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LCRS Endocrinology > Type 1 diabetes > Flashcards

Type 1 diabetes Flashcards

1
Q

What is latent autoimmune diabetes in adults (LADA)?

A

Autoimmune diabetes (type 1) leading to insulin deficiency that presents late (decades)

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2
Q

Which three endocrine diseases does diabetes particularly present after?

A

Phaeochromocytoma
Cushing’s
Acromegaly

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3
Q

What is the aetiology of type 1 diabetes?

A

Normally there is an environmental trigger that occurs in the background of a genetic component which leads to autoimmune destruction of islet cells

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4
Q

What is the aetiology of type 2 diabetes in comparison?

A

There is a much bigger genetic component in type 2, it is also caused by obesity which will lead to insulin resistance so the beta cells will fail

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5
Q

What is a good marker of insulin function?

A

C peptide- it can be measured in blood and is linked with insulin production

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6
Q

Why do some people believe that type 1 diabetes is a relapsing-remitting disease?

A

Over time beta cells reduce then stabilise then reduce again, some believe this is due to an imbalance between effector T cells and regulatory T cells (effectors cause destruction, regulatory control), over time effectors increase and regulatory decrease

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7
Q

What are the histological features of T1DM?

A

There is a lot of lymphocyte infiltration of the beta cells which destroys it so it can no longer release insulin

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8
Q

Where is human leukocyte antigen (HLA) located?

A

Chromosome 6

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9
Q

Which HLA DR alleles confer a particular risk of T1DM?

A

DR3 and DR4

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10
Q

Throughout the year, when does T1DM increase in prevalence?

A

Autumn

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11
Q

Why is T1DM thought to increase in autumn?

A

A pathogen in the air around this time of the year that triggers diabetes

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12
Q

What are the two most significant antibody markers for T1DM?

A

Islet cell antibodies (ICA)- group O human pancreas

Glutamic acid decarboxylase antibodies (GADA)- widespread neurotransmitter

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13
Q

What are the symptoms and signs of T1DM?

A 
Symptoms:
Polyuria
Nocturia
Polydipsia
Blurring of vision
Thrush
Weight loss
Fatigue
Signs:
Dehydration 
Cachexia
Hyperventilation
Smell of ketones
Glycosuria 
Ketonuria
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14
Q

Why do people with type 1 DM have hyperventilation?

A

They have metabolic acidosis so their body tries to get rid of acid by blowing out CO2- this is called Kussmaul breathing

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15
Q

What are the effects of insulin?

A

Decrease:
Hepatic glucose output
Protein breakdown in muscle
Glycerol being taken out from the fatty tissue into the periphery

Increase:
Glucose being taken up by muscle

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16
Q

What happens in insulin deficiency?

A

Lot of glucose goes into circulation but isn’t taken up by tissues

17
Q

What hormones increase hepatic glucose output?

A

Catecholamines
Cortisol
Glucagon
Growth hormone

18
Q

How does diabetic ketoacidosis occur?

A

Glucose isn’t taken up by cells so a lot of our energy comes from fatty acids so the lipid in adipocytes is broken down to fatty acids which enters circulation and are converted to ketones in the liver (this process is normally inhibited by insulin)

19
Q

Wha defines insulin deficiency?

A

Ketones

20
Q

What are the long term complications of T1DM?

A

Retinopathy
Nephropathy
Neuropathy
Vascular disease

21
Q

What sort of diet is recommended for someone with type 1 DM?

A

Reduce calories as fat
Reduce calories as refined carbohydrates
Increase calories as complex carbohydrates
Increase soluble fibre
Balance food distribution throughout the day

22
Q

Apart from insulin treatment, how can T1DM be treated?

A

Islet cell transplants-
Cells are isolated, harvested and injected into liver
Risk of rejection so on immunosuppressants for life

23
Q

How are glucose levels in a diabetes patient often measured?

A

Capillary blood glucose levels can be measured using a finger prick test which is reflective of venous blood glucose and patients can use this to titrate their own insulin

24
Q

What is HbA1c used for?

A

HbA1c is used as a long term blood glucose control marker over the last 3 months (as red cell lifespan is about 120 days)

25
Q

What HbA1c should you aim for in T1DM?

A

<7% (lower=less risk of complication particularly microvascular)

26
Q

When would HbA1c be inaccurate?

A

If anything causes increased turnover of haemoglobin (e.g. haemolytic anaemia or haemoglobinopathy)

27
Q

What is the main acute complication of T1DM?

A

Hyperglycaemia

28
Q

What are other acute complications of T1DM?

A

Metabolic acidosis
Circulating acetoacetate and hydroxybutyrate
Osmotic dehydration and poor tissue perfusion

29
Q

What is the definition of hypoglycaemia?

A

Plasma glucose < 3.6mmol/l

30
Q

What is severe hypoglycaemia?

A

Anything that requires someone to treat it

31
Q

What happens when blood glucose is < 3mmol/l?

A

Most mental processes impaired

32
Q

What happens when blood glucose is < 2mmol/l?

A

Consciousness impaired

33
Q

What happens with recurrent hypos?

A

Loss of warnings- hypoglycaemia unawareness

34
Q

What is the main risk factor of hypoglycaemia in T1DM patients?

A

Quality of glycemic control- most frequent in patients with low HbA1c

35
Q

When are hypos most common?

A

Pre lunch and nocturnal

36
Q

Why do T1DM patients become hypoglycaemic?

A 
Unaccustomed exercise
Missed meals
Inadequate snacks
Alcohol
Poor insulin regime
37
Q

What are the signs and symptoms of hypoglycaemia?

A 
Palpitations
Tremor
Sweating
Pallor/cold extremities
Anxiety
Drowsiness
Confusion
Altered behaviour
Focal neurology
Coma
38
Q

How do you treat hypoglycaemia?

A

Oral- feed the patient:
Glucose- rapidly absorbed as solution or tablets
Complex carbohydrates- maintain blood glucose after treatment

Parenteral- if consciousness impaired:
IV dextrose- 10% glucose infusion
1mg glucagon IM

LCRS Endocrinology (18 decks)

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