Lecture 4 - Type 1 Diabetes

Question 1

What is diabetes?

Answer 1

Autoimmune disease of the beta cells of the pancreas
Total lack of endogenous insulin
Not caused by eating too much sugar, being overweight, lack of exercise !

Question 2

How is type 1 diabetes treated?

Answer 2

Insulin

Question 3

When is insulin released?

Answer 3

50% of the total daily insulin is secreted during basal periods
in response to a meal, there is a large, rapid release of performed stored insulin

Question 4

What does insulin release promote?

Answer 4

Peripheral utilisation of glucose
Suppresses hepatic glucose production
Limits postprandial glucose elevation

Question 5

Describe the phases of release

Answer 5

1st phase within 2 minutes of food indigestion and continues for 10-15 mins
2nd phase follows and is sustained until normoglycemia is restored

Question 6

Describe the current NICE guidelines

Answer 6

Initiation of a basal bolus regimen with twice daily Levemir (long-acting analogue) and an injection of a rapid-acting analogue with each meal

Question 7

How is insulin delivered?

Answer 7

Vials, 3ml cartridge, pre-filled pen, insulin pump

Question 8

What is the target HbA1c?

Answer 8

<48 mmol/mol

Question 9

What is the target cholesterol?

Answer 9

< 4mmol/L

Question 10

What is the target BP?

Answer 10

<140/80

Question 11

What are the complications with diabetes?

Answer 11

Diabetic ketoacidosis (extreme hyperglycaemia)
CVD and stroke
Retinopathy and blindness
Kidney Disease
Neuropathy and amputations

Question 12

Define hypoglycaemia

Answer 12

glucose too low

Question 13

Define hyperglycaemia

Answer 13

glucose too high
above 7 mmol/l before a meal and above 8.5 mmol/l two hours after a meal

Question 14

Define the symptoms of hypos

Answer 14

feeling shaky, sweating, hunger, drowsiness, tiredness, blurred vision, lack of concentration, headaches, feeling tearful or moody, going pale

Question 15

Treatment of a hypo

Answer 15

15g-20g of fast-acting carb - sugary drinks, glucose tablets, sweets, pure fruit juice, glucose gel
followed by a snack of 15-20g of a slower-acting carbohydrate
Blood levels should be retested after 15-20 mins and retreated if levels are still <4 mmol/mol

Question 16

What causes hyperglycaemia?

Answer 16

missed dose of medication
eaten more carbs than body can cope with
stress
infection
over treating a hypo

Question 17

Define diabetic ketoacidosis

Answer 17

Consistently high blood glucose levels
Severe lack of insulin - body cannot use glucose for energy and uses fat as an alternative energy source
Ketones is the by product of this process and can build up and cause the body to become acidic
Is life threatening and requires hospital admission for IV insulin and fluids