Type 1 diabetes Flashcards
Ideal blood glucose concentration
4.4 - 6.1mmol/l
What is insulin?
hormone produced by pancreas to reduce blood sugar levels
what cells produce insulin?
pancreatic beta cells in islets of langerhans
Is insulin a catabolic or anabolic hormone?
anabolic
How does insulin reduce blood glucose?
muscle and liver to store glucose as glycogen
causes cells in body to absorb glucose and use as fuel
What is glucagon?
hormone produced by pancreas that increases blood sugar levels
what cells produce glucagon?
alpha cells in islets of langerhans in pancreas
is glucagon a catabolic or anabolic hormone?
catabolic
when is glucagon released?
low blood sugar levels and stress
actions of glucagon
liver break down glycogen
liver convert fats and protein into glucose
glycogenolysis
liver break down stored glycogen into glucose
gluconeogenesis
liver convert proteins and fats into glucose
When does ketogenesis occur?
insufficient glucose supply and glycogen stores are exhausted
eg prolonged fasting
what is ketogenesis?
liver takes fatty acids and converts into ketones
what are ketones?
water soluble fatty acids which can be used as fuel
can the brain use ketones for energy?
yes - can cross BBB
how can ketones be measured?
urine dipstick and blood
characteristic smell of ketosis
acetone smell to their breath
what is diabetic ketoacidosis?
type 1 DM causes hyperglycaemic ketosis
metabolic acidosis
what is type 1 DM?
pancreas stops producing insulin
causes of type 1 DM
genetics
viruses eg coxsackie B and enterovirus
pathophysiology of type 1 DM
cells cannot take up glucose when no insulin
cells think body is fasted and has no glucose
glucose level in blood keeps rising
hyperglycaemia
when does DKA occur?
not producing enough insulin and not injecting enough insulin
ketoacidosis in DKA
cells think they are starving so start producing ketones for fuel
higher glucose and ketones
ketoacidosis - kidneys
start producing more bicarbonate to maintain pH
overtime blood becomes acidotic
DKA - dehydration
glucose in urine draws water out
osmotic diuresis
polyuria and dehydration
excessive thirst?
polydipsia
DKA - potassium
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
symptoms of DKA
polyuria, polydipsia nausea and vomiting acetone smell to breath altered consciousness kussmaul breathing
priority in DKA
fluid resuscitation
insulin infusion
diagnosing DKA
hyperglycaemia >11mmol/l
ketosis >3mmol/l
acidosis pH <7.3
treating DKA (FIG-PICK)
IV fluids (saline then potassium) insulin glucose potassium infection? chart fluid balance ketones
Long term management type 1 DM?
patient education
subcut insulin regimes
monitor CHO
monitor blood sugar
insulin regimes
background, long acting insulin once a day and short acting 30 mins before CHO
what can injecting into same spot cause?
lipodystrophy
Type 1 DM - hypoglycaemia symptoms
sweaty tremor irritable dizziness pallor coma
treating hypoglycaemia
rapid acting glucose eg lucozade
slower acting CHO eg biscuits
IV dextrose and im glucagon
Chronic exposure to hyperglycaemia
damage to endothelial cells of blood vessels
suppression of immune system
macrovascular complications
coronary artery disease
peripheral ischaemia
stroke
hypertension
microvascular complications
peripheral neuropathy
retinopathy
glomerulosclerosis
Infection related complications
UTI
pneumonia
skin and soft tissue infections
fungal infections
HbA1c
glycated haemoglobin
average glucose over last 3 months
measure every 3-6months
capillary blood glucose
immediate result
flash glucose monitor
sensor on skin measures glucose of interstitial fluid
5 min delay behind blood glucose levels
