Type 1 Diabetes Flashcards
what is type 1 diabetes
autoimmune condition where beta cells are attacked and destroyed
= absolute insulin deficiency
what is the result of t1dm
hyperglycaemia
what is best treatment for t1dm
individualised to clinical status and preference
when does t1dm typically be diagnosed
in childhood
where is most genetic susceptibility of type 1 diabetes mediated
HLA area of gene
what are a few environmental factors though to contribute to t1dm
enteroviral infections E.g coxcasy virus
cows milk protein exposure
seasonal variation
changes in microbiota
what are the symptoms of T1DM
excessive urination - polyuria excessive thirst - polydipsia nocturia blurring of vision recurrent infection e.g thrust weight loss fatigue
what are the signs of T1DM
dehydration cachexia hyperventilation smell of ketones (pear drops) glycosuria ketonuria
how can we measure pancreatic auto antibodies
in sera of people
glutamic acid decarboxylase
insulinoma associated 2 antibodies
what happens if body is not making insulin
causes breakdown of muscle protein
increase glucose output from liver
break down fat cells = nefas and triglycerides - go to liver and make ketones
what are the aims of treatment in type 1 diabetes
maintain glucose levels without excessive hypoglycaemia
restore close to physiological insulin profile
prevent acute metabolic decomp
prevent micro and macro vascular complications
what are some complications of diabetes
hyperglycaemia:
acute = diabetic ketoacidosis
chronic =
macrovascular: ischaemic heart disease,cerebrovascular disease,peripheral vascular disease
microvascular = retinopathy,neuropathy, nephropathy
what are some of the ways to manage type 1 diabetes
insulin treatment
dietary support/ structured education
technology
transplantations
what is the insulin given with meals - quick acting
human insulin - exact molecular replicate
insulin analogue - lispro,aspart,glulisine
what is background insulin - long acting/basal
bound to zinc/protamine (nph) insulin analogues (glargine, determir, degludec)
what is insulin pump therapy
continous delivery of short acting insulin analogue e.g novorapid via pump
delivery of insulin into subcutaneous space
programme device to deliver fixed units
actively bolus for meals
what other advice must be given to those with type 1 dm
dose adjustment for carbohydrate content
offered structured education programme - DAFNE
where possible sustitute refined carbohydrates with complex carbohydrates
how can we get closed loop using artificial pancreas
it is a realtime continous glucose sensor
how do islet cell transplant work
isolate islets from pancreas of deceased donor
transplant into hepatic portal vein
requires lifelong immunosuppression
how does simultaneous pancreas and kidney transplant work
better survival of pancreas graft when transplanted with kidneys
why is organ transplant not so common
requires lifelong immunosupression
availability of organs
how do we monitor blood glucose levels
capillary finger prick - glucose monitoring
and continuous glucose monitoring
what is a more useful way of measuring blood glucose over an extended period of time
glycated haemoglobin - hba1c
what are some acute complications from type 1 diabetes
diabetic ketoacidosis
uncontrolled hyperglycaemia
hypoglycaemia
what is diagnosis for diabetic ketoacidosis
ph <7.3
increased ketones in blood and urine
what are some risks of hypoglycaemia
seizure/coma/death impacts on emotional wellbeing impacts on driving impacts on day to day function impacts on cognition
