Type 1 Diabetes Flashcards
diabetes mellitus?
chronic condition with abnormally raised levels of blood glucose
what does Type 1 result in?
absolute deficiency in insulin- may present in diabetic ketoacidosis
type 2?
relative deficiency of insulin due to an excess of adipose tissue
what may trigger type 1 diabetes?
coxsackie B and enterovirus
classic triad of type 1?
polydipisia
polyuria
weight loss
diabetic ketoacidosis
blood glucose ideally should be?
4.4- 6.1 mmol/L
how does insulin work?
absorb glucose from blood,
muscle and liver cells to store it as glycogen
what does glucagon do?
glycogenolysis
gluconeogenesis
when do you get ketogenesis?
prolonged fasting
in type 1 diabetes what can you get?
metabolic acidosis
Key features about diabetic ketoacidosis?
ketoacidosis, dehydration potassium imbalance
to combat the ketones the kidneys will produce?
bicarbonate
what does insulin do?
drive potassium into cell, hence high serum potassium but total body potassium is low
when insulin treat starts people may develop?
hypokalaemia, and so arrhythmias
presentation of diabetic ketoacidosis?
hyperglycaemia
potassium imbalance
metabolic acidosis (low bicarbonate)
ketosis
dehydration
symptoms of diabetic ketoacidosis?
polyuria, polydipsia, n/v, weight loss, actone smelling breath, dehydration, hypotension, altered consciousness, abdominal pain kussmal respiration (deep hyperventilation)
diagnosing ketoacidosis requires 3 criterion?
hyperglycaemia ( above 11mmol/L)
ketosis (ketones above 3mmol/L)
acidosis (below 7.3)
management of DKA?
F- fluids iv normal saline 1 litre first hour then 1 litre for 2 hours
I- insulin actrapid 0.1 units/kg/hour
G- glucose if below 14mmol/L
P- potassium
I- infection
C- chart fluid balance
K- ketones monitor alongside pH and bicarbonate
dont stop fluids and insulin until?
ketosis, acidosis have resolved, they are eating/drinking, subcut insulin started
key complications with treatment of DKA?
hypoglycaemia
hypokalaemia
cerebral oedema
pulmonary oedema
normal rate of k infusion compared to DKA?
not exceed 10mmol/hour but in DKA can go up to 20
autoantibodies in type 1?
anti-islet cell
anti- GAD
anti- insulin
serum c peptide is low with low insulin
Long term management of type 1?
basal/bolus or pump
injecting into same space can cause?
lipodystrophy- subcut fat hardens
symptoms of hypoglycaemia?
sweating, tremor, irritability, hunger, dizziness pallor
treatment of severe hypoglycaemia?
im glucagon, or iv dextrose
macrovascular complication?
CAD, peripheral ischaemia (diabetic foot ulcers), stroke, HTN
microvascular complications?
peripheral neuropathy, retinopathy, kidney disease glomerulosclerosis
infection related complication?
UTI, pneumonia, skin and soft tissue, fungal infection oral and vaginal candidiasis
diagnosis for type 1?
fasting glucose more than 7 or equal
random glucose more or equal to 11.1
diagnosis criteria for type 1?
ketosis
age below 50
bmi below 25
rapid weight loss
personal FH
if doubt between type 1 and 2 investigation of choice?
c-peptide levels, diabetes- specific autoantibodies
How often should HbA1c be monitored?
3-6 months 48 mmol/mol or lower
self monitoring for type 1?
x4 a day
blood glucose targets on waking and before meals?
waking- 5-7
before meals 4-7
when to add metformin for type 1?
if bmi over equal to 25
type of insulin?
- offer multiple daily injection basal–bolus insulin regimens, rather than twice‑daily mixed insulin regimens, as the insulin injection regimen of choice for all adults
- twice‑daily insulin detemir is the regime of choice. Once-daily insulin glargine or insulin detemir is an alternative
- offer rapid‑acting insulin analogues injected before meals, rather than rapid‑acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes
specific features of DKA?
kussmaul respiration (deep hyperventilation)
acetone smelling breath
