch pump replaced
When is a pancreas transplant used?
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)
How is T1DM monitored?
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
What is a closed-loop system?
Continuous glucose monitor with an insulin pump
Adjusts insulin automatically
What are the short-term complications to insulin?
Hypoglycaemia
Hyperglycaemia and DKA
How is severe hypoglycaemia treated?
IV dextrose
IM glucagon
What are the long-term complications of high glucose levels in the blood?
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
