Type 1 Diabetes Flashcards
What are possible environmental triggers for type 1 diabetes?
viral infection; maternal factors; weight gain; vitamin D deficiency; dietary factors; environmental toxins
What antigens with which auto-antibodies are formed against in type 1?
glutamine acid decaroxylase
islet-antigen 2
insulin
ZnT8 transporter
What are the auto-antibodies in type 1?
GAD65Ab
IA-2Ab
IAA
ZnT8Ab
What are the accelerating factors for diabetes?
infection; insulin resistance; puberty; diet/weight; stress
What are the features of type 1 diabetes?
raised glucose; ketones; decreased insulin; decreased beta cell mass; decreased C-peptide
What are the typical presenting symptoms of type 1 diabetes?
polyuria (enuresis in children); polydipsia; weight loss; fatigue and somnelence; blurred vision; candidal infection
What is the ideal range of HbA1c?
48 to 58 mmol/mol
What are the two phases of insulin secretion?
rapid phase of pre-formed insulin and slow phase over 1 to 2 hours
What vessel is insulin secreted into?
portal vein
What type of diabetes should you suspectin a patient under the age of 6?
monogenic diabetes
What is LADA?
latent onset diabetes of adulthood
How is a diagnosis of LADA made?
the presence of elevated levels of pancreatic auto-antibodies in patients who do not initially require insulin
Who gets LADA?
young adults 25-40; male; usually non-obese
How many patients with CF get diabetes?
more than 25% will have a 20 years
What is Wolfram syndrome?
DIDMOAD Diabetes Insipidus Diabetes MEllitus Optic Atrophy Deafness
What are the features of bardet-beidl syndrome?
very obese; polydactyly; hypogonadal; visual impairment; hearing impairment; mental retardation; diabetes
What are the associated auto-immune conditions with type 1?
thyroid disease; coeliac disease; pernicious anaemia; addisons disease; IgA deficiency
How is coeliac disease diagnosed?
anti-TTG antibodies; duodenal biopsy
What are the symtoms of thyroid disease?
wegith change; deterioration in HbA1c; hypoglycasemia
What is polyglandular endocrinopathy?
The polyglandular autoimmune syndromes (PAS) form
different clusters of autoimmune disorders and are
rare endocrinopathies characterized by the coexistence
of at least two glandular autoimmune mediated
diseases
What are the symptoms of hypoglycaemia?
pallor; sweating; tremor; palpitations; confusion; nausea; hunger
What are the symtpoms of hyperglycaemia?
thrist; tiredness; blurred vision; weight loss; polyuria; nocturia; fungal infections
What percentage of insulin produced does the basal rate of insulin account for?
50%
Give examples of rapid-acting analogues?
humalog; novorapid; apidra
Give examples of long acting analogues?
lantus; levemir
How should most people with type 1 diabetes be treated?
with MDI or CSII
What is the initial amount of insulin given to a patient?
0.3units/kg of body weight
What is the target for blood glucose before a meal?
3.9-7.2
What is the blood glucose target 1-2 hours after beginning of meal?
<10mmol/l
How long do insulin analogues take to act?
10-15 minutes
What is onset of action of soluble insulin?
30-60 minutes
What is advanced carbohydrate counting?
synchronising the amount of insulin to amount of carbohydrate consumed
What do insulin pumps deliver?
continuous administration of short acting insulin subcutaenously
How is glycated haemoglobin formed?
by non-enzymatic glycation of haemoglobin on exposure to glucose
What factors can affect insulin absorption/action?
tempreature; injection site; injection depth; exercise
Do you stop insulin if patient has a hypo?
No- treat hypo and administer insulin as normal
What should also be given with IV insulin infusions?
glucose
Who is given IV insulin?
DKA; in hyperosmolar hyperglycaemic state; acute illness; fasting patients who are unable to tolerate oral intake
What is the blood glucose level aimed for with IV insulin?
5-12 mmol
How often should patients on IV insulin have their blood glucose checked?
hourly
