Type 1 diabetes Flashcards

1
Q

Ideal blood glucose concentration

A

4.4 - 6.1mmol/l

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2
Q

What is insulin?

A

hormone produced by pancreas to reduce blood sugar levels

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3
Q

what cells produce insulin?

A

pancreatic beta cells in islets of langerhans

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4
Q

Is insulin a catabolic or anabolic hormone?

A

anabolic

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5
Q

How does insulin reduce blood glucose?

A

muscle and liver to store glucose as glycogen

causes cells in body to absorb glucose and use as fuel

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6
Q

What is glucagon?

A

hormone produced by pancreas that increases blood sugar levels

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7
Q

what cells produce glucagon?

A

alpha cells in islets of langerhans in pancreas

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8
Q

is glucagon a catabolic or anabolic hormone?

A

catabolic

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9
Q

when is glucagon released?

A

low blood sugar levels and stress

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10
Q

actions of glucagon

A

liver break down glycogen

liver convert fats and protein into glucose

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11
Q

glycogenolysis

A

liver break down stored glycogen into glucose

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12
Q

gluconeogenesis

A

liver convert proteins and fats into glucose

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13
Q

When does ketogenesis occur?

A

insufficient glucose supply and glycogen stores are exhausted
eg prolonged fasting

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14
Q

what is ketogenesis?

A

liver takes fatty acids and converts into ketones

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15
Q

what are ketones?

A

water soluble fatty acids which can be used as fuel

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16
Q

can the brain use ketones for energy?

A

yes - can cross BBB

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17
Q

how can ketones be measured?

A

urine dipstick and blood

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18
Q

characteristic smell of ketosis

A

acetone smell to their breath

19
Q

what is diabetic ketoacidosis?

A

type 1 DM causes hyperglycaemic ketosis

metabolic acidosis

20
Q

what is type 1 DM?

A

pancreas stops producing insulin

21
Q

causes of type 1 DM

A

genetics

viruses eg coxsackie B and enterovirus

22
Q

pathophysiology of type 1 DM

A

cells cannot take up glucose when no insulin
cells think body is fasted and has no glucose
glucose level in blood keeps rising
hyperglycaemia

23
Q

when does DKA occur?

A

not producing enough insulin and not injecting enough insulin

24
Q

ketoacidosis in DKA

A

cells think they are starving so start producing ketones for fuel
higher glucose and ketones

25
Q

ketoacidosis - kidneys

A

start producing more bicarbonate to maintain pH

overtime blood becomes acidotic

26
Q

DKA - dehydration

A

glucose in urine draws water out
osmotic diuresis
polyuria and dehydration

27
Q

excessive thirst?

A

polydipsia

28
Q

DKA - potassium

A

insulin drives potassium into cells
serum potassium can be high or normal
total body potassium low as none in cells
when started on insulin can develop hypokalaemia

29
Q

symptoms of DKA

A
polyuria, polydipsia
nausea and vomiting
acetone smell to breath 
altered consciousness
kussmaul breathing
30
Q

priority in DKA

A

fluid resuscitation

insulin infusion

31
Q

diagnosing DKA

A

hyperglycaemia >11mmol/l
ketosis >3mmol/l
acidosis pH <7.3

32
Q

treating DKA (FIG-PICK)

A
IV fluids (saline then potassium)
insulin 
glucose
potassium
infection?
chart fluid balance
ketones
33
Q

Long term management type 1 DM?

A

patient education
subcut insulin regimes
monitor CHO
monitor blood sugar

34
Q

insulin regimes

A

background, long acting insulin once a day and short acting 30 mins before CHO

35
Q

what can injecting into same spot cause?

A

lipodystrophy

36
Q

Type 1 DM - hypoglycaemia symptoms

A
sweaty
tremor 
irritable 
dizziness 
pallor 
coma
37
Q

treating hypoglycaemia

A

rapid acting glucose eg lucozade
slower acting CHO eg biscuits
IV dextrose and im glucagon

38
Q

Chronic exposure to hyperglycaemia

A

damage to endothelial cells of blood vessels

suppression of immune system

39
Q

macrovascular complications

A

coronary artery disease
peripheral ischaemia
stroke
hypertension

40
Q

microvascular complications

A

peripheral neuropathy
retinopathy
glomerulosclerosis

41
Q

Infection related complications

A

UTI
pneumonia
skin and soft tissue infections
fungal infections

42
Q

HbA1c

A

glycated haemoglobin
average glucose over last 3 months
measure every 3-6months

43
Q

capillary blood glucose

A

immediate result

44
Q

flash glucose monitor

A

sensor on skin measures glucose of interstitial fluid

5 min delay behind blood glucose levels