Type 1 Diabetes Flashcards
What does body want to keep glucose levels between?
4.4-6.1 mmol/L
What type of substance is insulin?
Anabolic hormone produced in the pancreas
Role of insulin?
Reduces BG levels
What type of cells produce insulin?
Beta cells in the islets of Langerhans in pancreas
When does insulin increase?
Increases when blood sugar levels rise, insulin reduces BG by causing cells in body to absorb glucose from blood and use it as fuel
Also causes muscles and liver cells to absorb glucose out of blood and use it as fuel
How insulin acts?
Insulin reduces BG by causing cells in body to absorb glucose from blood and use it as fuel
Also causes muscles and liver cells to absorb glucose out of blood and use it as fuel
What is insulin essential for?
Letting cells take glucose out of blood and use it as fuel
Without insulin, cells cannot take up glucose and use it
What type of substance is glucagon?
Catabolic hormone produced in pancreas that increases BG levels
General role of glucagon?
Increases BG levels
What produces Glucagon?
Alpha cells in islets of Langerhans in pancreas
What is glucagon released in response to?
In response to low BG levels and stress
What does glucagon do?
Tells liver to break down stored glycogen into glucose
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Glycogenolysis
Also tells liver to convert proteins and fats into glucose
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Gluconeogenesis
When does ketogenesis occur?
When insufficient glucose supply & glycogens stores are exhausted eg in prolonged fasting
What are ketones?
Water soluble fatty acids
What is T1DM?
Disease where pancreas stops being able to produce insulin
What happens when insulin is not produced?
The cells of the body cannot take glucose from blood & use it for fuel meaning cells think body is being fasted and has no glucose supply
-Meanwhile glucose levels keep rising=hyperglycaemia
Viruses which could trigger diabetes type 1?
Coxsackie B virus
Enterovirus
Main problems in diabetic ketoacidosis?
Ketoacidosis
Dehydration
K+ imbalance
What is ketoacidosis?
Cells of body have no fuel, think they are starving and initiate ketogenesis
Why does dehydration occur in DKA?
- Hyperglycaemia overwhelms kidneys and glucose starts being filtered into urine
- Glucose in urine draws water out in osmotic diuresis
- This causes polyuria resulting in severe dehydration
- This stimulates thirst centre (polydipsia)
What does insulin normally do to K+?
Normally drives K+ into cells
-Without insulin K+ is not added into & stored in cells
What can serum K+ be like in potassium imbalance?
Can be high or normal as kidneys continue to balance Blood K+ with K+ excreted in urine
What can a patient develop when insulin treatment begins?
Hypokalaemia
Can lead to
Fatal arrhythmia
Presnetation of DKA?
- Hyperglycaemia
- Dehydration
- Ketosis
- Metabolic acidosis
- K+ imbalance
- Polyuria
- Polydipsia
- N/V
- Acetone smell to breath
- Subsequent hypotension from dehydration
- Altered consciousness
- Symptoms of underlying trigger
Priority in treating DKA?
Fluid resus followed by insulin infusion
Diagnosing DKA?
Requires the criteria for diagnosis:
- Hyperglycaemia (>11mmol/L)
- Ketosis (>3mmol/L)
- Acidosis (pH <7.3)
Treating DKA pneumonic?
FIG PICK
Treatment of DKA?
F: Fluids I: Insulin infusion G: Glucose closely monitor P: Potassium closely monitor I: Infection C: Chart fluid balance K: Ketones monitor
What is involved in treating fluids of DKA?
- IV resus with normal saline
- 1L stat the 4L and K+ over 12hours
Treatment of DKA with insulin invovles?
Actrapid @ 0.1 unit/Kg/hour
Don’t infuse K+ how?
At a rate of more than 10mmol per hour
Long term management of diabetes type 1?
- SC insulin regimes
- Monitoring dietary carb intake
What is lipdystrophy?
Injecting into same spot can cause this
-Where SC fat hardens & patients don’t absorb insulin properly
Short term complications of Diabetes type 1?
Hypoglycaemia
Hyperglycaemia (&DKA)
Symptoms of hypoglycaemia?
- Tremor
- Dizziness
- Sweating
- Pallor
- Irritability
Treatment of hypoglycaemia?
Rapid acting glucose
Slower acting carbs
Treatment of severe hypo?
IV Dextrose
IM glucagon
Microvascular complications of DKA?
Retinal neuropathy
Retinopathy
Kidney disease particularly glomerulosclerosis
Infection related complications?
- UTI
- Pneumonia
- Skin soft tissue infections espesh in feet
- Fungal infections
Monitoring of T1DM?
- HbA1c measured every months
- Capillary blood glucose: using glucose meter
- Flash glucose monitoring (freestyle libre) lag of 5 mins behind BG
