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Finals: Medicine > Type 1 Diabetes > Flashcards

Type 1 Diabetes Flashcards

1
Q

Define type 1 diabetes mellitus

A

Autoimmune disorder characterised by hyperglycaemia due to absolute insulin deficiency

Develops due to destruction of the insulin-producing beta cells of the Islets of Langerhans in the pancreas by the immune system

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2
Q

What are the two key characteristics of type 1 diabetes

A

Absolute insulin deficiency

State of persistent hyperglycaemia

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3
Q

When does type 1 diabetes typically present

A

Tend to develop in childhood/early adult life

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4
Q

Diabetic ketoacidosis (DKA) is usually a first presentation of which type of diabetes

A

T1DM

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5
Q

What is the name of the emergency condition associated with T1DM

A

Diabetic ketoacidosis (DKA)

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6
Q

What causes the development of T1DM

A
  • Mechanism is not fully understood
  • The underlying cause is thought to be a combination of genetics and environmental triggers e.g. Enterovirus
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7
Q

What produces insulin

A

Insulin is produced by the beta cells in the Islets of Langerhans in the pancreas

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8
Q

Insulin functions to:

a) lowers blood glucose level
b) raises blood glucose level

A

Insulin functions to lowers blood glucose level

Background levels of insulin are always there but there is a rise with a rise in blood sugar levels

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9
Q

Insulin acts to two-fold to reduced blood sugar.

What are these?

A

Tells cells of the body to absorb the glucose and use it as fuel

Stimulates glycogenesis i.e. formation of glycogen from glucose – in the muscles and liver

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10
Q

What is glycogenesis

A

formation of glycogen from glucose

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11
Q

Where is glycogen stored

A

In the muscles and liver

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12
Q

Where is glucagon produced

A

Hormone produced by the alpha cells in the Islets of Langerhans in the pancreas

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13
Q

Glucagon functions to:

a) lowers blood glucose level
b) raises blood glucose level

A

b) raises blood glucose level

Glucagon is used when glucose is gone

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14
Q

Glucagon functions to raise glucose levels

What are the two ways in which it raises blood glucose levels

A

Stimulates glycogenolysis i.e. the breakdown of glycogen stores into glucose

Stimulates gluconeogenesis i.e. the conversion of fat and protein into glucose in the liver

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15
Q

What is glycogenolysis

A

The breakdown of glycogen stores into glucose

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16
Q

What is gluconeogenesis

A

The conversion of fat and protein into glucose in the liver

17
Q

When does Ketogenesis occur

A

Occurs when there is insufficient glucose supply and glycogens stores are exhausted

18
Q

What is ketogenesis

A

The liver takes fatty acids and converts them to ketone acids (ketones).

19
Q

What are ketones

A

Ketones are water soluble fatty acids that can be used as fuel.

They can cross the BBB and be used by the brain as fuel

The final product of ketogenesis - the conversion of fats into ketones

20
Q

What are the triad of symptoms for diabetes

A

Polyuria

Polydipsia

Weight loss

21
Q

What is polyuria?

A

Excessive production and passage of urine

22
Q

What is polydipsia

A

Increased thrist

23
Q

Why is intensive glycaemic control important?

A

Decrease the incidence of microvascular and macrovascular complications

Prevents emergency presentations e.g. DKA (T1DM), HHS (T2DM)

24
Q

Name the three microvascular complications of diabetes

A

Retinopathy

Nephropathy

Neuropathy

25
Q

Name three macrovascular complications of diabetes

A

Coronary artery

Cerebrovascular

Peripheral vascular disease

26
Q

How can you measure ketones

A

In the blood or urine

27
Q

The presence of C peptide can be useful to investigate T1DM.

What are C peptides

A

C peptide is an amino acid that is released at the same time as insulin from the pancreas

28
Q

Name the three diabetes-specific autoantibody titres?

A

Anti-GAD (antibodies to glutamic acid decarboxylase)

ICA (Islet cells antibodies)

IAA (Insulin AutoAntibodies)

29
Q

Name two potential short term complications of T1DM

A

Hypoglycaemia

DKA

30
Q

What are the three components of the T1DM management

A

Patient education

Insulin therapy

Monitoring

31
Q

Why should T1DM cycle their injection sites

A

To prevent lipodystrophy, condition in which the subcutaneous fat hardens which affects the absorption of insulin from that site.

32
Q

Patients are able to monitor their blood glucose level by capillary blood glucose monitoring kits.

How many times a day are they recommended to check it

A

four times a day

33
Q

HbA1c indicates the average blood glucose concentration over a three-month period.

What is the target level of HbA1c?

A

<= 48mmol/mol

34
Q

Name the three types of insulin regimens

A

Basal-bolus

Mixed (biphasic) regimen

Continuous insulin infusion (insulin pump)

35
Q

Which insulin regiment is 1st line

A

Basal-bolus – best mimics the physiology

36
Q

Describe the basal bolus insulin regiments

A

Combination of long acting insulin for basal dosing and rapid-acting insulin for bolus dosing.

Correction dose may be added to the bolus insulin based on the pre-meal blood glucose level.

Offers flexibility to tailor insulin therapy with the carbohydrate load of each meal.

37
Q

Describe the mixed (biphasic) insulin regiment

A

Use of both short-acting and intermediate-acting insulin

Can be a premixed product or the preparation can be mixed by the patient

38
Q

Describe the continuous insulin infusion (insulin pump) insulin regiment

A

Supplies regular amount via rapid or short acting insulin, which is delivered by a programmable pump and insulin storage reservoir via a subcutaneous needle or cannula

39
Q

Why sometiems after diagnosis are insulin levels low?

A

There may be some residual function of the beta cells

Insulin requirement may suddenly rise as the remaing beta cells are destroyed

Finals: Medicine (91 decks)

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