T1DM Flashcards
What is the current T1DM WHO classification?
Genetics + environmental trigger causes an autoimmune destruction of islet cells leading to islet deficiency leading to hyperglycaemia
What is the current T2DM WHO classification?
Genetics and obesity causes insulin resistance leading to B cell failure leading to hyperglycaemia
Why is the immune basis of T2Dm importnt
Increased prevalence of other autoimmune diseases, and leads to a risk of autoimmunity in relatives. It also leads to more complete destruction of B cells. Auto-antibodies can be useful clinically and immune modulation offers the possibility of novel treatments
What are markers for T1DM?
Islet cell antibodies (ICA)- grp O human pancreas
Insulin antibodies (IAA)
Glutamic acid decarboxylase (GADA) – widespread nuerotransmitter
Insulinoma-associated-2 autoantibodies (IA-2A)-receptor like family
What are symptoms of diabetes?
polyuria nocturia polydipsia blurring of vision ‘thrush’ weight loss fatigue
What are signs of diabetes?
dehydration cachexia hyperventilation smell of ketones glycosuria ketonuria
What are aims of treatment in type 1 diabetes?
- Reduce early mortality and avoid acute metabolic decompensation
- Prevent long term complications; retinopathy, nephropathy, neuropathy, vascular disease
What is the recommended diet in type 1 diabetes?
- reduce calories as fat
- reduce calories as refined carbohydrate
- increase calories as complex carbohydrate
- increase soluble fibre
- balanced distribution of food over course of day with regular meals and snacks
What insulin analogues are used in insulin treatments with meals and which are background treatments
Lispro, aspart, glulisine with meals or Glargine, Determir, degludec in the background
What is the acting speed of insulin treatment with meals and in the background
With meals: short acting and background: long acting
What is the type of insulin used with meals and which in the background
Human insulin with meals or non-c bound to zinc or protamine in the background
What does an insulin pump do?
Provides continuous insulin delivery - preprogrammed basal rates and bolus for meals
What is the disadvantage of insulin pumps
They do not measure glucose and there is no completion of feedback loops
What is a surgical treatment option for treating diabetes T1
Islet cell transplants
What are the consequences of hypoglycaemia in diabetes?
- most mental processes impaired at <3 mmol/l
- consciousness impaired at <2 mmol/l
- severe hypoglycaemia may contribute to arrhythmia and sudden death
- may have long-term effects on the brain
recurrent hypos result in loss of warnings
What is the main risk factor of diabetic hypoglycaemia?
Quality of glycaemic control
Which patients have more frequent diabetic hypoglycaemia?
Patients with a low HbA1c
When can diabetic hypoglycaemia occur?
Anytime but often a clear pattern, pre lunch hypos common and nocturnal hypos very common and often not recognised
Why can diabetic hypoglycaemia occur?
- unaccustomed exercise
- missed meals
- inadequate snacks
- alcohol
- inappropriate insulin regime
What are signs and symptoms of hypoglycaemia that are due to increased autonomic activation?
Palpitations (tachycardia) Tremor Sweating Pallow/cold extremities Anxiety
What are signs and symptoms of hypoglycaemia that are due to impaired CNS function
- drowsiness
- confusion
- altered behaviouor
- focal neurology
- coma
What are oral ways of treating hypoglycaemia?
feed the patient!
glucose
- rapidly absorbed as solution or tablets
complex CHO
- to maintain blood glucose after initial treatment
What are parenteral ways of treating hypoglycaemia
give if consciousness impaired
IV dextrose e.g 10% glucose infusion
1mg Glucagon IM
avoid concentrated solutions if possible (e.g 50% glucose)
What are causes of the ketoacidosis complication of diabetes?
new presentation
insulin omission
infection / other illness
