Type 1 diabetes Flashcards
What is type 1 diabetes?
A condition in which the pancreas stops being able to produce adequate insulin
What is hyperglycaemia?
High blood glucose concentrations
What is hypoglycaemia?
Low high glucose concentrations
What is the classic triad of symptoms of hyperglycaemia?
Polyuria
Polydipsia
Weight loss
What is the recommended blood glucose concentration?
Between 4.4 and 6.1mmol/L
Where is insulin produced?
Beta cells in the Islets of Langerhans in the pancreas
What is insulin?
An anabolic hormone that reduces blood sugar levels
What are the two ways in which insulin works?
It causes cells in the body to absorb glucose for fuel
It causes muscle and liver cells to absorb glucose and store it as glycogen (glycogenesis)
Where is glucagon produced?
Alpha cells in the Islets of Langerhans in the pancreas
What is glucagon?
A catabolic hormone released in response to low blood sugar levels and stress
What are the two things that glucagon does?
It tells the liver to break down stored glycogen and release it as glucose (glycogenolysis)
It tells the liver to convert proteins and fats into glucose (gluconeogenesis)
What is the production of ketones called?
Ketogenesis
When does ketogenesis occur?
When there is insufficient glucose supply and glycogen stores and exhausted e.g. prolonged fasting
How are ketones produced?
Fatty acids
How are ketone levels measured in the urine?
Urine dipstick
How are ketone levels measured in the blood?
Ketone meter
What is the characteristic sign of diabetic ketoacidosis?
Acetone smelling breath
What are the common presentations of diabetic ketoacidosis?
Initial presentation of diabetes
Type 1 diabetic who is acutely unwell
Type 1 diabetic who is not adhering to an insulin regime
What are the three key features of diabetic ketoacidosis?
Ketoacidosis
Dehydration
Potassium imbalance
How do kidneys counteract ketone acids in the blood to maintain an normal pH?
They produce bicarbonate which neutralises to acidic ketones
What is the typical presentation of someone with diabetic ketoacidosis?
Polyuria
Polydipsia
Acetone smell to breath
Nausea and vomiting
Altered consciousness / confusion
What three things does a diagnosis of diabetic ketoacidosis require?
Hyperglycaemia - blood glucose of 11mmol/L or more
Ketosis - blood ketones above 3mmol/L
Acidosis - pH below 7.3
What is the initial management of diabetic ketoacidosis?
Use FIG-PICK mnemonic
Fluids - IV saline
Insulin - fixed rate infusion
Glucose - monitor
Potassium - add to IV fluids
Infection - check
Chart fluid balance
Ketones - monitor
What are complications in the management of diabetic ketoacidosis?
Hypoglycaemia
Hypokalaemia
Cerebral oedema
Pulmonary oedema
How is type 1 diabetes managed?
Monitoring dietary carbohydrates
Monitoring blood sugar levels
Subcutaneous insulin
What is lipodystrophy?
Hardening of subcutaneous fat as a result of administering insulin injections into the same spot repeatedly
What is a basal-bolus regime of insulin?
A once-daily long-acting insulin injection combined with short-acting insulin injections 30 minutes before consuming carbohydrates
What is an insulin pump?
A device that continuously infuse insulin to control blood sugar levels
What are some advantages of insulin pumps?
Better blood sugar control
Flexibility with eating
Less injections
What are some disadvantages of insulin pumps?
Continuous attachment
Infusion sets can become blocked
Slightly higher risk of infection
What is HbA1c?
A measure of glycated haemoglobin
(how much glucose is attached to haemoglobin molecules)
What does HbA1c reflect?
The average glucose level over the previous 2-3 months
What is done to measure blood glucose with a monitor?
Capillary blood glucose by finger-prick test
What should always be done if hypoglycaemia is suspected?
Capillary blood glucose testing
What are common symptoms in hypoglycaemia?
Hunger
Tremor
Sweating
Irritability
Dizziness
Pallor
How should hypoglycaemia be treated?
Rapid-acting glucose should be given initially (oral or subcut / IV)
Once the blood glucose rises a slower-acting carbohydrate should be given (biscuits, toast)
Name some macrovascular complications of type 1 diabetes?
Coronary artery disease
Peripheral ischaemia
Diabetic foot ulcers
Stroke
Hypertension
Name some microvascular complications of type 1 diabetes?
Peripheral neuropathy
Retinopathy
Nephropathy
Name some infection-related complications of type 1 diabetes?
Fungal infections - candidiasis
Urinary tract infections
Pneumonia
Skin / soft tissue infections
