T1DM Flashcards
normal blood gluclose
4.4-6.1mmol/l
insulin is produced by
beta cells in islets of langerhans
when is insulin released
in response to raised blood glucose
how does insulin reduce blood glucose level
- causes cells to absorb Glc to use at fuel
- causes muscle and liver to absorb glucose and store it as glycogen
glucagon in produced by
alpha cells in islets of langerhans
glucagon released in response to
low blood glucose
how does glucagon raise blood glucose
glycogenolysis
gluconeogenesis
glycogenolysis
liver breaks down stored glycogen into glucose
gluconeogenesis
liver converts proteins and fats into glucose
ketogenesis
liver takes fatty acids and converts them to ketons
when does ketogenesis occur
insufficient glucose supply and glycogen stores exhausted
what are ketones
water soluble fatty acid that can be used as fuel
can cross BBB and be used as fuel by brain
pancreas in T1DM
pancreas stops being able to produce insulin
why does T1DM happen
genetic component
viral trigger e.g. Coxsackie B, enterovirus
what happens in T1DM
no insulin so cells cannot take up glucose
cells think body is fasted with no glucose, meanwhile Glc in blood rising = hyperglycaemia
main problems in DKA
ketoacidosis
dehydration
potassium imbalance
DKA - ketoacidosis
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
DKA - dehydration
hyperglycaemia overwhelms kidneys and Glc is filtered into urine
osmotic diuresis - Glc in urine pulls out water
results in dehydration
DKA - potassium imbalance
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
presentation of DKA
polyuria polydipsia n+v acetone smell to breath dehydration hypotension alt conscousness
diagnosing DKA
hyperglycaemia >11
ketosis >3
acidosis
DKA Mx
IV fluids insulin infusion dextrose infusion monitor K treat underlying trigger monitor ketones
DKA Mx - restarting patient on normal insulin regime
establish patient on their normal subcut insulin regime prior to stopping insulin and fluid infusion
potassium should not be infused at a rate of more than….
10mmol per hour
long term Mx T1DM
patient education
S/c insulin regime
monitor carb intake, BG and complications
usual insulin regime
long acting insulin once a day
or
short acting insulin 30min before meals
short term complications of diabetes
hypoglycaemia
hyperglycaemia + DKA
hypoglycaemia Mx
rapid acting Glc e.g. lucozade
+
slower acintg carb e.g. biscuit, toast
severe hypoglycaemai Mx
IV dextrose
IM glucagon
long term complications - macrovascular
coronary artery disease
peripheral ischaemia: ulcers
stroke
hypertension
long term complications - microvascular
peripheral neuropathy
ritinopathy
kidney disease esp glomerulosclerosis
long term complications - infection
UTI
pneumonia
skin and soft tissue esp feet
fungal esp thrush
monitoring
HbA1c
cap BG ]libre
