T1DM

Question 1

normal blood gluclose

Answer 1

4.4-6.1mmol/l

Question 2

insulin is produced by

Answer 2

beta cells in islets of langerhans

Question 3

when is insulin released

Answer 3

in response to raised blood glucose

Question 4

how does insulin reduce blood glucose level

Answer 4

• causes cells to absorb Glc to use at fuel

- causes muscle and liver to absorb glucose and store it as glycogen

Question 5

glucagon in produced by

Answer 5

alpha cells in islets of langerhans

Question 6

glucagon released in response to

Answer 6

low blood glucose

Question 7

how does glucagon raise blood glucose

Answer 7

glycogenolysis

gluconeogenesis

Question 8

glycogenolysis

Answer 8

liver breaks down stored glycogen into glucose

Question 9

gluconeogenesis

Answer 9

liver converts proteins and fats into glucose

Question 10

ketogenesis

Answer 10

liver takes fatty acids and converts them to ketons

Question 11

when does ketogenesis occur

Answer 11

insufficient glucose supply and glycogen stores exhausted

Question 12

what are ketones

Answer 12

water soluble fatty acid that can be used as fuel

can cross BBB and be used as fuel by brain

Question 13

pancreas in T1DM

Answer 13

pancreas stops being able to produce insulin

Question 14

why does T1DM happen

Answer 14

genetic component

viral trigger e.g. Coxsackie B, enterovirus

Question 15

what happens in T1DM

Answer 15

no insulin so cells cannot take up glucose

cells think body is fasted with no glucose, meanwhile Glc in blood rising = hyperglycaemia

Question 16

main problems in DKA

Answer 16

ketoacidosis
dehydration
potassium imbalance

Question 17

DKA - ketoacidosis

Answer 17

cells have no fuel –> initiate ketogenesis

ketone and glucose levels rise

kidneys unable to keep up, ketone acids use up all the bicarbonate

blood becomes acidotic

Question 18

DKA - dehydration

Answer 18

hyperglycaemia overwhelms kidneys and Glc is filtered into urine

osmotic diuresis - Glc in urine pulls out water

results in dehydration

Question 19

DKA - potassium imbalance

Answer 19

insulin drives K into cells, w/o it K is not stored in cells

serum potsssium normal as kidneys excrete K in urine but total body K low as none stored in cells

when treatment with insulin initiates, hypokalaemia can occur which can lead to arrythmia

Question 20

presentation of DKA

Answer 20

polyuria 
polydipsia
n+v
acetone smell to breath
dehydration 
hypotension 
alt conscousness

Question 21

diagnosing DKA

Answer 21

hyperglycaemia >11
ketosis >3
acidosis

Question 22

DKA Mx

Answer 22

IV fluids 
insulin infusion 
dextrose infusion 
monitor K 
treat underlying trigger
monitor ketones

Question 23

DKA Mx - restarting patient on normal insulin regime

Answer 23

establish patient on their normal subcut insulin regime prior to stopping insulin and fluid infusion

Question 24

potassium should not be infused at a rate of more than….

Answer 24

10mmol per hour

Question 25

long term Mx T1DM

Answer 25

patient education
S/c insulin regime
monitor carb intake, BG and complications

Question 26

usual insulin regime

Answer 26

long acting insulin once a day
or
short acting insulin 30min before meals

Question 27

short term complications of diabetes

Answer 27

hypoglycaemia

hyperglycaemia + DKA

Question 28

hypoglycaemia Mx

Answer 28

rapid acting Glc e.g. lucozade
+
slower acintg carb e.g. biscuit, toast

Question 29

severe hypoglycaemai Mx

Answer 29

IV dextrose

IM glucagon

Question 30

long term complications - macrovascular

Answer 30

coronary artery disease
peripheral ischaemia: ulcers
stroke
hypertension

Question 31

long term complications - microvascular

Answer 31

peripheral neuropathy
ritinopathy
kidney disease esp glomerulosclerosis

Question 32

long term complications - infection

Answer 32

UTI
pneumonia
skin and soft tissue esp feet
fungal esp thrush

Question 33

monitoring

Answer 33

HbA1c

cap BG ]libre