Type 1 Diabetes Flashcards
What is Type 1 diabetes characterised as?
An autoimmune disorder causing pancreatic beta-cell destruction (absolute insulin deficiency)
What is the classic clinical presentation for T1DM?
Pre-school and peri-puberty, usually lean, acute, severe weight loss, ketonuria, candidal infection, 4T’s - toilet, thirsty, tired, thinner
What is the classic triad of symptoms in T1DM?
Polyuria (frequent peeing), polydipsia (thirstiness) and weight loss
What is the pathogenesis of Type 1 DM?
Which auto-antibodies are associated with Type 1 Diabetes?
Glutamic acid decarboxylase (GAD 65Ab), Islet-antigen 2 (IA-2Ab), Insulin (IAA) and ZnT8 transporter
What auto-immune conditions are associated with T1DM?
• Thyroid disease • Coeliac disease • Pernicious Anaemia • Addison’s disease • Polyglandular Endocrinopathy
Which genes are associated with Type 1 Diabetes?
Human Leukocyte Antigen (HLA)
When should you question diagnosis of T1DM in youth?
- Diabetes diagnosed < 6 months (?neonatal) - Family history of DM [parent] (?MODY) - Detectable insulin production ≥ 3 years after diagnosis - Undetectable pancreatic antibodies {at diagnosis}
What are the 2 main components of normal insulin secretion?
Basal secretion and prandial responses (post-meals)
In normal insulin secretion, what is the normal insulin response to meals?
Biphasic: 1) Rapid phase of pre-formed insulin lasts 5 to 10 mins 2) Slow phase over 1 to 2 hours.
What kind of insulin are Homalog, Novorapid and apidra examples of?
Rapid-acting analogue
What kind of insulin are Humulin S, Actrapid and Insuman Rapid examples of?
Short-Acting (soluble/regular)
What kind of insulin are Insulatard, Humulin I and Insuman basal examples of?
Intermediate (Isophane - Basal)
What kind of insulin are Lantus, Levemir or Degludec examples of?
Long acting analogue
What kind of insulin are Homalog Mix 25/50 or NovoMix 30 examples of?
Rapid acting analogue-intermediate mixture
What kind of insulin are Humulin M3 or Insuman Comb 15/25/50 examples of?
Short acting-intermediate mixture
What ratio should insulin regime be divided between prandial and basal?
50/50
How do insulin pumps work?
Continuous administration of short acting insulin subcutaneously. 1) Deliver background insulin dictated by BASAL rate - programmed in advance and may be set to different rates at different times of the day. 2) Deliver manually activated BOLUS’ of insulin to cover meals (calculated by CHO counting)
In what ways can metabolic control be evaluated?
- Home Blood Glucose Monitoring (fingersticking) - Urine Testing (Glucose/ Ketones) - Glycated Hemoglobin (HbA1C) - Continuous glucose monitor - ideal
What factors limit insulin injection/pumps vs the natural system?
• Enters subcutaneous tissue rather than direct to blood stream • Peak too slow to prevent post-meal hyperglycaemic spike • Slow clearance
When should IV insulin be given?
- Diabetic Ketoacidosis (DKA) - Hyperosmolar Hyperglycaemic State (HHS) - Acute illness - Fasting patients who are unable to tolerate oral intake
When are Pancreatic Islet transplantations indicated?
• Episodes of severe hypoglycaemia • Severe and progressive long-term complications despite maximal therapy • Uncontrolled diabetes despite maximal treatment
