T1DM Flashcards
Briefly describe ketogenesis
Ketogenesis occurs when there is insufficient glucose supply and glycogens stores are exhausted, such as in prolonged fasting.
The liver takes fatty acids and converts them to ketones. Ketones are water soluble fatty acids that can be used as fuel. They can cross the blood brain barrier and be used by the brain as fuel.
Briefly describe T1DM
The pancreas is unable to produce insulin.
Briefly describe how T1DM is managed
Subcutaneous insulin regimes
Monitoring dietary carbohydrate intake
Monitoring blood sugar levels on waking, at each meal and before bed
Monitoring for and managing complications, both short and long term
Briefly describe the most common insulin regime for T1DM
a combination of a background, long acting insulin given once a day and a short acting insulin injected 30 minutes before intake of carbohydrate
What are the short term complications of T2DM?
Hypoglycaemia
Hyperglycaemia (and DKA)
What are the 3 main problems in DKA?
Ketoacidosis
Dehydration
Hypokalaemia
Briefly describe how DKA leads to dehydration
Hyperglycaemia overwhelms the kidneys and glucose starts being filtered into the urine. The glucose in the urine draws water out with it in a process called osmotic diuresis.
This causes polyuria, -> severe dehydration -> polydipsia
Briefly describe how DKA leads to hypokalaemia and the consequences of this
Insulin normally drives potassium into cells. Without insulin potassium is not added to and stored in cells. Serum potassium can be high or normal as the kidneys continue to balance blood potassium with the potassium excreted in the urine, however total body potassium is low because no potassium is stored in the cells.
When treatment with insulin starts patients can develop severe hypokalaemia (low serum potassium) very quickly and this can lead to fatal arrhythmias.
What are the symptoms of DKA?
Polyuria Polydipsia Nausea and vomiting Acetone smell to their breath Kussmaul breathing Dehydration and subsequent hypotension Altered Consciousness
How can you diagnose DKA?
Hyperglycaemia (i.e. blood glucose > 11 mmol/l)
Ketosis (i.e. blood ketones > 3 mmol/l)
Acidosis (i.e. pH < 7.3)
Briefly describe how to treat DKA
FIG-PICK
F – Fluids – IV fluid resuscitation with normal saline
I – Insulin – Add an insulin infusion
G – Glucose – Closely monitor blood glucose and add a dextrose infusion if below a certain level (e.g. 14 mmol/l)
P – Potassium – Closely monitor serum potassium, 4 hourly and correct
I – Infection – Treat underlying triggers such as infection
C – Chart fluid balance
K – Ketones – Monitor blood ketones (or bicarbonate if ketone monitoring is unavailable)
What is the maximum rate of infusion of potassium?
10 mmol per hour.
What complication of insulin injections can occur? How can this be prevented?
Lipodystrophy- the subcutaneous fat hardens and patients do not absorb insulin properly from further injections into this spot.
Patients should cycle their injection sites.
What are the 3 main types of long term complications of diabetes?
Macrovascular
Microvascular
Infection-related
What macrovascular complications of diabetes are there?
Coronary artery disease is a major cause of death in diabetics
Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”
Stroke
Hypertension
