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Endocrinology > Type 1 diabetes > Flashcards

Type 1 diabetes Flashcards

1
Q

What ages are affected by T1DM?

A

Young

Ages 0-4/10-14

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2
Q

What is the BMI of T1DM patients?

A

Normal/Low

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3
Q

What may you find on urinalysis in T1DM?

A

Ketones +++

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4
Q

What is the acute presentation of T1DM?

A

DKA

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5
Q

What antibodies will you look for if unsure of T1DM?

A

GAD65/IA2 Ab

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6
Q

What levels of C-peptide will you have in T1DM at diagnosis?

A

Low (but variable)

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7
Q

What levels of C-peptide will you have in T1DM at 5 years post diagnosis?

A

Absent

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8
Q

Why do levels of C-peptide move from low to absent in T1DM?

A

Natural history and disease progression

Reducing beta cell function

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9
Q

What microvascular complications are present in T1DM?

A

None

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10
Q

What symptoms occur in T1DM?

A 
Weight loss
Polydipsia
Polyuria
Fatigue
Somnolence 
Blurred vision
Candidal infection
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11
Q

What candidal infections occur in T1DM?

A

pruritus vulvae

balantitis

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12
Q

What glucose levels confirm diabetes? a) fasting b) random

A

a) 7+

b) 11.1

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13
Q

What would T1DM islets look like under the microscope histologically?

A

Purple lymphocytes

Attacking islets

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14
Q

What are the anti islet cells antibodies?

A

IA2
GAD65
IAA
ZnT8

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15
Q

What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of IA2 Ab?

A

a) islet antigen 2
b) 60-70%
c) Unknown
d) reduces with age, more males

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16
Q

What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of GAD65 Ab?

A

a) Glutamic acid decarboxylase
b) 70-80%
c) GABA production
d) increases with age (<10), more females

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17
Q

What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of IAA Ab?

A

a) Insulin
b) 50%
c) regulation of glucose
d) more in children M=F

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18
Q

What is the a) antigen b) occurrence at diagnosis c) function of antigen d) age and gender association of ZnT8 Ab?

A

a) ZnT8 transporter
b) 60-80%
c) Zn function in beta cell
d) more in older population M=F

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19
Q

What is the definition of T1DM?

A

Absolute insulin deficiency from autoimmune attack of beta cells

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20
Q

Which HLA types show increased risk of T1DM?

A

HLA DR3-DQ2

HLA DR4-DQ8

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21
Q

What are the risk factors for pre clinical T1DM?

A

Viral infection!
Vitamin D deficiency
Dietary/environmental

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22
Q

What risk factors can induce T1DM?

A

Puberty (stress hormones)
Weight
Infection
Insulin resistance

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23
Q

What autoimmune conditions can be associated with T1DM?

A 
Thyroid disease
Coeliac 
Pernicious anaemia 
Addison's
IgA Deficiency
Autoimmune polyglandular syndrome
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24
Q

How is T1DM treated?

A

Insulin

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25
Q

What things are monitored in a yearly diabetic review?

A 
Weight 
Blood Pressure
HbA1c
Retinal screening 
Foot screening 10 microgram monofilament
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26
Q

What should be monitored all the time in T1DM management?

A 
Blood glucose
Ketones
CHO estimation
Insulin 
Record of hypos/DKA
27
Q

What tools are available for patient monitoring?

A

Blood glucose at home

Ketones/urinalysis

28
Q

What does HbA1c measure?

A

Glycalated haemoglobin

29
Q

Why is HbA1c important in diabetes?

A

Increases in response to prevailing high blood glucose levels

30
Q

What factors can influence HbA1c?

A

Pregnancy
Haemolytic anaemia
Chronic/acute blood loss

31
Q

What is the target HbA1c for diabetic patients? Are there any exceptions?

A

53mmol/mol

Older population may be higher

32
Q

What are the disadvantages of measuring HbA1c?

A

Only getting brief screenshots, not whole picture

33
Q

What adjunct therapies may patients use in T1DM?

A 
Ketone meter (detects early ketone formation)
Continuous glucose monitor
34
Q

What are the symptoms of hyperglycaemia?

A 
Thirst 
Fatigue
Polyuria
Blurred vision
Nocturia
Weight loss
Candidiasis
Reduced mood
Cognitive impairment
35
Q

What blood test are needed to diagnose DKA?

A

Ketones
Glucose
Bicarbonate

36
Q

What level on ketones would suggest DKA?

A

> 3mmol/l or >2+ urinalysis

37
Q

What level of blood gucose would suggest DKA?

A

> 11 mmol/mol

or known DM

38
Q

What levels of bicarbonate would suggest DKA?

A

<7.3 (ie acidosis)

39
Q

What are the symptoms of DKA caused by osmotic changes?

A

Thirst
Polyuria
Dehydration

40
Q

What are the symptoms of DKA caused by ketone body formation?

A 
Flushing
Vomiting 
Abdo pain
Kassmaul breathing 
Smell of ketones
41
Q

What causes DKA?

A

Absolute insulin deficiency

Stress hormones

42
Q

What are the stress hormones?

A

Cortisol
Growth Hormone
Glucagon
Adrenaline

43
Q

How does acidosis happen in DKA?

A

Increased lipolysis
Increased free fatty acids to liver
Increased ketogenesis
Leads to acidosis (lactate)

44
Q

Why does hyperglycaemia happen in DKA?

A

Less glucose utilised
Less proteolysis
Increased glycogenesis in liver

45
Q

How does hyperosmolarity happen in DKA?

A

Hyperglycaemia causes glycosuria
Electrolyte loss causes dehydration
Leads to hyperosmolarity

46
Q

What ketone is found in blood?

A

Beta-hydroxybutarate

47
Q

What ketone is found in the urine?

A

Acetoacetate

48
Q

What are the range of glucose levels in DKA?

A

10-100

40 median

49
Q

When would blood glucose be 10 in DKA?

A

euglycaemic DKA

50
Q

What are the levels of a) creatinine b) lactate c) bicarbonate d) sodium e) potassium in DKA?

A

a) raised
b) raised
c) reduced
d) reduced
e) raised (more than 5.5)

51
Q

How is DKA managed?

A

Replace losses; fluid (1L saline over 1hr), insulin (6 Units), potassium
Address risks; monitor K, prophylactic LMWH

52
Q

What fluids are given in DKA management?

A

0.9% saline

dextrose when glucose reaches 9-14

53
Q

What are the symptoms of hypoglycaemia?

A 
Pallor
Sweating
Tremor
Anxious
Palpitations
Confusion
Nausea
Hunger
Irritable
Post hypo headache
54
Q

What blood glucose level does glucagon and adrenaline set in for hypoglycaemia?

A

3.8 mmol

55
Q

What blood glucose level will symptoms of hypoglycaemia occur?

A

3.0mmol

56
Q

When will congitive impairment happen in hypoglycaemia?

A

2.8mmol

57
Q

What can cause reduced hypoglycaemic awareness?

A

Frequent hypos
3.5mmol - 4.0mmol
Long duration of DM
Intensively treated T1DM

58
Q

How do you treat a hypoglycaemic attack?

A

15g of simple CHO
Recheck blood glucose in 15 mins
Continued low blood sugar then another 15g
Small snack if next meal >2hrs away

59
Q

What is equivalent to 15g CHO?

A

glucose tablets
glucose gel tube
1-2 cup fizzy drink (no diet)
1tbsp sugar/honey

60
Q

What should be administered in severe hypo?

A

1mg glucagon injection into arm/thigh/buttock

61
Q

What may occur when patient recovers from severe hypo?

A

Nausea and vomiting

62
Q

What is the most common symptom of T1DM in children?

A

nocturnal enuresis

63
Q

How is management of DKA different in under 16yrs

A

based on weight
careful fluid resuss
risk of cerebral oedema
insulin commenced 1 hr after IV fluids

Endocrinology (17 decks)

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