pathophysiology and treatment of type 1 diabetes Flashcards
what is T1D called that presents later in life?
latent autoimmune diabetes in adults (LADA)
T1D is an autoimmune condition- why is this important?
Increased prevalence of other autoimmune disease
Risk of autoimmunity in relatives
More complete destruction of B-cells
Auto antibodies can be useful clinically
Immune modulation offers the possibility of novel treatments
what are the markers for T1D?
Islet cell antibodies (ICA)- grp O human pancreas
Insulin antibodies (IAA)
Glutamic acid decarboxylase (GADA) – widespread nuerotransmitter
Insulinoma-associated-2 autoantibodies (IA-2A)-receptor like family
symptoms for T1D
polyuria nocturia polydipsia blurring of vision ‘thrush’ weight loss fatigue
Signs for T1D
dehydration cachexia hyperventilation smell of ketones glycosuria ketonuria
aims of treatment in type 1 diabetes
Reduce early mortality
Avoid acute metabolic decompensation
Type 1 diabetics need exogenous insulin to preserve lifeKetones define insulin deficiency
what long term complications arise from T1D?
- retinopathy
- nephropathy
- neuropathy
- vascular disease
what diet should be aimed in T1D?
reduce calories as fat
reduce calories as refined carbohydrate
increase calories as complex carbohydrate
increase soluble fibre
balanced distribution of food over course of day with regular meals and snacks
what is the insulin like with meals?
Short acting
Human insulin
Insulin analogue (Lispro, Aspart, Glulisine)
what is the background insulin given like?
Long acting
Non-c bound to zinc or protamine
Insulin analogue (Glargine, Determir, Degludec)
what does the insulin pump do?
Continuous insulin delivery
Preprogrammed basal rates and bolus for meals
Does NOT measure glucose, no completion of feedback loop
other methods of treating insulin deficiency
islet cell transplants
how do we know the treatment is successful?
capillary monitoring
how can HbA1c be used for glycaemic control?
low HbA1c = less sugar
HbA1c red cells react with glucose, as it does with all proteins. Irreversible, non-covalent depends on;
Lifespan of red cell, about 120 days
Rate of glycation, faster in some individuals
Hb opathy, renal failure etc
Forms ideal measure of long term glycaemic control and has been shown to be related to risk of complications.
Furthermore lowering HbA1c associated lower risk of complication particularly microvascular complication
what are some acute complications in T1D?
hyperglycaemia
reduced tissue glucose utilisation, increased hepatic glucose production
metabolic acidosis
circulating acetoacetate & hydroxybutyrate
osmotic dehydration and poor tissue perfusion
