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RE > T1DM > Flashcards

T1DM Flashcards

1
Q

What percentage of patients who have T1DM, have no family history?

A

85%

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2
Q

When is the peak incidence of T1DM in childhood?

A

6 months - 5 years

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3
Q

At what age are 50% of T1DM diagnosed?

A

> 18 years old

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4
Q

Where is the highest incidence of T1DM in the world?

A

Canada, Saudi Arabia, Sweden, Finland, Norway UK
I.e. Northern Hemisphere

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5
Q

Is T1DM more common in females or males?

A

Males up to the age of 70, then females.

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6
Q

What percentage of people with diabetes in the UK, have T1DM?

A

10-15%

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7
Q

Does genetics affect someones risk of developing T1DM?

A

Yes - monozygotic twin has highest risk at 36%.
Sibling - 6%
Father - 3-6%
Mother - 1-2%
0.5% background risk

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8
Q

Which genes are linked to an increased risk of T1DM?

A

Most on HLA region of Ch 6
HLA DR3-DQ2 + DR4-DQ8

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9
Q

Which genes are linked to a decreased risk of T1DM?

A

HLA-DMA and DQB1

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10
Q

Which genes are linked to insulin deficiency?

A

VNTR
PTPN22
CTLA4
IL2RA

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11
Q

What are the 5 cell types of the pancreas and what do they secrete?

A

Alpha - Glucagon
Beta - Insulin
Delta - Somatostatin
Gamma - Pancreatic polypeptide
Epsilon - Ghrelin

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12
Q

What cells of the pancreas have the highest number of cells?

A

Insulin - 70%

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13
Q

What are Gamma and Epsilon cells involved in?

A

Appetite

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14
Q

Which cells does T1DM affect?

A

Beta cells

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15
Q

What causes T1DM?

A

Autoimmune destruction of the insulin secreting pancreatic B cells –> chronic inflammation of pancreas –> Beta cells cannot produce insulin.

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16
Q

Can beta cells regenerate?

A

no

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17
Q

Which antibodies are associated with T1DM?

A

GAD
IA2
Zn T8

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18
Q

What pancreatic changes occur with T1DM?

A

Decreased weight of the pancreas
Atrophy/hypertrophy
Beta cell loss

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19
Q

What Islet cell changes occur with T1DM?

A

Insulitis
Loss of beta cells through necrosis

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20
Q

What is insulitis?

A

Inflammation of the islet of langerhans

21
Q

What is the honeymoon phase?

A

In pre-diabetes, body is still able to produce small amounts of insulin but decreases over 3-5 years.

22
Q

Do patients with pre-diabetes have diabetic symptoms?

A

Usually day to day - no symptoms.
During stress response - may not be able to produce insulin and therefore symptoms develop.

23
Q

Which conditions are associated with T1DM?

A

Coeliac
Hypothyroidism
Graves disease
Addisons
Hypogonadism
Pernicious anaemia
Vitiligo
Autoimmune polyglandular syndromes

24
Q

What are the commons symptoms of T1DM?

A

Thirst
Polyuria
Lethargy
Weight loss (unintentional)
Recurrent candidiasis
Visual changes - glucose can affect optic disc
Ketone breath
DKA
Coma/death

25
Q

How can insulin levels be measured in T1DM?

A

Through measuring C-peptide

26
Q

What the three ketone bodies?

A

Acetoacetate
3 beta hydroxybutyrate (most)
Acetone (least)

27
Q

When are ketone bodies produced?

A

In fasting, exercise + pregnancy.
Used peripherally as an energy source if glucose not available.

28
Q

How is C-peptide produced?

A

End product of proinsulin.
Proinsulin –> Insulin –> C-Peptide.
If no C-peptide = No insulin production

29
Q

What would C-peptide levels be in T1DM?

A

Low

30
Q

What would C-peptide levels be in T2DM?

A

High - means insulin resistance

31
Q

What does an intermediate level of C-peptide mean?

A

Favours T2DM over T1DM
Consider rare genetic forms of diabetes.

32
Q

When can C-peptide levels not be an accurate measure of diabetes?

A

If measured within 3-5 years of diagnosis, C-peptide levels can still be high/intermediate due to the honeymoon phase. After 3-5 years, there will be no C-Peptides if T1DM.

33
Q

What is the difference between flash and continuous glucose monitoring?

A

Flash - you need to put device onto sensor every 8 hours.
Continuous - Will continually monitor glucose levels and send to device.
Both sit in s/c tissue

34
Q

Why is it recommended that when unwell, a patient with diabetes should check their glucose levels via a CBG finger test rather than flash/continuous monitoring?

A

There can be a delay with flash/continuous monitoring as this sits in the subcutaneous tissue.
Lag time now reduced on newer models to 2-3 minutes.

35
Q

What is a glucose management indictor?

A

A level that can indicate the HBA1C level.
Need to make sure it’s not an average of lots of highs and lots of lows though.

36
Q

What type of hormone is insulin?

A

Peptide

37
Q

What is the first line insulin regimen for T1DM?

A

Basal-bolus

38
Q

What insulin therapy would be offered to someone with disabling hypoglycaemia or high HBA1C with multiple daily injections, aged >12?

A

Insulin pump

39
Q

Which insulin therapy would not be recommended for those newly diagnosed with T1DM?

A

Twice daily mixed, basal only or bolus only regimens.
As this requires a consistent daily routine that includes three meals a day.

40
Q

When would ‘ultra strength’ insulin be used?

A

If there are problems with recurrent DKA, absorption, compliance or insulin stacking.

41
Q

What national educational programme can those with T1DM attend?

A

DAFNE
Dose Adjustment for Normal Eating
Teaches about carb counting and how to manage fluctuations and sick day rules etc.

42
Q

How much is a carb portion?

A

10g = 1 carb point

43
Q

What are the symptoms of hypoglycaemia?

A

Dizzy
Blurred vision
Sweaty
Weak or tired
Upset or nervous
Headache
Hungry

44
Q

What are the symptoms of hyperglycaemia?

A

Extreme thirst
Hungry
Frequent urination
Blurred vision
Drowsy
Wounds healing slow

45
Q

When would someone with T1DM be unable to drive?

A

If they have an impaired awareness of hypoglycaemia or >1 episode of severe hypoglycaemia (needing third party assistance) within last 12 months.
If blood sugar <5.

46
Q

Which questionnaire is used at a diabetics annual review?

A

DDS - Diabetes distress Score

47
Q

What complications can occur from diabetes?

A

Microvascular
Macrovascular

48
Q

What future treatments could there be for T1DM?

A

Islet cell transplant
Artificial pancreas
Cure - whole genome sequencing to prevent autoimmune destruction

49
Q

When does insulin spike in the day?

A

After meals

RE (18 decks)

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