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Exam - M - Diabetes > Type 1 diabetes > Flashcards

Type 1 diabetes Flashcards

1
Q

What is type 1 diabetes?

A

An autoimmune disease where the pancreas stops making insulin.

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2
Q

Which cells produce insulin?

A

The beta cells in the islets of Langerhans in the pancreas.

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3
Q

What is the role of insulin?

A
  • Drives glucose into cells to be used as energy.
  • Drives potassium into cells.
  • Builds up glucose into glycogen to be stored in the liver and muscles (glycogenesis).
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4
Q

What is glycogenesis?

A

The production of glycogen from glucose (due to insulin).

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5
Q

What cells secrete glucagon?

A

The alpha cells in the islets of Langerhans of the pancreas.

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6
Q

What is the role of glucagon?

A
  • Breaks down glycogen into glucose (glycogenolysis).

- Converts proteins and fats into glucose (gluconeogenesis).

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7
Q

What is glycogenolysis?

A

The breakdown of glycogen into glucose.

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8
Q

What is gluconeogenesis?

A

The conversion of fats and proteins into glucose (in the liver and kidneys).

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9
Q

what is the ideal blood glucose level?

A

Between 4.4 - 6.1 mol/L.

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10
Q

What blood glucose results give a diagnosis of diabetes?

A

Fasting blood glucose >7.1mmol/L.

Random blood glucose >11.1mmol/L (or after 75mg oral glucose tolerance test).

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11
Q

Which HbA1c result can diagnose diabetes?

A

> 48mmol/L.

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12
Q

What does HbA1c show?

A

The level of glycated haemoglobin.

It measures your blood glucose levels over the last 2-3 months.

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13
Q

What investigations should be done in suspected type 1 diabetes?

A 
Random blood glucose
Fasting blood glucose
Urine dip (for ketones and glucose)

If any doubt:
C-peptide
Auto-antibodies

Not as useful:
HbA1c

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14
Q

What is the exact diagnostic criteria for type 1 diabetes?

A

If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)

If the patient is asymptomatic the above criteria apply but must be demonstrated on two separate occasions.

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15
Q

What is usually needed for a diagnosis of type 1 diabetes?

A
  1. Random blood glucose >11.1mmol/L.
  2. usually one of these other presenting signs:
    <50yrs old
    rapid weight loss
    personal or family history of autoimmune disease
    BMI <25
    ketosis
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16
Q

When should diabetes specific antibodies or C-peptide be investigated?

A

Investigation of choice if there is any doubt as to whether its T1D or T2D.

Only if type 1 diabetes is suspected but there are atypical features: >50yrs, BMI >25, slow onset.

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17
Q

What are the signs of type 1 diabetes?

A 
Polydipsia
Polyuria
Weight loss (rapid)
Tiredness
Ketonuria (common)
Onset is over days/hours
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18
Q

Why is HbA1c not useful in the acute diagnosis of type 1 diabetes?

A

Because it measures the average blood glucose levels over the last 2-3 months so might not show the acute rise in glucose.

19
Q

How many children first present in DKA with type 1 diabetes?

A

25-50%

20
Q

what other signs are common in children with type 1 diabetes?

A 
Secondary enuresis (bedwetting in a previously dry child)
Recurrent infections
21
Q

What is hypoglycaemia?

A

Usually occurs when the patient has used too much insulin and blood glucose levels drop.

22
Q

what are the signs of hypoglycaemia?

A 
Hunger
tremor
sweating
irritability
dizziness
pallor
reduced consciousness
coma
death
23
Q

what are the treatments for moderate and severe hypoglycaemia?

A

Moderate:
Rapid acting glucose + Slower acting carbohydrates

Severe:
IV glucose
IM glucagon

24
Q

what are the microvascular complications of type 1 diabetes?

A

Retinopathy
Peripheral neuropathy
Kidney disease

25
Q

which kidney disease is a common complication of type 1 diabetes?

A

Glomerulosclerosis

26
Q

which macrovascular complications are common in type 1 diabetes?

A

Coronary artery disease
peripheral vascular disease (diabetic foot)
stroke
hypertension

27
Q

how often is HbA1c measured?

A

every 3-6 months.

28
Q

what are the common regimes of insulin used to treat type 1 diabetes?

A

Basal bolus regime (1 long acting insulin injection + 3 short acting injections).

Insulin pump.

29
Q

How long does rapid acting insulin take to work?

What are some examples?

A

after 10 mins.
lasts for 4 hours.
Novorapid, humalog, apidra.

30
Q

how long does short acting insulin take to work?

What are some examples?

A

after 30 mins, lasts 8 hours.

Actrapid, humulin S, insuman rapid.

31
Q

How long does intermediate-acting insulin take to work?

What are some examples?

A

after 1 hour, lasts 16 hours.

Humulin I, Insulatard, Insuman Basal.

32
Q

How long does long-acting insulin take to work?

What are some examples?

A

take 1 hour, last for 24 hours.

Lantus, Levemir, degludec (lasts over 40hrs).

33
Q

What are the 3 combination insulins?

A

Rapid acting insulin:Intermediate acting insulin.

Humalog 25 (25:75)
Humalog 50 (50:50)
Novomix 30 (30:70)
34
Q

What is the honeymoon period in type 1 diabetes?

A

When first diagnosed, the patient has very good blood glucose control (because they still have some insulin being produced).

As the disease progresses they stop producing insulin so have to rely completely on injections making control much harder.

35
Q

Which antibodies can be found positive in type 1 diabetes?

A

ICA
GAD
IAA
IA-2A

36
Q

What blood pressure is considered to be good in type 1 diabetes?

A

Below 140/80mmHg.

37
Q

What test can be done to determine kidney function in type 1 diabetes?

A

Albumin: Creatinine ratio.

38
Q

What does C peptide levels do?

A

They are only present when the body is producing natural insulin. So it lets you know how much insulin you are creating on your own.

39
Q

When is a hypo classed as severe?

A

When a 3rd party is involved in treatment (you can’t treat yourself).

40
Q

What is insulin sensitivity?

A

This describes how sensitive the body is to insulin.
Usually, the more sensitive you are to insulin, the better.

You can create a sensitivity ratio. Where you can determine how much 1 unit of insulin drops your blood glucose level.

1:5 means 1 unit of insulin causes a drop of 5mmol/L of glucose.

41
Q

what is the goal glucose level in type 1 diabetes?

A

4.4-7.2.

(between 4-10 is good).

42
Q

What should blood glucose be before driving?

A

Should be checked just before driving.

No lower than 5mmol/L.

43
Q

how often should blood glucose levels be checked whilst driving?

A

every 2 hours.

Exam - M - Diabetes (4 decks)

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