Treatment of Type 1 Diabetes Flashcards
describe the 1st stage in the development of type 1 diabetes
genetic predisposition- mutation making it more likely to develop type 1
- combination of genes and an environmental trigger that causes the development of the disease
what are HLA/MHC molecules
- major histocompatibility molecules
-make you more likely to develop type 1 diabetes - when the body is exposed to bacteria, it is presented to these cells in the immune system
- in type 1, the wrong MHC molecule combines with environmental trigger
what is insulitis
islets being invaded and destroyed by immune system
- leading to a drop in B cell mass
what are B cells
- low antioxidant defences
- highly specialised cellular functions
- dependent on other cells within an islet
- Fas L (apoptosis regulating protein)/Fas R expression
give examples of causes of type 1 diabetes
- genetics
- environment
- diet
- vaccination
- viral infections
- beta cell low defences
what is diabetes distress
where diabetes management becomes overwhelming, feeling that the diabetes controls them
what is diabetes burnout
feeling burnt out because of their diabetes
- can lead patient to stop taking care of their diabetes
- state of frustration and disillusionment with regards to diabetes
what is the purpose of structured education programmes
- aim to increase the patients knowledge and understanding of the condition and to boost their skills and confidence with self management
describe the 2nd stage in the development of type 1 diabetes
- insulitis and beta cell injury
-beta cells start to get destroyed by apoptosis and beta cell mass drops - autoantibodies to insulin produced
what is the first sign of type 1 diabetes
insulitis- inflammation of insulin producing cells
describe the 3rd stage in the development of type 1 diabetes
- pre diabetes stage
- loss of 1st phase insulin response
describe the 4th stage in the development of type 1 diabetes
- diabetes stage
- where beta cell mass is done to around 10%
- newly diagnosed type 1 diabetes
describe the properties of beta cells that make them vulnerable in the development of diabetes
- low antioxidant defences
- highly specialised cellular functions
- dependent on other cells within an islet
- FasL/FasR expression
at what stage do patients start coming into the clinic for type 1 diabetes
some at pre diabetes stage, but most at diabetes stage
what is the standardised insulin dose
100 units/ml
what are the 4 most common insulin regimes
- once daily injection- mixture of a very long acting and short acting analogues
- twice daily injections- mixture of short and long acting insulin
- multiple daily injections (before meals)- short acting insulin and one daily injection of long acting insulin
- basal bolus - insulin pump- short acting insulin only
describe the onset and duration of action of rapid acting insulins (lispro, aspart)
very fast onset of action but short duration of action
describe the onset and duration of action of short acting insulins
slower onset of action and short duration of action (about 10 hours)
describe the onset and duration of action of intermediate acting insulins
slow onset of action, but has a longer duration of action
- up to about 15 hours
describe the onset and duration of action of long acting insulins (glargine, detemir)
very slow onset of action, long duration of action
- about 24 hours
how can we work out how much insulin is needed for a meal
10g of carbohydrate= 1 unit of insulin
what do patients need to be aware of when reading food labels
- portion/serving size
- total carbohydrate
- raw or cooked
- glycaemic index
What is the NICE gold standard treatment
Basal bolus regime
When would the basal bolus regime not be offered to children and young people diagnosed with type 1 diabetes
-If a child needs such a small dose that it is too difficult to get the dosing right
- if it is felt inappropriate to expect a child under 5 years to have 4 or more injections per day
