Type 1 Diabetes Flashcards
What is Type 1 Diabetes Melitus
Insulin deficiency caused by auto-immune beta cell damage
When does Type 1 generally manifest
<30 years
Except for Latent Autoimmune Diabetes in Adults (LADA)
What is LADA
Slow burning with slow progression to insulin deficiency
Occurs as an adult
Can be mistaken as Type 2
-Lean build
What are some autoimmune associations with Type 1 (risk factors)
Auto immune thyroid
Coeliac Disease
Addison’s (high cortisol)
Pernicious Anaemia
What environmental factors are associated with Type 1
Diet
Enteroviruses
Vitamin D deficiency
Clean environment
What are the clinical values for Diabetes Melitus
Random plasma glucose >11mmol/l
Fasting plasma glucose >7mmol/l
No symptoms – GTT fasting >7
HbA1c >48mmol/mol
What are the common symptoms of Diabetes Melitus
Polydipsia Polyuria Weight loss Fatigue Hunger Pruritis vulvae Balanitis Blurred vision
What are the features of Type 1
Onset in childhood/ adolescence Lean build Acute onset of osmotic symptoms Prone to ketoacidosis High levels of islet autoantibodies
What are the features of newly diagnosed Type 1
Weight loss
Short history of symptoms
Moderate or large urinary ketones
What are the genetic associations of Type 1 DM
HLA- DR3/DQ2
HLA- DR4-DQ8
What is the pathology of Type 1 DM
Autoantibodies destroy B cells of Islet of Langerhans
Insulin deficiency and Glycogen breakdown
Hyperglycemia and Glycosuria
What is the treatment of Type 1 DM
First line = Insulin injected subcutaneously (aware patient)
If patient is unaware give Insulin pump
What is the major complication of T1DM
Ketoacidosis
What are the investigations for Type 1 DM
Urine dipstick = Glycosuria
Resting Plasma Glucose >11.1mmol/L
HbA1c >48mmol/L >6.5%
What causes Ketoacidosis
Untreated T1DM
What is the Patho for Ketoacidosis
No insulin production = increased gluconeogenesis and decreased tissue uptake = HYPERGLYCEMIA
Osmotic diuresis causes dehydration
Lipolysis induced increasing Fatty Acids so more Acetyl CoA producing ketones = Acidosis
What are the investigations for ketoacidosis
Hyperglycemia? >11.1 mmol/L RPG
Ketonaemia? >3mmol/L plasma ketones
Acidosis? pH <7.35 or HCO3 <15mmol/L
Urine dipstick = Glycosuria/ketonuria
What are the complications of Ketoacidosis
Cerebral oedema
Coma
Pneumonia
Death
What is the management of Ketoacidosis in an aware patient and not vomiting
Oral and Subcutaneous Insulin Injection
Does Ketoacidosis present with fever and hyperglycemia
Fever = no Hyperglycemia = sometimes
What is the Presentation for DKA
Acetone fruity breath Kussmaul Breathing (sigh) Hypovolemic shock Dehydration Vomiting Abdominal pain Coma
What is the management of Ketoacidosis in a vomiting, confused patient
1st) IV 0.9% NaCl
- 0.1 Insulin infusion
- Potassium
What is the management of Ketoacidosis in a coma patient
ABCDE for resuscitation
Who is basal-bolus insulin appropriate for
Patients who have the ability to regulate and manage their insulin///i.e young people
What kind of Hypersensitive is Type 1 DM
T4
What is the difference between basal and bolus insulin
Basal = Long and slow (for the day) Bolus = fast and short (For a meal)
