Type 1 Diabetes (+DKA) Flashcards
what is the ideal blood glucose level?
4.4-6.1mmol/L
where is insulin produced?
beta cells in islets of Langerhans
how does insulin cause a drop in blood glucose levels?
- causes the cells to uptake glucose from the blood and use it as fuel.
- causes muscle and liver cells to take up glucose from the blood and store it as glycogen.
where is glucagon produced?
alpha cells in the islets of Langerhans
how does glucagon cause an increase in blood glucose levels?
glycogenolysis - tells the body to break down stored glycogen.
gluconeogenesis - tells the liver to convert proteins and fat into glucose.
what is ketogenesis?
The liver takes fatty acids and makes them into ketones.
when theres insufficient glucose and glycogen stores have been used up during fasting.
what is special about ketones?
they are water soluble fatty acids - can cross the blood brain barrier.
how many children presenting with type 1 diabetes for the first time present in DKA?
25-50%
what are the symptoms of type 1 diabetes?
polyuria
polydipsia
weight loss (due to dehydration)
tiredness
Bedwetting in previously dry kids
recurrent infections
when do symptoms of type 1 diabetes occur?
symptoms appear 1-6 weeks before DKA occurs.
what is the treatment options for type 1 diabetes?
Basal bolus insulin regime.
Insulin pump regime.
when can an insulin pump be used?
in children >12yrs who have problems controlling their HbA1C.
what is a complication of subcutaneous insulin injecting?
Lipodystrophy - this is why patients have to change their injecting sites.
what is the basal bolus regime?
- Basal (long acting) is given 1x per day.
- Bolus (short acting) is given 3x per day or before having a snack.
what is hypoglycaemia?
a low blood sugar caused by too much insulin or not enough carbohydrates.
what are the symptoms of hypoglycaemia?
hunger tremor sweating irritability dizziness pallor reduced consciousness coma death
how is hypoglycaemia treated?
rapid acting glucose (lucozade) + slower acting carbs (biscuits or toast).
How is severe hypoglycaemia treated?
IV dextrose.
IM glucagon.
what is one problem with hyperglycaemia?
the insulin administered might take a while to act and giving another dose might lead to hypoglycaemia.
what are the microvascular complications of type 1 diabetes?
peripheral neuropathy
retinopathy
glomerular sclerosis
what infections are common in type 1 diabetes?
UTI
pneumonia
skin and soft tissue infections
oral or vaginal fungal candidiasis
what are the macrovascular complications of type 1 diabetes?
coronary artery disease
peripheral ischaemia (ulcers, diabetic foot)
Hypertension
strokes.
when is HbA1C measured?
every 3-6 months
what are the 3 main problems in DKA?
Metabolic acidosis.
Dehydration.
Potassium imbalance.
what happens to potassium in DKA?
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.
what can happen in hypokalaemia?
fatal arrhythmias
what is the treatment of DKA?
Fluid resuscitation and insulin.
Add potassium
what is a complication of treating DKA?
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.
How should fluid resuscitation be given during DKA?
Fluids should be given over 48hrs.
Hourly Glasgow coma scale monitoring.
what are signs of DKA?
polyuria polydipsia nausea vomiting weight loss acetone smell on breath dehydration hypotension altered consciousness sepsis kussmal breathing
what are signs of cerebral oedema?
headaches
bradycardia
altered behaviour
changes in consciousness
what are the diagnostic levels for DKA?
pH = <7.3
Ketones = >3mmol/L.
Blood glucose = >11mmol/L.
when is someone through to be in DKA?
Any child with diabetes who is vomiting is classed as having DKA until proven otherwise.
