T1DM Flashcards
what is T1DM
autoimmune against B cells of islets of langerhans in pancreas
what type of insulin deficiency is in T1DM
absolute
symptoms T1DM
weight loss // polydipsia // polyuria // blurred vision // DKA = abdo pain, vomiting, reduced consiousness, ketonuria
how does polyuria and dipsia occur in diabetes
glycosuria ‘drags’ water out in urine by osmosis
what glucose levels indicate diabetes
fasting > 7 // random or after glucose tolerance > 11.1 // if symptomatic 1 off is diagnostic, if asymptomatic 2 is diagnostic
when can T1DM be diagnosed on a clinical basis in a person presenting with hyperglycaemia
ketosis // rapid weight loss // <50 // BMI <25 // FH autoimmune disease
when would hyperglycaemia in a suspected new diagnosis of T1DM need further testing + what testing is done
atypical eg 50+, BMI 25+, slow onset hyperglycaemia // C peptide and antibodies
antibodies in T1DM
low C peptide!!! // anti-GAD // ICA // IAA // IA2
HbA1c in T1DM
not as useful - >6.5% (48mmol)
how often should HbA1c be measured in T1DM + what level is aimed for
3-6 months // <48 or 6.5%
how often is monitoring of blood glucose recommended T1DM
minimum 4x/day // before each meal and before bed
glucose targets T1DM
5-7 on waking // 4-7 before meals
what is the optimal insulin regime for T1DM
basal-bolus (basal as a long acting, bolus as a top up when required at meals throughout the day)
what is the twice daily insulin (basal) regime of choice
detemir
what is the once daily insulin regime (alternative to twice daily)
glargine or detemir
what insulin should be taken before bed
rapid acting analogues
if insulin is not enough to control T1DM what adjuvant can be given
metformin (if BMI >25)
onset, peak, duration of rapid acting insulin analogues
onset = 5mins // peak = 1hr // duration = 3-5 hours
examples rapid acting insulin analogues
NovaRapid or Humalog
onset, peak, duration of short acting insulin
onset = 30mins // peak = 3 hours // duration = 6-8hrs
examples of short acting insulins + what are they
actarapid // Humulin S // come from human insulins
examples intermediate insulins
isophane
onset, peak, duration of long acting insulin analogues
onset = 1-2hrs // peak = flat profile // duration = 24hours
examples long acting insulin analogues
determir (levemir) + glargine (lantus) // basal regime
biggest SE of insulin
hypogylcaemia
hypogylcaemia symptoms
sweating, anxious, blurry vision, confused, agitated
mx of hypoglycaemia in a conscious patient
10-20g carb // lucozade, 3 glucose tablets, glucose gel
what emergency kit should all patients on insulin have
glucagon
what medication can reduce hypoglycaemic awareness
BB
lipodystrophy symptoms
atrophy or lump of s/cut fat
how is lipodystrophy prevented
rotating injection site
how can lipodystrophy affect insulin mx
erratic absorption
when are T1DM started on statins
over 40 + nephropathy OR diagnosed 10+ years ago
what is obese class 1-3
1 = 30-35 // 2 = 35-40 // 3 = >40
what meds can be used in obesity
orlistat + liraglutide
action orlistat
pancreatic lipase inhibitor
indications starting orlistat
BMI 28 with 2+ risk factors // BMI 30+ // continued weight loss
how long is orlistat used for
<1 year
action Liraglutide
GLP1 mimetic
