Type 1 Diabetes Flashcards
Define Type 1 diabetes.
Type 1 diabetes is an autoimmune disease in which the pancreatic beta cells become unable to produce insulin.
Explain some factors that contribute to Type 1 Diabetes.
Genetic
- family history of T1D increases risk
Lifestyle
- infection by pathogen can increase risk of T1D
- socioeconomic status
- Vitamin D deficiency - high prevalence of T1D in northern hemisphere
Immunological
- autoimmune destruction of pancreatic beta cells is a combination of both adaptive and immune response.
Describe the signs and symptoms of T1D.
- excessive thirst
- frequent urination
- unexplainable weight loss
- sexual dysfunction e.g, erectile dysfunction
- slow healing wounds
- vision changes
- tiredness/fatigue
Explain some acute and chronic complications of T1D if left untreated.
Acute
- hyperglycaemia
- hypoglycaemia
- diabetic ketoacidosis
Chronic
- diabetic retinopathy
- amputation due to infection
- renal dysfunction
- peripheral neuropathy
Describe insulin and explain how it is used to treat Type 1 Diabetes.
Insulin is a peptide hormone produced by the pancreas.
- proinsulin is produced by the pancreatic beta cells
- C-peptide is cleaved by endoproteases
- this produces mature insulin and C peptide
Insulin is not secreted continuously, it is produced in a pulse-like effect.
Describe the 4 main types of insulin and their use.
Rapid acting insulin
- used in emergency situations
Long acting insulin
- provides a blanket of insulin for long period of time
Intermediate acting insulin
Short acting insulin
- provides a short burst of insulin e.g., mealtimes
Explain conventional insulin therapy, including it’s strengths and limitations.
Conventional and Intensive insulin therapy.
Conventional insulin therapy
- 2 doses of long/intermediate acting insulin mixed with rapid/short acting insulin
- administered before breakfast and dinner
- blanket of insulin throughout the day and peak of insulin at main mealtimes
- does not accurately replicate the function of a healthy pancreas
Strengths
- unobtrusive and easy
Limitations
- difficult to achieve glycemic control
- requires strict/regimented lifestyle RE food choices and mealtimes
Explain intensive insulin therapy, including strengths and limitations.
Intensive insulin therapy includes multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII).
Multiple daily injections:
- multiple injections throughout the day
- patients follow a basal/bolus regime (basal is long acting insulin to provide a blanket of insulin throughout the day, bolus insulin is rapid acting insulin to provide a peak of insulin when needed e.g, mealtimes.
- more accurately replicates the function of a healthy pancreas.
Strengths:
- better glycaemic control
- less restricted in food choice and eating times
- less chance of blood sugar spiking
Limitations:
- more injections so more of a burden
- requires strong understanding of insulin
Continuous subcutaneous Insulin Infusion:
- short acting insulin administered via a cannula attached to a pump
- pump regularly administers insulin to ensure needs are always met
Strengths
- lower overall requirement of insulin (up to 26% less)
- reduction in incidence of severe hypo’s
- offers the most flexibility
- reduction in risk of diabetes related complications
- significant improvement in HbA1c
Limitations
- still need to carry back up insulin pen
- still need to check insulin levels multiple times daily
- risk of pump breaking/short acting insulin running out
- impractical when playing sport/certain clothing
Explain the requirements to gain access to a CSII pump.
- incidence of severe and disabling hypos
- attempts to regulate HbA1c leads to hypos
- attempts to regulate HbA1c are unsuccessful despite high level of care/understanding
- MDI is considered impractical or inappropriate
Discuss the appropriateness of the pump over the pen.
CSII - the greatest reduction in HbA1c was observed in patients with the worst glycaemic control.
Therefore, the best use of the CSII is for those who struggle to regulate HbA1c levels, and who suffer with debilitating hypo’s.
However, for those who are well educated and informed regarding insulin administration, MDI has proven just as effective at achieving glycaemic control.
