Type 1 Diabetes Flashcards
What is type 1 diabetes?
absolute insulin deficiency
What two factors result in the onset of T1DM?
- genetic susceptibility
- environmental trigger
Name some environmental triggers
- Diet
- Environmental toxin
- Viral infection
What autoantibodies are associated with T1DM?
Anti GAD
Anti IA2
Anti ZnT8
Describe the progression from trigger to diagnosis
- Exposure to trigger
- Production of autoantibodies
- Inflammation of beta cells (insulinitis)
- Destruction of beta cells
- Insulin deficiency
What percentage of risk is related to genetics?
1/3
If your parent has type 1 diabetes what is the chance of you developing it?
25%
Describe the typical presentation of type 1 diabetes
‘toilet, thirst, thinner, tired’, usually presents with severe symptoms, often acute onset (30% kids have DKA at presentation)
What investigations are carried out for suspected T1DM?
- random plasma glucose/2 hour OGTT plasma glucose >11
- fasting plasma glucose >6.1
- urinalysis (ketones)
- Blood test for autoantibodies
Describe the test that portrays long term glucose control
HbA1c - glycosylated haemoglobin - haemoglobin is exposed to glucose over lifespan of RBC so reflects long term control (6-8 weeks)
State three key aims of treatment
- prevent hyperglycaemia
- avoid hypoglycaemia
- reduce chronic complications
What is the normal insulin physiology?
Insulin is secreted at a low basal rate which accounts for 50% of insulin produced. Post-prandial insulin is secreted in relation to post-meal glucose
State the target HbA1c
48-59
Name three short acting insulins
Humulin, Homolog, Novorapid
Name two long acting insulins
lantus, lenevinir
Name a mixed solution
Novomix
What are the two options for insulin administration?
Biphasic & basal bolus
Describe basal bolus administration
Take long acting before bed and then short acting before each meal. Good for young/active people with varied lifestyle.
Describe bi-phasic insulin administration
2 injections of mixed insulin at breakfast & dinner - less flexible and requires regular diet & lifestyle
What are the two general types of insulin used?
Human & Analogue (most commonly used in UK)
State the target blood glucose levels
- 3.9 - 7.2 mmol/l pre meal
- <10mmol/l 1-2 hours after start of meal
Describe advanced carbohydrate counting
synchronising the amount of insulin taken to amount of carbs consumed
Who is suitable for ACC?
Patients with an insulin pump or on multiple daily injections
How do insulin pumps work?
Deliver continuous short acting insulin (basal). Manually activated bolus of insulin is given to cover meals - calculated by carbohydrate counting
What factors affect absorption/action of insulin?
- temperature
- injection site
- injection depth
- exercise
Why is it important to rotate injection site?
To avoid lipohypertrophy which will mean insulin is not absorbed
What is involved in the long term management of T1DM?
- HbA1c checks
- weight
- blood pressure
- renal function/lipids
- retinal screening
- foot risk assessment
- DKA/hypo monitoring
