Type 1 Diabetes (+DKA)

Question 1

what is the ideal blood glucose level?

Answer 1

4.4-6.1mmol/L

Question 2

where is insulin produced?

Answer 2

beta cells in islets of Langerhans

Question 3

how does insulin cause a drop in blood glucose levels?

Answer 3

1. causes the cells to uptake glucose from the blood and use it as fuel.
2. causes muscle and liver cells to take up glucose from the blood and store it as glycogen.

Question 4

where is glucagon produced?

Answer 4

alpha cells in the islets of Langerhans

Question 5

how does glucagon cause an increase in blood glucose levels?

Answer 5

glycogenolysis - tells the body to break down stored glycogen.
gluconeogenesis - tells the liver to convert proteins and fat into glucose.

Question 6

what is ketogenesis?

Answer 6

The liver takes fatty acids and makes them into ketones.

when theres insufficient glucose and glycogen stores have been used up during fasting.

Question 7

what is special about ketones?

Answer 7

they are water soluble fatty acids - can cross the blood brain barrier.

Question 8

how many children presenting with type 1 diabetes for the first time present in DKA?

Answer 8

25-50%

Question 9

what are the symptoms of type 1 diabetes?

Answer 9

polyuria
polydipsia
weight loss (due to dehydration)
tiredness

Bedwetting in previously dry kids
recurrent infections

Question 10

when do symptoms of type 1 diabetes occur?

Answer 10

symptoms appear 1-6 weeks before DKA occurs.

Question 11

what is the treatment options for type 1 diabetes?

Answer 11

Basal bolus insulin regime.

Insulin pump regime.

Question 12

when can an insulin pump be used?

Answer 12

in children >12yrs who have problems controlling their HbA1C.

Question 13

what is a complication of subcutaneous insulin injecting?

Answer 13

Lipodystrophy - this is why patients have to change their injecting sites.

Question 14

what is the basal bolus regime?

Answer 14

• Basal (long acting) is given 1x per day.

- Bolus (short acting) is given 3x per day or before having a snack.

Question 15

what is hypoglycaemia?

Answer 15

a low blood sugar caused by too much insulin or not enough carbohydrates.

Question 16

what are the symptoms of hypoglycaemia?

Answer 16

hunger
tremor
sweating
irritability 
dizziness
pallor
reduced consciousness 
coma
death

Question 17

how is hypoglycaemia treated?

Answer 17

rapid acting glucose (lucozade) + slower acting carbs (biscuits or toast).

Question 18

How is severe hypoglycaemia treated?

Answer 18

IV dextrose.

IM glucagon.

Question 19

what is one problem with hyperglycaemia?

Answer 19

the insulin administered might take a while to act and giving another dose might lead to hypoglycaemia.

Question 20

what are the microvascular complications of type 1 diabetes?

Answer 20

peripheral neuropathy
retinopathy
glomerular sclerosis

Question 21

what infections are common in type 1 diabetes?

Answer 21

UTI
pneumonia
skin and soft tissue infections
oral or vaginal fungal candidiasis

Question 22

what are the macrovascular complications of type 1 diabetes?

Answer 22

coronary artery disease
peripheral ischaemia (ulcers, diabetic foot)
Hypertension
strokes.

Question 23

when is HbA1C measured?

Answer 23

every 3-6 months

Question 24

what are the 3 main problems in DKA?

Answer 24

Metabolic acidosis.
Dehydration.
Potassium imbalance.

Question 25

what happens to potassium in DKA?

Answer 25

Insulin drives potassium into cells so in DKA serum potassium can be high or normal.
When insulin is given, all of the potassium is taken into cells making serum potassium low - leading to hypokalaemia.

Question 26

what can happen in hypokalaemia?

Answer 26

fatal arrhythmias

Question 27

what is the treatment of DKA?

Answer 27

Fluid resuscitation and insulin.

Add potassium

Question 28

what is a complication of treating DKA?

Answer 28

Cerebral oedema - the brain cells were dehydration and when rehydration occurs, water rapidly moves into brain cells and can cause brain oedema, cell destruction and death.

Question 29

How should fluid resuscitation be given during DKA?

Answer 29

Fluids should be given over 48hrs.

Hourly Glasgow coma scale monitoring.

Question 30

what are signs of DKA?

Answer 30

polyuria
polydipsia
nausea
vomiting
weight loss
acetone smell on breath 
dehydration
hypotension
altered consciousness 
sepsis
kussmal breathing

Question 31

what are signs of cerebral oedema?

Answer 31

headaches
bradycardia
altered behaviour
changes in consciousness

Question 32

what are the diagnostic levels for DKA?

Answer 32

pH = <7.3
Ketones = >3mmol/L.
Blood glucose = >11mmol/L.

Question 33

when is someone through to be in DKA?

Answer 33

Any child with diabetes who is vomiting is classed as having DKA until proven otherwise.