Type 1, Clinical Features, Pathophysiology, Treatment Flashcards
what used to be the biggest killer of diabetic and what is now
used to be coma
now thanks to insulin is cardiac/renal complications
what is the definition of type 1 diabetes
A state of absolute insulin deficiency probably caused by an environmental trigger in a genetically susceptible individual mediated by an auto immune response attacking the pancreatic B cells
how do you diagnose diabetes
fasting glucose >7
random >11.1
and symptoms OR repeat
how to diagnose type 1 or type 2 diabetes
Type 1 - history and presentation eg. DKA alone
If in doubt, GAD/IA2 antibodies (and C peptide) may help
what happens to a normal pancreatic islet in type 1 diabetes
it gets attacked by lymphocytes
what happens to a normal pancreatic islet in type 2 diabetes
as the B cells start to go into decline amyloid deposits start to form in the pancreas
what is the association between HLA and risk of type 1 diabetes
HLA genes represent 50% of the familial risk of T1DM
95% of those with T1DM under 30 have one or both of the HLA genotypes
Only 10% of people with susceptible HLA develop DM
what are some environmental triggers for the onset of T1DM
viral infection
maternal factors
weight gain
also a seasonal variation in date of diagnosis (more in winter)
What are the islet cell auto-antibodies
IA-2
IAA
GAD65
ZnT8
what are the autoantibodies seen in type 1 diabetes
GAD65Ab (targets glutamic acid decarboxylase)
IA-2AB (targets islet antigen 2)
IAA (targets insulin)
ZnT8Ab (targets ZnT8 transporter)
what are some foetal risk factors for type 1 diabetes
infection
age
ABO mismatch
Birth order
what are the histopathological disease markers of T1DM
raised glucose ketones decreased insulin decreased B cell mass decreased c peptide
what is the classical triad of presenting features of T1DM
Polyuria
-also enuresis in children
Polydipsia (thirst)
Weight loss
What are the clinical features other than the classic triad that present in T1DM
fatigue and somnolence blurred vision Candidal infection pruritus vulvae balanitis in established ketone-acidosiss
things to ask/think about in a newly presenting patient
has diabetes been confirm what type (antibody testing) is hospitalisation required -DKA -significant ketonaemia -vomiting are they at school/college/uni if not what's their employment do they drive
Management of a newly diagnosed T1DM patient
blood glucose and ketone monitoring Insulin usually basal (once daily) and bolus (with meals) carbohydrate estimation regular dietitian contact appropriate medical clinic review
what is the ideal HbA1c range for T1DM
48-58 mmol/mol
what is checked in the annual review assessment
weight bp bloods - HbA1c, Renal function, Lipids retinal screening foot risk assessment
what % of patients with cystic fibrosis will go on to develop T1DM
20%
what intensified insulin therapy should be given for type 1 adults
human or rapid acting insulin analogues
when are basal insulin analogues recommended
in patients with type 1 who are experiencing severe or nocturnal hypos
what insulin regimen is given to children
insulin analogs (rapid or basal)
regular human insulin
NPH preparations (intermediate)
combination of all 3
what are the overlap diabetes between types 1 and 2
MODY
LADA
Mitochondrial gene mutations
Amylin gene mutations
how is insulin secreted normally
Biphasic secretion in response to a meal
- rapid phase of preformed insulin lasts 5-10 mins
- slow phase over 1-2 hours
