T1DM Flashcards

1
Q

normal blood gluclose

A

4.4-6.1mmol/l

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2
Q

insulin is produced by

A

beta cells in islets of langerhans

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3
Q

when is insulin released

A

in response to raised blood glucose

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4
Q

how does insulin reduce blood glucose level

A
  • causes cells to absorb Glc to use at fuel

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

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5
Q

glucagon in produced by

A

alpha cells in islets of langerhans

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6
Q

glucagon released in response to

A

low blood glucose

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7
Q

how does glucagon raise blood glucose

A

glycogenolysis

gluconeogenesis

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8
Q

glycogenolysis

A

liver breaks down stored glycogen into glucose

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9
Q

gluconeogenesis

A

liver converts proteins and fats into glucose

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10
Q

ketogenesis

A

liver takes fatty acids and converts them to ketons

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11
Q

when does ketogenesis occur

A

insufficient glucose supply and glycogen stores exhausted

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12
Q

what are ketones

A

water soluble fatty acid that can be used as fuel

can cross BBB and be used as fuel by brain

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13
Q

pancreas in T1DM

A

pancreas stops being able to produce insulin

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14
Q

why does T1DM happen

A

genetic component

viral trigger e.g. Coxsackie B, enterovirus

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15
Q

what happens in T1DM

A

no insulin so cells cannot take up glucose

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

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16
Q

main problems in DKA

A

ketoacidosis
dehydration
potassium imbalance

17
Q

DKA - ketoacidosis

A

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

18
Q

DKA - dehydration

A

hyperglycaemia overwhelms kidneys and Glc is filtered into urine

osmotic diuresis - Glc in urine pulls out water

results in dehydration

19
Q

DKA - potassium imbalance

A

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

20
Q

presentation of DKA

A
polyuria 
polydipsia
n+v
acetone smell to breath
dehydration 
hypotension 
alt conscousness
21
Q

diagnosing DKA

A

hyperglycaemia >11
ketosis >3
acidosis

22
Q

DKA Mx

A
IV fluids 
insulin infusion 
dextrose infusion 
monitor K 
treat underlying trigger
monitor ketones
23
Q

DKA Mx - restarting patient on normal insulin regime

A

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

24
Q

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

A

10mmol per hour

25
Q

long term Mx T1DM

A

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

26
Q

usual insulin regime

A

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

27
Q

short term complications of diabetes

A

hypoglycaemia

hyperglycaemia + DKA

28
Q

hypoglycaemia Mx

A

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

29
Q

severe hypoglycaemai Mx

A

IV dextrose

IM glucagon

30
Q

long term complications - macrovascular

A

coronary artery disease
peripheral ischaemia: ulcers
stroke
hypertension

31
Q

long term complications - microvascular

A

peripheral neuropathy
ritinopathy
kidney disease esp glomerulosclerosis

32
Q

long term complications - infection

A

UTI
pneumonia
skin and soft tissue esp feet
fungal esp thrush

33
Q

monitoring

A

HbA1c

cap BG ]libre