T1 L16 :L16 (Theme 1): Type 1 diabetes Mellitus Flashcards
what is the epidemiology ofT1+2 diabetes
in the UK 6.7%
what is the prevalence of T1 diabetes
0.5%
peak onset at adolescence
genetic predisposition
0.5% background risk 1-2% if mother affected 3-6% if father has affected 6% if sibling has affected 36% if monozygotic twin affected
Associated with HLA antigens
pathophysiology
- 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
schematic evolution of T1 diabetes
Genetic predisposition
Insulitis
Pre-diabetes
Diabetes
what are the auto-immune triggers
- Viral infection (Coxsackie)
- ER stress
- Cytokines
associations with T1 diabetes
- Coeliac disease
- Hypothyroidism
- Grave’s disease
- Addison’s disease
- Hypogonadism
- Pernicious anaemia
- Vitiligo
- Autoimmune polyglandular syndromes
what are the symptoms of T1 diabetes
- Lethargy
- Polyuria
- Polydipsia
- Blurred Vision
- Candida infections
- Weight Loss
- Ketosis/ - Ketoacidosis
- Death
how to diagnose T1 diabetes
- Age of onset
- Rapidity of onset
- Phenotype
- C-peptide
- Ketosis
- weight loss
what is C-peptide
By product of the breakdown of Pro-insulin into insulin and C-peptide
Produced in 1:1 molar ratio with insulin
Need adequate stimulus for secretion
How ca insulin be given
Peptide hormone needs to be given parenterally
Subcutaneously
Inhaled
Mucous membranes
where are the subcutaneous injection sites
Lower abdomen
Upper outer arms
Upper outer thighs
Buttocks
what is the typical insulin regimen
-Basal Bolus regimen
- -rapid acting insulin pre-meal bolus
- -long acting background insulin- basal
what does the rapid acting insulin reflect
the CHO intake
what factors affect blood glucose
Diet Injection site Temperature Exercise Illness Stress Alcohol Menstrual cycle
