Introduction to Case Flashcards
What are the complications of type 1 diabetes
- leading cause of heart disease
- most common cause of blindness, renal failure, ulceration and amputation
where does type 1 diabetes occur
in the pancreas
- pancreas detects changes in blood glucose
name the cells within the pancreas
- alpha-cells
- insulin producing B cells
what are a-cells in the pancreas
red cells surrounding islets which mobilise glucose
what are insulin producing b cells
respond to changes in blood glucose and secrete insulin
what cells are damaged in type 1 diabetes
insulin producing B cells
what is meant by hypoglycaemia
low blood glucose
what is meant by hyperglycaemia
high blood glucose
describe the islets found in type 1 diabetes
no insulin producing cells
- B cells failure
- leaving patients dependent on insulin injections
describe the islets found in type 2 diabetes
slower but eventual B cell failure
what is type 1 diabetes known as
insulin dependent diabetes mellitus
describe the onset of type 1 diabetes
early/juvenile onset
5-10% of diabetes is type 1
how does type 1 diabetes occur
autoimmune destruction of B cells
what can be used to test blood glucose
finger prick monitoring testing 10-15 times a day
- to keep blood glucose under control
what are insulin pumps
automated system to deliver insulin
- cannula with a small needle given in the abdomen
outline the symptoms of type 1 diabetes
- unexplained weight loss- as glucose is not being used for energy
- polydipsia (increased thirst)- as body is trying to get rid of excess blood glucose
- polyuria (frequent urination)
- polyphagia (increased hunger)- without insulin, unaware that you have high glucose level
- blurred vision (one or both eyes)- due to changes in osmotic pressure in the eye
- dizziness, due to dehydration/low blood pressure
- fatigue- can’t process glucose
- genital itching, bacterial infections or yeast infections
- slow wound healing/infections- due to nerve damage
name the diagnostic tests used for type 1 diabetes
- a random plasma glucose test
- fasting plasma glucose tolerance test
- oral glucose tolerance tests
- HbA1c
how is a random plasma glucose test used as a diagnostic test for type 1 diabetes
- blood is drawn and tested for the level of glucose in the blood
- random plasma glucose concentration of >11.1mmol/l
how is a fasting plasma glucose tolerance test used as a diagnostic test for type 1 diabetes
- no food/drink 8-12 hours prior to test
- blood is drawn and tested for level of glucose in blood
- fasting plasma glucose concentration of >7mmol/l
how are oral glucose tolerance tests used as a diagnostic test for type 1 diabetes
- no food/drink 8-12 hours prior to test
- drink 75g of glucose (lucozade)
- blood is tested 2 hours later
- plasma glucose concentration of >11.1mmol/l, 2 hours after test
what is HbA1c used for
used as a diagnostic test and management tool
what is HbA1c
glycosylated haemoglobin
what is HbA1c level like in patients with type 1 diabetes
high HbA1C
how can HbA1C be used as a management tool
- tells us how controlled blood glucose is over last 3 months
- looking to see if HbA1C decreases after starting treatment regime
what is the target range of HbA1C
6% or 42mmol/mol
describe the self care problems in type 1 diabetes
- optimal glycaemic control is very hard to achieve
- complex to manage- all patients offered a structured education programme (SEP)
- adolescents become increasingly independent as part of normal development
- managing transition from paediatric care to adult care
what is meant by transition in type 1 diabetes
refers to the movement of an adolescent from paediatric to adult diabetes care services
what is the difference between paediatric and adult services
paediatric care is holistic and family centred, adult services are more disease focussed
why might it be difficult to transition from paediatric to adult services
- parents can feel left out or that they are losing control
- young person can feel anonymous and not important to new care team
how does the NHS ensure good transitional care
paediatric NHS diabetes services are commissioned under a Best practice tariff for every young patient up to age 19
what is the best practice tariff
- sets out high standards of care and providers will be paid only when they prove their service meets required standards
- includes requirements for a transitional care policy, where young people will be gradually handed over to adult services in an individualised, collaborative way
what are some aspects of managing good transition
- care team needs to be flexible
- provide individualised care, only hand over when the young person has self care autonomy
- involve family members/carers
- both paediatric and adult teams should overlap
- work through as a process, transition is not a one off event
