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Endocrinology > Type 1 Diabetes > Flashcards

Type 1 Diabetes Flashcards

1
Q

What is the normal blood glucose range?

A
  • 4.4 - 6.1 mmol/L
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2
Q

What is the physiology of insulin?

*think what cells produce it and function

A
  • B cells of islet of langerhans
  • Anabolic hormone
    • Increase glucose entry into muscle and adipose
    • Increase liver glycogenesis
    • Increase lipid synthesis
    • Inh. glucose production from liver
    • Stimulate protein synthesis, ing protein breakdown
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3
Q

What is the physiology of glucagon?

*think cells producing it and function

A
  • A cells if islets of langerhans
  • Catabolic hormone
    • Inc. glycogenolysis
    • Inc. gluconeogenesis
    • Incr. satiety
    • Inc. lipolysis
    • Inc. ketogenesis
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4
Q

What is T1DM?

A
  • inability to produce/secrete insulin due to autoimmune destruction of the beta-cells in the pancreatic islets of Langerhan.
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5
Q

What is the classic presentation of T1DM?

A
  • polyuria
  • polydipsia
  • weight loss
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6
Q

What age group is typically affected by T1DM?

A
  • Children (95%)
  • Adults (10%)
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7
Q

What are the causes of T1DM?

A
  • Genetics
    • HLA-D3 & HLA-D4
  • Autoimmune
    • anti-Glutamic acid Decarboxylase antibody (GAD)
  • Virus
    • Coxsackie B virus
    • Enterovirus
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8
Q

What other autoimmune diseases is T1DM associated with?

A
  • Graves’ disease
  • autoimmune thyroiditis
  • Addison’s disease
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9
Q

What hormones counter regulate Insulin?

A
  • Glucagon
  • Adrenaline
  • Growth hormone
  • Cortisol
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10
Q

What is Latent-onset Autoimmune Diabetes in Adults (LADA)?

A
  • a variant of T1DM that occur later in life
  • patients who develop diabetes in adult life with associated ketosis, weight loss, low BMI and family history of autoimmune disease
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11
Q
A
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12
Q

What are the sx of T1DM?

A
  • Polyuria & polydipsia
  • Weight loss
  • Vomiting
  • Lethargy

Signs

  • mild-moderate dehydration (dry skin, dry mucous membranes, reduced skin turgor)
  • BMI <25

If features go unnotice > can progress to DKA

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13
Q

What are the sx of DKA?

A
  • Confusion
  • Moderate-severe dehydration (sunken eyes, prolonged capillary refill time)
  • Vomiting +/- diarrhoea
  • Abdominal pain
  • Decreased urine output
  • Reduced GCS
  • Coma
  • Shock (tachycardia, hypotension)
  • Kussmaul breathing (Deep sighing respiration)
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14
Q

What Ix would you order for T1DM?

A
  • Clinically diagnosed + random blood glucose >11
  • Refer to endocrinologist within 24hrs if T1DM suspected
  • Further Ix
    • Bedside (urine dip, random BM, urinary/blood ketones)
    • Bloods (FBC, U&E, HbA1c, CRP, cultures)
    • Special test (C-peptide, islet cell autoantibodies, GAD autoantibodies)
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15
Q

What are the 3 main insulin regimes used in T1DM?

A
  • Basal-bolus regime
    • use of rapid- or short-acting insulin before meals and a long-acting preparation for basal requirements
  • One, two, or three injections per day regime​
    • ​ biphasic regime with the use of both short-acting and intermediate-acting insulin
  • Continuous insulin infusion via a pump
    • ​supplies rapid- or short-acting insulin
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16
Q

What are the main targets for blood glucose monitoring?

A
  • On waking: fasting blood glucose 5–7 mmol/L
  • Before meals: blood glucose 4–7 mmol/L
  • Post meals: test after 90 minutes, blood glucose 5–9 mmol/L
17
Q

What is the main tx target using HbA1c?

A
  • <6.5%
  • monitored every 3-6months
18
Q

How do you monitor for T1DM Cx?

A

Diabetic review annually

  • assessment of injection site - lipohyertrophy
  • Retinopathy: annual screening
  • Nephropathy: renal function (eGFR) and albumin:creatinine ratio (ACR)
  • Diabetic foot problems: full examination including footwear, monofilament assessment of neuropathy, vascular assessment +/- dopplers.
  • Cardiovascular risk factors: primary/secondary prevention strategy with optimisation of blood pressure, lipids, weight, smoking and others
  • Thyroid disease: screening blood test
19
Q

What pt education would you recommend so pt can calculate carbohydrate in each meal and adjust their insulin accordingly?

A
  • Dose Adjustment For Normal Eating (DAFNE)
20
Q

What are the 2 special circumstances in T1DM mx?

A
  • Honeymoon period
  • Sick day rules
21
Q

What is the Honeymoon period?

A
  • newly diagnosed patients in whom there is residual beta cell function
  • can last for weeks to months
  • May not need exogenous insulin during this period
22
Q

What is sick day rules?

A
  • number of recommendations in T1DM with an intercurrent illness
23
Q

What are the 5 recommendations in sick day rules?

A
  1. Continue insulin therapy, alterations may be required, advice from a specialist may be sought
  2. Increase frequency of blood glucose monitoring
  3. Consider ketone monitoring
  4. Maintain good hydration and when possible a normal meal pattern, meals may be replaced by carbohydrate based drinks
  5. Seek urgent medical attention if unable to tolerate oral intake, drowsy or sustained vomiting
24
Q

What are the cx of T1DM?

*think acute and chronic

A

Acute

  • Hypoglycaemia
  • DKA

Chronic

  • Microvascular cx
    • Retinopathy, neuropathy, nephropathy, diabetic foot
  • Macrovascular cx
    • Atherosclerosis
25
Q

What are the cx associated with retinopathy?

A
  • retinal haemorrhage
  • fibrosis
  • retinal detachment
26
Q

Describe the NSC-UK Classification of Retinopathy?

A
  • Non-proliferative:
    • Background (R1): dot and blot haemorrhages, hard exudates, cotton wool spots
    • Pre-proliferative (R2): intraretinal microvascular abnormalities (IRMA), venous beading
  • Proliferative:
    • Proliferative (R3): new vessels at the disc and elsewhere (NVD, NVE), fibrosis, traction retinal detachment
  • Maculopathy: exudates, oedema, NVE
27
Q

What are the types of neuropathy associated with T1D?

A
  • Symmetrical polyneuropathy
  • Mononeuropathy
  • Diabetic amyotrophy
    • spectrum of disease affecting the lumbosacral plexus leading to symmetrical pain, weakness and wasting in the proximal muscles of the leg
  • Autonomic neuropathy
    • damage of the autonomic nervous system, which can effect multiple systems

Endocrinology (17 decks)

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