Type 1 diabetes Flashcards
What is type 1 diabetes?
Characterised by hyperglycaemia, together with disturbances of carbohydrate, fat and protein metabolism resulting from defect in insulin secretion
What causes type 1DM?
Genetic and environmental triggers
HLA molecules launch an autoimmune attack on pancreatic beta cells
Environmental triggers stimulate the autoimmune attack
What are some signs and symptoms of T1DM?
Thirst
Tired
Thinner
Toilet more- bed wetting in previously dry child
Recurrent infections- candida, skin and UTIs
What is the presentation of T1DM in under 5s?
Heavier than usual nappies Blurred vision Constipation Irritability Behaviour change
What investigations are doe for T1DM?
Random blood glucose >11= same day review
Fasting blood glucose >7
OGTT >11.1
How is T1DM diagnosed?
One diagnostic lab glucose plus symtoms
2 diagnostic glucose without symptoms
What is the management of T1DM?
Insulin injections
What are the types of insulin?
Soluble- associated into hexameters so give 30 mins before eating to give time to dissociate
Rapid acting analogues
Long acting- basal
What is the management of hypoglycaemia?
15-20g simple carb if able
Unable= 1mg IM glucagon, glycogel/dextrogel
What is the management of hypoglycaemia in hospital?
75-80ml 20% IV glucose or 25-50ml IV dextrose
What is DKA?
Biochemical triad of hyperglycaemia
Ketonaemia
Acidaemia
What is the pathophysiology of DKA?
Low insulin –> increased gluconeogeness and decreased peripheral glucose utilisation –> hyperglycaemia
Decreased insulin –> uncontrolled lipolysis –> excessive free fatty acids –> excessive ketones
What is the presentation of DKA?
Abdo pain N&V Polyuria, polydipsia, dehydration Deep hyperventilation- Kussmaul respiration, sighing Pear drop breath
What investigations are done in DKA?
Glucose >11
pH <7.3
Bicarb <15
Ketones >3, or urine ++
What is the management of DKA?
Fluid replacement 0.9% saline +/- K
IV insulin
-if glucose >15=0.1unit/kg/hr
-if glucose <15=0.1/kg/hr plus 5% dextrose
