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BRS Y2 > Type 1 Diabetes > Flashcards

Type 1 Diabetes Flashcards

1
Q

What type of condition is T1 diabetes? What happens?

A

An autoimmune condition in which insulin-producing beta-cells in the pancreas are attacked and destroyed by the immune system

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2
Q

What cells are involved with T1 diabetes?

A

Insulin-producing beta-cells in the pancreas

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3
Q

What happens to insulin levels and glucose levels in T1 diabetes?

A

The result is a partial or complete deficiency of insulin production, which results in hyperglycaemia that requires life long insulin treatment

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4
Q

What are treatment options for T1 diabetes?

A

Multiple daily insulin injections
Insulin pump
Islet cell transplant
Artificial pancreas (pump + real-time glucose monitoring)

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5
Q

At what ages does T1 diabetes present?

A

Usually in childhood but can be later

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6
Q

At what ages does T2 diabetes present?

A

Usually in adulthood but can be in children

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7
Q

Is diabetic ketoacidosis a feature of T1 or T2 diabetes?

A

Mainly T1 but can present in T2

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8
Q

How does T1 diabetes develop?

A

In stages:
Starts w genetic predisposition
Precipitating event (eg virus)
Autoimmune events are triggered

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9
Q

What is long standing T1 diabetes?

A

Immune cells are not near the islets and you are left with peri islet fibrosis

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10
Q

Describe the immunology of T1 diabetes

A

Primary step is the presentation of auto-antigen to auto-reactive CD4+ T lymphocytes
CD4+ cells activate CD8+ T lymphocytes
CD8+ cells travel to islets and lyse beta-cells expressing auto-antigen
Exacerbated by release of pro-inflammatory cytokines
Underpinned also, by defects in regulatory T-cells that fail to suppress autoimmunity

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11
Q

Are all beta cells destroyed in T1 diabetes?

A

No, a small amount of insulin may still be produced

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12
Q

Why is it useful to produce a small amount of insulin in T1 diabetes?

A

Less risk of complications occouring

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13
Q

What genes increase susceptibility of developing T1 diabetes most?

A

HLA genes

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14
Q

What are some environmental factors that can trigger T1 diabetes

A 
There are loads but some include:
Enteroviral infections
Cow’s milk protein exposure
Seasonal variation
Changes in microbiota
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15
Q

What antibodies are present in T1 diabetes?

A

Pancreatic auto-antibodies

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16
Q

What are symptoms of T1 diabetes?

A 
Excessive urination (polyuria) 
Nocturia
Excessive thirst (polydipsia) 
Blurring of vision
Recurrent infections eg thrush
Weight loss
Fatigue
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17
Q

What are signs of T1 diabetes?

A 
dehydration 
cachexia (ongoing muscle wastage that can't be reversed by nutritional supplements)
hyperventilation
smell of ketones
glycosuria 
ketonuria
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18
Q

What does lack of insulin do in muscles?

A

Increase proteinolysis

19
Q

What does lack of insulin do in the liver?

A

Inhibit hepatic glucose output

Increase output of ketone bodies

20
Q

What does lack of insulin do in adipose tissue?

A

Increase lipolysis

21
Q

What are the aims for treatment in T1 diabetes?

A

Maintain glucose levels without excessive hypoglycaemia
Restore a close to physiological insulin profile
Prevent acute metabolic decompensation
Prevent microvascular and macro vascular complications

22
Q

What are the main acute complication of T1 diabetes?

A

Diabetic ketoacidosis
Uncontrolled hyperglycaemia
Hypoglycaemia

23
Q

Is human insulin ever zero?

A

No, we have a basal insulin level (it is relatively flat)

24
Q

What are the 2 types of insulin given to diabetics?

A

Short acting insulin

Basal (long lasting) insulin

25
Q

What is insulin pump therapy?

A

Continuous delivery of short-acting insulin analogue e.g. novorapid via pump into subcutaneous space

26
Q

What do you have to do with an insulin pump?

A

Actively bolus for meals

27
Q

What dietary advice are T1 diabetics given?

A

They should receive training for carbohydrate counting

Swap refined carbs for complex carbs

28
Q

How does a closed loop/artificial pancreas work?

A

Have a real time glucose sensor that detects changes in glucose
Use an algorithm to calculate insulin requirement
Insulin pump delivers calculates insulin

29
Q

What are choices for transplantation?

A

Islet cell transplant

Whole pancreas and kidney transplant

30
Q

What do we need to transplant with the pancreas? When is pancreas transplant given

A

Transplant kidneys too

For those with end stage renal failure

31
Q

What does transplantation require life long?

A

Immunosupression

32
Q

What is the best blood test to monitor diabetes control?

A

Hba1c (glycated haemoglobin)

33
Q

How are glucose levels mainly monitored?

A

Capillary (finger prick) blood glucose monitoring

34
Q

What does Hba1c show? Give one disadvantage of it

A

Reflect last 3 months (red blood cell lifespan) of glycaemia

Biased to the 30 days preceding measurement

35
Q

What is used to guide insulin dose?

A

Self monitoring and hba1c

36
Q

How urgent is diabetic ketoacidosis?

A

Extremely, its a medical emergency

37
Q

How is diabetic ketoacidosis diagnosed?

A

pH <7.3
Ketones increased (urine of capillary blood)
HCO3- <15 mmol/L
Glucose >11 mmol/L

38
Q

How is hypoglycaemia diagnosed?

A

<3.6 mmol/L

39
Q

What are symptoms of hypoglycaemia?

A

Adrenergic- tremor, palpitation, sweating, hunger

Neuroglycopaenic- somnolence, confusion, in cooridination, seizures/coma

40
Q

When does hypoglycaemia become problematic?

A

Excessive frequency
Impaired awareness (unable to detect low blood glucose)
Nocturnal hypoglycaemia
Recurrent severe hypoglycaemia

41
Q

What are risks of hypoglycaemia?

A 
Seizure / coma/ death (dead in bed)
Impacts on emotional well-being
Impacts on driving
Impacts on day to day function
Impacts on cognition
42
Q

What are risk factors for developing hypoglycaemia?

A 
Exercise
Missed meals
Inappropriate insulin regime
Alcohol intake- can blunt symptoms
Lower HbA1c
Lack of training around dose-adjustment for meals
43
Q

How can we help those with hypoglycaemia?

A

Indication for insulin-pump therapy (CSII)
May try different insulin analogues
Revisit carbohydrate counting / structured education
Behavioral psychology support
Transplantation

BRS Y2 (85 decks)

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