Type 1 Diabetes

Question 1

What does body want to keep glucose levels between?

Answer 1

4.4-6.1 mmol/L

Question 2

What type of substance is insulin?

Answer 2

Anabolic hormone produced in the pancreas

Question 3

Role of insulin?

Answer 3

Reduces BG levels

Question 4

What type of cells produce insulin?

Answer 4

Beta cells in the islets of Langerhans in pancreas

Question 5

When does insulin increase?

Answer 5

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

Question 6

How insulin acts?

Answer 6

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

Question 7

What is insulin essential for?

Answer 7

Letting cells take glucose out of blood and use it as fuel

Without insulin, cells cannot take up glucose and use it

Question 8

What type of substance is glucagon?

Answer 8

Catabolic hormone produced in pancreas that increases BG levels

Question 9

General role of glucagon?

Answer 9

Increases BG levels

Question 10

What produces Glucagon?

Answer 10

Alpha cells in islets of Langerhans in pancreas

Question 11

What is glucagon released in response to?

Answer 11

In response to low BG levels and stress

Question 12

What does glucagon do?

Answer 12

Tells liver to break down stored glycogen into glucose
|
Glycogenolysis

Also tells liver to convert proteins and fats into glucose
|
Gluconeogenesis

Question 13

When does ketogenesis occur?

Answer 13

When insufficient glucose supply & glycogens stores are exhausted eg in prolonged fasting

Question 14

What are ketones?

Answer 14

Water soluble fatty acids

Question 15

What is T1DM?

Answer 15

Disease where pancreas stops being able to produce insulin

Question 16

What happens when insulin is not produced?

Answer 16

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

Question 17

Viruses which could trigger diabetes type 1?

Answer 17

Coxsackie B virus

Enterovirus

Question 18

Main problems in diabetic ketoacidosis?

Answer 18

Ketoacidosis
Dehydration
K+ imbalance

Question 19

What is ketoacidosis?

Answer 19

Cells of body have no fuel, think they are starving and initiate ketogenesis

Question 20

Why does dehydration occur in DKA?

Answer 20

• 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)

Question 21

What does insulin normally do to K+?

Answer 21

Normally drives K+ into cells

-Without insulin K+ is not added into & stored in cells

Question 22

What can serum K+ be like in potassium imbalance?

Answer 22

Can be high or normal as kidneys continue to balance Blood K+ with K+ excreted in urine

Question 23

What can a patient develop when insulin treatment begins?

Answer 23

Hypokalaemia
Can lead to
Fatal arrhythmia

Question 24

Presnetation of DKA?

Answer 24

• 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

Question 25

Priority in treating DKA?

Answer 25

Fluid resus followed by insulin infusion

Question 26

Diagnosing DKA?

Answer 26

Requires the criteria for diagnosis:

• Hyperglycaemia (>11mmol/L)
• Ketosis (>3mmol/L)
• Acidosis (pH <7.3)

Question 27

Treating DKA pneumonic?

Answer 27

FIG PICK

Question 28

Treatment of DKA?

Answer 28

F: Fluids 
I: Insulin infusion 
G: Glucose closely monitor 
P: Potassium closely monitor
I: Infection 
C: Chart fluid balance 
K: Ketones monitor

Question 29

What is involved in treating fluids of DKA?

Answer 29

• IV resus with normal saline

- 1L stat the 4L and K+ over 12hours

Question 30

Treatment of DKA with insulin invovles?

Answer 30

Actrapid @ 0.1 unit/Kg/hour

Question 31

Don’t infuse K+ how?

Answer 31

At a rate of more than 10mmol per hour

Question 32

Long term management of diabetes type 1?

Answer 32

• SC insulin regimes

- Monitoring dietary carb intake

Question 33

What is lipdystrophy?

Answer 33

Injecting into same spot can cause this

-Where SC fat hardens & patients don’t absorb insulin properly

Question 34

Short term complications of Diabetes type 1?

Answer 34

Hypoglycaemia

Hyperglycaemia (&DKA)

Question 35

Symptoms of hypoglycaemia?

Answer 35

• Tremor
• Dizziness
• Sweating
• Pallor
• Irritability

Question 36

Treatment of hypoglycaemia?

Answer 36

Rapid acting glucose

Slower acting carbs

Question 37

Treatment of severe hypo?

Answer 37

IV Dextrose

IM glucagon

Question 38

Microvascular complications of DKA?

Answer 38

Retinal neuropathy
Retinopathy
Kidney disease particularly glomerulosclerosis

Question 39

Infection related complications?

Answer 39

• UTI
• Pneumonia
• Skin soft tissue infections espesh in feet
• Fungal infections

Question 40

Monitoring of T1DM?

Answer 40

• HbA1c measured every months
• Capillary blood glucose: using glucose meter
• Flash glucose monitoring (freestyle libre) lag of 5 mins behind BG