Type 1 diabetes Flashcards
What ages are affected by T1DM?
Young
Ages 0-4/10-14
What is the BMI of T1DM patients?
Normal/Low
What may you find on urinalysis in T1DM?
Ketones +++
What is the acute presentation of T1DM?
DKA
What antibodies will you look for if unsure of T1DM?
GAD65/IA2 Ab
What levels of C-peptide will you have in T1DM at diagnosis?
Low (but variable)
What levels of C-peptide will you have in T1DM at 5 years post diagnosis?
Absent
Why do levels of C-peptide move from low to absent in T1DM?
Natural history and disease progression
Reducing beta cell function
What microvascular complications are present in T1DM?
None
What symptoms occur in T1DM?
Weight loss Polydipsia Polyuria Fatigue Somnolence Blurred vision Candidal infection
What candidal infections occur in T1DM?
pruritus vulvae
balantitis
What glucose levels confirm diabetes? a) fasting b) random
a) 7+
b) 11.1
What would T1DM islets look like under the microscope histologically?
Purple lymphocytes
Attacking islets
What are the anti islet cells antibodies?
IA2
GAD65
IAA
ZnT8
What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of IA2 Ab?
a) islet antigen 2
b) 60-70%
c) Unknown
d) reduces with age, more males
What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of GAD65 Ab?
a) Glutamic acid decarboxylase
b) 70-80%
c) GABA production
d) increases with age (<10), more females
What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of IAA Ab?
a) Insulin
b) 50%
c) regulation of glucose
d) more in children M=F
What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of ZnT8 Ab?
a) ZnT8 transporter
b) 60-80%
c) Zn function in beta cell
d) more in older population M=F
What is the definition of T1DM?
Absolute insulin deficiency from autoimmune attack of beta cells
Which HLA types show increased risk of T1DM?
HLA DR3-DQ2
HLA DR4-DQ8
What are the risk factors for pre clinical T1DM?
Viral infection!
Vitamin D deficiency
Dietary/environmental
What risk factors can induce T1DM?
Puberty (stress hormones)
Weight
Infection
Insulin resistance
What autoimmune conditions can be associated with T1DM?
Thyroid disease Coeliac Pernicious anaemia Addison's IgA Deficiency Autoimmune polyglandular syndrome
How is T1DM treated?
Insulin
What things are monitored in a yearly diabetic review?
Weight Blood Pressure HbA1c Retinal screening Foot screening 10 microgram monofilament
What should be monitored all the time in T1DM management?
Blood glucose Ketones CHO estimation Insulin Record of hypos/DKA
What tools are available for patient monitoring?
Blood glucose at home
Ketones/urinalysis
What does HbA1c measure?
Glycalated haemoglobin
Why is HbA1c important in diabetes?
Increases in response to prevailing high blood glucose levels
What factors can influence HbA1c?
Pregnancy
Haemolytic anaemia
Chronic/acute blood loss
What is the target HbA1c for diabetic patients? Are there any exceptions?
53mmol/mol
Older population may be higher
What are the disadvantages of measuring HbA1c?
Only getting brief screenshots, not whole picture
What adjunct therapies may patients use in T1DM?
Ketone meter (detects early ketone formation) Continuous glucose monitor
What are the symptoms of hyperglycaemia?
Thirst Fatigue Polyuria Blurred vision Nocturia Weight loss Candidiasis Reduced mood Cognitive impairment
What blood test are needed to diagnose DKA?
Ketones
Glucose
Bicarbonate
What level on ketones would suggest DKA?
> 3mmol/l or >2+ urinalysis
What level of blood gucose would suggest DKA?
> 11 mmol/mol
or known DM
What levels of bicarbonate would suggest DKA?
<7.3 (ie acidosis)
What are the symptoms of DKA caused by osmotic changes?
Thirst
Polyuria
Dehydration
What are the symptoms of DKA caused by ketone body formation?
Flushing Vomiting Abdo pain Kassmaul breathing Smell of ketones
What causes DKA?
Absolute insulin deficiency
Stress hormones
What are the stress hormones?
Cortisol
Growth Hormone
Glucagon
Adrenaline
How does acidosis happen in DKA?
Increased lipolysis
Increased free fatty acids to liver
Increased ketogenesis
Leads to acidosis (lactate)
Why does hyperglycaemia happen in DKA?
Less glucose utilised
Less proteolysis
Increased glycogenesis in liver
How does hyperosmolarity happen in DKA?
Hyperglycaemia causes glycosuria
Electrolyte loss causes dehydration
Leads to hyperosmolarity
What ketone is found in blood?
Beta-hydroxybutarate
What ketone is found in the urine?
Acetoacetate
What are the range of glucose levels in DKA?
10-100
40 median
When would blood glucose be 10 in DKA?
euglycaemic DKA
What are the levels of a) creatinine b) lactate c) bicarbonate d) sodium e) potassium in DKA?
a) raised
b) raised
c) reduced
d) reduced
e) raised (more than 5.5)
How is DKA managed?
Replace losses; fluid (1L saline over 1hr), insulin (6 Units), potassium
Address risks; monitor K, prophylactic LMWH
What fluids are given in DKA management?
0.9% saline
dextrose when glucose reaches 9-14
What are the symptoms of hypoglycaemia?
Pallor Sweating Tremor Anxious Palpitations Confusion Nausea Hunger Irritable Post hypo headache
What blood glucose level does glucagon and adrenaline set in for hypoglycaemia?
3.8 mmol
What blood glucose level will symptoms of hypoglycaemia occur?
3.0mmol
When will congitive impairment happen in hypoglycaemia?
2.8mmol
What can cause reduced hypoglycaemic awareness?
Frequent hypos
3.5mmol - 4.0mmol
Long duration of DM
Intensively treated T1DM
How do you treat a hypoglycaemic attack?
15g of simple CHO
Recheck blood glucose in 15 mins
Continued low blood sugar then another 15g
Small snack if next meal >2hrs away
What is equivalent to 15g CHO?
glucose tablets
glucose gel tube
1-2 cup fizzy drink (no diet)
1tbsp sugar/honey
What should be administered in severe hypo?
1mg glucagon injection into arm/thigh/buttock
What may occur when patient recovers from severe hypo?
Nausea and vomiting
What is the most common symptom of T1DM in children?
nocturnal enuresis
How is management of DKA different in under 16yrs
based on weight
careful fluid resuss
risk of cerebral oedema
insulin commenced 1 hr after IV fluids
