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203 - Theme 1 - The Endocrine System > L16 - Type 1 Diabetes mellitus > Flashcards

L16 - Type 1 Diabetes mellitus Flashcards

1
Q

Prevalence of diabetes in UK (adults > 16yrs)

A

UK - 2009 5.1%

UK - 2016/7 6.7%

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2
Q

Epidemiology

A

Prevalence 0.5%

Peak onset at adolescence 6/12 to 80

M=F

White caucasian

Seasonal variability

More prevalent Northern latitudes

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3
Q

Type 1 Registrations - characteristics

A

There is a higher proportion of males in those with T1DM

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4
Q

Type 2 and other registrations - characteristics

A

There is a higher proportion of males in those with T2DM

People with T2DM are older than those with T1DM

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5
Q

Genetic predisposition

A

0.5% background risk

1-2% if mother affected

3-6% if father affected

6% if sibling affected

36% if monozygotic twin affected

Association with HLA antigens:

  • HLA DR3-DQ2 and DR4-DQ8 predispose
  • 90% of Scandinavians with type 1 diabetes positive for 1 or both
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6
Q

GRS2 discrimination between T1DM and T2DM

A
  1. 8% t2DM
  2. 7% T1DM

Similar distribution of T1DM GRS2 scores in the background population and in those with T2DM

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7
Q

Pathophysiology of T1DM

A

Beta-cell events trigger autoimmune response

Antibodies to insulin or GAD generally appear first

Other beta-cell antibodies follow:
-IA2, Zn2+ transporter 8

Selective immune beta-cell destruction

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8
Q

Trend of number of antibodies in normal patients

A

Decrease in number of islet antibodies

?

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9
Q

Autoimmune destruction in T1DM is called

A

insulitis

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10
Q

Schematic evolution of T1DM

A

Genetic predisposition

=>environmental trigger

Insulitis

Pre diabetes

Diabetes

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11
Q

Autoimmune trigger?

A

Viral infection

ER stress

Cytokines

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12
Q

Associations with T1DM

A

Coeliac disease

Hypothyroidism

Grave’s disease

Addison’s disease

Hypogonadism

Pernicious anaemia

Vitiligo

Autoimmune polyglandular syndromes

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13
Q

Symptoms of T1DM

A

Lethargy

Polyuria

Polydipsia

Blurred vision

Candida infections

Weight loss

Ketosis/ketoacidosis

Death

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14
Q

Diagnosis of T1DM

A

Age of onset

Rapidity of onset

Phenotype

PMH

FH

Weight loss

Ketosis

GAD/IA2/Zinc transporter 8 antibody positive

C-peptide

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15
Q

C-peptide

A

Produced in 1:1 molar ratio with insulin

Need adequate stimulus for secretion

C-peptide cleaved away from Proinsulin leaving insulin there

C-peptide tells you how much insulin someone is making

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16
Q

Insulin

A

Necessary for survival

Peptide hormone needs to be given parenterally

  • subcutaneously
  • inhaled
  • mucous membranes

Various types

  • primary structure (animal, human, analogue)
  • duration of action (addition of protamine, altered solubility, fatty acid chain)
  • strength: (100, 200, 300, 500 units/ml)
17
Q

What are ketone bodies?

A

If you can’t use glucose because you have no insulin, you start breaking down fat/protein etc

Ketone products are the dirty by-products

18
Q

Injection sited of insulin

A

Upper outer arms

Lower abdomen

Buttocks

Upper outer thighs

19
Q

Physiological insulin secretion

A

Insulin secreted before every meal

Also a basal level of insulin at night

20
Q

Typical insulin regimen

A

Basal bolus regimen

  • rapid acting insulin pre-meal (bolus)
  • long-acting background insulin (basal)

Balanced regimen

Rapid acting insulin reflects CHO intake

21
Q

Factors affecting blood glucose

A

Diet

Injection site

Temperature

Exercise

Illness

Stress

Alcohol

Menstrual cycle

22
Q

Hypoglycaemia

A

Autonomic symptoms
-palpitation, sweating, tremor

Neuroglycopaenic symptoms
-confusion

Mild and severe

Mild hypoglycaemia inevitable with good control

Loss of warning signs

23
Q

Transplantation

A

Pancreas
-almost always SPK or PAK

Islet cell

  • edmonton protocol
  • UK islet cell programme
24
Q

Monitoring T1DM

A

Glucose monitoring

  • minimum 4xdaily
  • driving
  • unwell
  • hypoglycaemia

CGMS - continous glucose monitoring system

25
Q

CGMS - Libre

A

Available on the NHS in certain circumstances

26
Q

Ketone monitoring

A

Urine (acetoacetate)

Blood (beta-hydroxybutyrate)

27
Q

Monitoring (clinician)

A

HbA1c (glycated haemoglobin)

  • reflects glucose over last 3 months
  • weighted towards last 6 weeks
  • affected by red cell lifespan

203 - Theme 1 - The Endocrine System (11 decks)

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