Type 1 Diabetes Flashcards

1
Q

diabetes mellitus?

A

chronic condition with abnormally raised levels of blood glucose

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2
Q

what does Type 1 result in?

A

absolute deficiency in insulin- may present in diabetic ketoacidosis

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3
Q

type 2?

A

relative deficiency of insulin due to an excess of adipose tissue

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4
Q

what may trigger type 1 diabetes?

A

coxsackie B and enterovirus

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5
Q

classic triad of type 1?

A

polydipisia
polyuria
weight loss

diabetic ketoacidosis

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6
Q

blood glucose ideally should be?

A

4.4- 6.1 mmol/L

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7
Q

how does insulin work?

A

absorb glucose from blood,
muscle and liver cells to store it as glycogen

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8
Q

what does glucagon do?

A

glycogenolysis
gluconeogenesis

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9
Q

when do you get ketogenesis?

A

prolonged fasting

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10
Q

in type 1 diabetes what can you get?

A

metabolic acidosis

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11
Q

Key features about diabetic ketoacidosis?

A

ketoacidosis, dehydration potassium imbalance

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12
Q

to combat the ketones the kidneys will produce?

A

bicarbonate

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13
Q

what does insulin do?

A

drive potassium into cell, hence high serum potassium but total body potassium is low

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14
Q

when insulin treat starts people may develop?

A

hypokalaemia, and so arrhythmias

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15
Q

presentation of diabetic ketoacidosis?

A

hyperglycaemia
potassium imbalance
metabolic acidosis (low bicarbonate)
ketosis
dehydration

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16
Q

symptoms of diabetic ketoacidosis?

A

polyuria, polydipsia, n/v, weight loss, actone smelling breath, dehydration, hypotension, altered consciousness, abdominal pain kussmal respiration (deep hyperventilation)

17
Q

diagnosing ketoacidosis requires 3 criterion?

A

hyperglycaemia ( above 11mmol/L)
ketosis (ketones above 3mmol/L)
acidosis (below 7.3)

18
Q

management of DKA?

A

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

19
Q

dont stop fluids and insulin until?

A

ketosis, acidosis have resolved, they are eating/drinking, subcut insulin started

20
Q

key complications with treatment of DKA?

A

hypoglycaemia
hypokalaemia
cerebral oedema
pulmonary oedema

21
Q

normal rate of k infusion compared to DKA?

A

not exceed 10mmol/hour but in DKA can go up to 20

22
Q

autoantibodies in type 1?

A

anti-islet cell
anti- GAD
anti- insulin

serum c peptide is low with low insulin

23
Q

Long term management of type 1?

A

basal/bolus or pump

24
Q

injecting into same space can cause?

A

lipodystrophy- subcut fat hardens

25
Q

symptoms of hypoglycaemia?

A

sweating, tremor, irritability, hunger, dizziness pallor

26
Q

treatment of severe hypoglycaemia?

A

im glucagon, or iv dextrose

27
Q

macrovascular complication?

A

CAD, peripheral ischaemia (diabetic foot ulcers), stroke, HTN

28
Q

microvascular complications?

A

peripheral neuropathy, retinopathy, kidney disease glomerulosclerosis

29
Q

infection related complication?

A

UTI, pneumonia, skin and soft tissue, fungal infection oral and vaginal candidiasis

30
Q

diagnosis for type 1?

A

fasting glucose more than 7 or equal
random glucose more or equal to 11.1

31
Q

diagnosis criteria for type 1?

A

ketosis
age below 50
bmi below 25
rapid weight loss
personal FH

32
Q

if doubt between type 1 and 2 investigation of choice?

A

c-peptide levels, diabetes- specific autoantibodies

33
Q

How often should HbA1c be monitored?

A

3-6 months 48 mmol/mol or lower

34
Q

self monitoring for type 1?

A

x4 a day

35
Q

blood glucose targets on waking and before meals?

A

waking- 5-7
before meals 4-7

36
Q

when to add metformin for type 1?

A

if bmi over equal to 25

37
Q

type of insulin?

A
  1. 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
  2. twice‑daily insulin detemir is the regime of choice. Once-daily insulin glargine or insulin detemir is an alternative
  3. 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
38
Q

specific features of DKA?

A

kussmaul respiration (deep hyperventilation)
acetone smelling breath