T1DM Flashcards

1
Q

what is T1DM

A

autoimmune against B cells of islets of langerhans in pancreas

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2
Q

what type of insulin deficiency is in T1DM

A

absolute

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3
Q

symptoms T1DM

A

weight loss // polydipsia // polyuria // blurred vision // DKA = abdo pain, vomiting, reduced consiousness, ketonuria

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4
Q

how does polyuria and dipsia occur in diabetes

A

glycosuria ‘drags’ water out in urine by osmosis

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5
Q

what glucose levels indicate diabetes

A

fasting > 7 // random or after glucose tolerance > 11.1 // if symptomatic 1 off is diagnostic, if asymptomatic 2 is diagnostic

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6
Q

when can T1DM be diagnosed on a clinical basis in a person presenting with hyperglycaemia

A

ketosis // rapid weight loss // <50 // BMI <25 // FH autoimmune disease

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7
Q

when would hyperglycaemia in a suspected new diagnosis of T1DM need further testing + what testing is done

A

atypical eg 50+, BMI 25+, slow onset hyperglycaemia // C peptide and antibodies

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8
Q

antibodies in T1DM

A

low C peptide!!! // anti-GAD // ICA // IAA // IA2

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9
Q

HbA1c in T1DM

A

not as useful - >6.5% (48mmol)

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10
Q

how often should HbA1c be measured in T1DM + what level is aimed for

A

3-6 months // <48 or 6.5%

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11
Q

how often is monitoring of blood glucose recommended T1DM

A

minimum 4x/day // before each meal and before bed

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12
Q

glucose targets T1DM

A

5-7 on waking // 4-7 before meals

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13
Q

what is the optimal insulin regime for T1DM

A

basal-bolus (basal as a long acting, bolus as a top up when required at meals throughout the day)

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14
Q

what is the twice daily insulin (basal) regime of choice

A

detemir

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15
Q

what is the once daily insulin regime (alternative to twice daily)

A

glargine or detemir

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16
Q

what insulin should be taken before bed

A

rapid acting analogues

17
Q

if insulin is not enough to control T1DM what adjuvant can be given

A

metformin (if BMI >25)

18
Q

onset, peak, duration of rapid acting insulin analogues

A

onset = 5mins // peak = 1hr // duration = 3-5 hours

19
Q

examples rapid acting insulin analogues

A

NovaRapid or Humalog

20
Q

onset, peak, duration of short acting insulin

A

onset = 30mins // peak = 3 hours // duration = 6-8hrs

21
Q

examples of short acting insulins + what are they

A

actarapid // Humulin S // come from human insulins

22
Q

examples intermediate insulins

23
Q

onset, peak, duration of long acting insulin analogues

A

onset = 1-2hrs // peak = flat profile // duration = 24hours

24
Q

examples long acting insulin analogues

A

determir (levemir) + glargine (lantus) // basal regime

25
biggest SE of insulin
hypogylcaemia
26
hypogylcaemia symptoms
sweating, anxious, blurry vision, confused, agitated
27
mx of hypoglycaemia in a conscious patient
10-20g carb // lucozade, 3 glucose tablets, glucose gel
28
what emergency kit should all patients on insulin have
glucagon
29
what medication can reduce hypoglycaemic awareness
BB
30
lipodystrophy symptoms
atrophy or lump of s/cut fat
31
how is lipodystrophy prevented
rotating injection site
32
how can lipodystrophy affect insulin mx
erratic absorption
33
when are T1DM started on statins
over 40 + nephropathy OR diagnosed 10+ years ago
34
what is obese class 1-3
1 = 30-35 // 2 = 35-40 // 3 = >40
35
what meds can be used in obesity
orlistat + liraglutide
36
action orlistat
pancreatic lipase inhibitor
37
indications starting orlistat
BMI 28 with 2+ risk factors // BMI 30+ // continued weight loss
38
how long is orlistat used for
<1 year
39
action Liraglutide
GLP1 mimetic