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Charis & Ellie vs Endocrine > Type 1 Diabetes Mellitus > Flashcards

Type 1 Diabetes Mellitus Flashcards

1
Q

how is type 1 diabetes excluded?

A

antibodies
c-peptide
T1 genetic risk score

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2
Q

what is GAD?

A

glutamic acid decarboxylase - pancreatic autoantibody

2.5% of normal population are GAD +ve through so doesn’t necessarily mean you have T1 diabetes

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3
Q

what is C-peptide?

A

an easy confirmatory test for T1DM after 3 years - usually low in T1DM
usually present at time of diagnosis
can do fasting and non-fasting

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4
Q

what negative tests result in a 5% chance of T1DM?

A

GAD, IA-2 and ZnT8 are negative

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5
Q

what is it?

A

a state of absolute insulin deficiency, probably due to an environmental trigger in a genetically susceptible person, involves an auto-immune process that affects pancreatic beta-cells with varying degree of severity

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6
Q

what is the genetic correlation?

A

HLA genes - represents 50% of family risk of T1DM

95% of people diagnosed with T1DM under 30 have either (DR3-DQU/DR4-DQ8) genotype or both

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7
Q

Who gets it?

A 
genetic link 
infection 
vit D deficiency 
puberty and stress can accerlerate
autoantibodies
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8
Q

autoantibodies seen in T1DM

A

GAD 65Ab - antigen = glutamic acid decarboxylase, function = GABA production, increases with age
1A-2Ab - antigen = islet antigen 2, decreases with age in males
IAA - antigen = insulin, function = regulates glucose better in children?
ZnT8Ab - antigen = ZnT8 transporter, function in beta cells, better in the older?

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9
Q

how is normal insulin secreted?

A

biphasic secretion in response to a meal
1. rapid phase of pre-formed insulin lasts 5 to 10 mins
2. slow phase over 1 to 2 hours
insulin secreted into portal vein and secretion continues in the fasted rate of 0.25 to 1.5 units/insulin/hr

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10
Q

what autoimmune conditions are associated with it?

A 
relatively common:
pernicious anaemia 
Addison's disease 
IgA deficiency
vitiligo 
primary hypogonadism 
primary hypothyroidism 
coeliac disease 
Cystic Fibrosis
very rare - auto-immune polyglandular syndromes, IPEX syndrome
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11
Q

types of insulin

A

rapid-acting analogue e.g. Humalog, NovoRapid
Short-acting e.g. Humulin S, Insuman Rapid
Intermediate acting e.g. Humulin I, Insuman Basal
Long acting analogue e.g. lantus
Rapid acting analogue-intermediate mixture - Humalog Mix 25/Mix 50 or NovoMix 30
short acting-intermediate mixture - Humulin M3

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12
Q

how is insulin delivered?

A 
there are a variety of insulin delivery systems 
pens - disposable or with refillable cartridges 
insulin pump (more modern)
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13
Q

aims of T1DM therapy

A

prevent hyperglycaemia
avoid hypoglycaemia
reduce chronic complications

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14
Q

signs and symptoms of hyperglycaemia

A 
thirst 
tiredness 
blurred vision 
weight loss 
polyuria 
nocturia 
fungal infections 
moot state 
can affect cognitive function (information processing and working memory)
potential risk of diabetic ketoacidosis
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15
Q

signs and symptoms of hypoglycaemia

A 
pallor 
sweating 
tremor 
palpitations 
confusion 
nausea
hunger 
can affect cognitive functions (tense-tiredness, information processing, working memory, coma)
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16
Q

what is normal glucose/ insulin physiology?

A

insulin is secreted at a low basal rate which accounts for about 50% of insulin produced
post-prandial insulin is secreted in relation to post-meal glucose
this is the ultimate aim of trying to achieve insulin replacement therapy

17
Q

why is insulin therapy not as good as the real thing?

A

exogenous will always never be as good as endogenous insulin because of individual variations - absorption, timing and dose of insulin, condition of injection sites etc.

18
Q

what are the prandial insulins?

A

insulin analogues

soluble insulin

19
Q

what are basal insulins?

A

isophane ‘basal’ insulins

analogue basal insulins

20
Q

what does the basal bolus insulin regimen aim to do?

A

to mimic normal endogenous insulin production so is considered the best regime - rapid acting insulin is given before each meal and then long acting insulin before bed

21
Q

BD regimen

A

insulin is given twice a day
it’s less flexible
given in the morning and the evening

22
Q

OD regimen

A

insulin given once a day before bed

23
Q

what parent has a greater likelihood of passing on T1DM?

A

children are 3x more likely to develop diabetes than if their mother has it

24
Q

how is it managed?

A

most people get MDI or CSII

most people with T1DM should use insulin analogues to reduce hypoglycaemia risk

25
Q

what insulin are adults given?

A

regular human/rapid-acting analogues - if they are experiencing severe/nocturnal hypoglycaemia and are using an intensified insulin regimen - basal insulin analogues

26
Q

what insulin are children and adolescents given?

A

insulin analogues (rapid acting or basal) or regular human insulin and NPH preparations or an appropriate combo

27
Q

how is metabolic control evaluated?

A

home blood glucose monitoring (SBGM)
glycated haemoglobin (HbA1C)
flash glucose monitoring freestyle libre
continuous glucose monitor (CMS)
BGM - very important but only provides a snap shot at any given moment

28
Q

what are the HbA1C targets

A

first 10 years = 48 mmol/mol

as they get older = 53/58 mmol/mol

29
Q

what is the characteristics of normal physiological (pancreatic) insulin

A

secreted directly into the portal bloodstream
rapidly prevents post-meal hyperglycaemia
rapidly cleared

30
Q

what are the characteristics of insulin therapy (injection/pump)

A

injection into subcutaneous tissue
peaks too slow to precent post-meal hyperglycaemic spike
slow clearance

31
Q

what factors affect insulin absorption/action

A 
temperature 
injection site 
injection depth 
exercise 
check needle - may need new one
32
Q

what are important safety measures in insulin prescription

A

make sure not to use abbreviations because they all have similar names and there is danger in the unit symbols being mistaken for numbers

33
Q

principles of insulin dose adjustment

A

review glycaemic control
adjust routine insulin proactively to optimise glycaemic control - be aware that reactive insulin adjustment can cause hypoglycaemia
adjust insulin dose prescribed before the problem
DON’T omit insulin if hypoglycaemic, treat hypo and administer insulin as usual

34
Q

non-insulin adjunct therapy in T1DM

A

metformin
leptin
GLP-1
SGLT2i

35
Q

how should insulin never be administered

A

IV syringe

36
Q

what are the rules for insulin for short fast/minor surgery?

A

IV insulin is not necessary if a rapid recovery is expected and the patient is expected to eat following the procedure
avoid glucose infusions if possible
monitor blood glucose
there is risk of hypoglycaemia in people prescribed oral hypoglycaemic agents and insulin
the Diabetes team can offer advice

Charis & Ellie vs Endocrine (79 decks)

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