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Year 2 Medicine > Type 1 Diabetes Mellitus > Flashcards

Type 1 Diabetes Mellitus Flashcards

1
Q

Epidemiology of Diabetes:

  • Is the prevalence of all types of diabetes in the UK increasing?
  • Adults > 16 years of age 2009 vs 2016/2017 % with diabetes
A
  • Is the prevalence of diabetes in the UK increasing - yes
  • Adults > 16 years of age 2009 - 5.1% vs 2016/2017 6.7% with diabetes
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2
Q

Epidemiology of Type 1 Diabetes:

  • Prevalence is about …%
  • Peak onset at …
  • More common in men or women?
  • White vs BAME - more common in who?
  • … variability
  • More prevalent … latitudes
A
  • Prevalence is about 0.5%
  • Peak onset at adolescence (youngest 6 months to 80+)
  • M=F
  • White>Bame
  • Seasonal variability
  • More prevalent Northern latitudes
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3
Q

What is this figure representing?

A

Age and gender of patients with Type 1 diabetes in England and Wales, 2016-17

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4
Q

What is this showing?

A

Diabetes - geographical incidence

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5
Q

Genetic Predisposition to Type 1 Diabetes

  • …% background risk
  • 1-2% if … affected
  • 3-6% if … has affected
  • 6% if … has affected
  • 36% if … affected
A
  • 0.5% background risk
  • 1-2% if mother affected
  • 3-6% if father has affected
  • 6% if sibling has affected
  • 36% if monozygotic twin affected
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6
Q

Genetic Predisposition

  • Association with … antigens
    • two in particular: these are…
    • …% of Scandinavians with type 1 diabetes positive for 1 or both
A
  • Association with HLA antigens
    • HLA DR3-DQ2 and DR4-DQ8 predispose
    • 90% of Scandinavians with type 1 diabetes positive for 1 or both
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7
Q

What is this showing (diabetes)

A
  • How well Genetic risk score (GRS2) discriminates those with T1D diabetes from T2 diabetes
  • The more one has of those predisposing genotypes the more likely that the person has T1 vs T2 diabetes
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8
Q

Pathophysiology of Type 1 Diabetes

  • …-cell events trigger … response
  • antibodies to … or … generally appear first
  • Other …-cell antibodies follow:
    • 1A2, Xn2+ transporter 8
  • Selective immune …-cell destruction
    • The … antibodies you get, the more likely you are to develop type 1 diabetes
A
  • beta-cell events trigger autoimmune response
  • antibodies to insulin or GAD generally appear first
  • Other beta-cell antibodies follow:
    • 1A2, Xn2+ transporter 8
  • Selective immune beta-cell destruction
  • The more antibodies you get, the more likely you are to develop type 1 diabetes (shown in graph)
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9
Q

What is shown on this slide?

A

Normal pancreatic islet

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10
Q

What is shown on this slide?

A

Pancreatic islets are destroyed (autoimmune destruction insulitis)

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11
Q

What is this showing?

  • Schematic evolution of ….
A
  • type 1 diabetes
  • Genetic predisposition, environmental trigger leading to an inflammatory process, beta cells destroyed - mass down - pre diabetes -> diabetes
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12
Q

Autoimmune triggers for Type 1 Diabetes may be … (3)

​

A
  • Viral infection (Coxackie)
  • Endoreticular stress
  • Cytokines release - destruction of beta cell
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13
Q

Autoimmune diseases associated with T1 diabetes

  • … disease
  • …thyroidism
  • … disease
  • … disease
  • Hypo…
  • … anaemia
  • Vi…
  • Autoimmune … syndromes
A
  • Coeliac disease
  • Hypothyroidism
  • Grave’s disease
  • Addison’s disease
  • Hypogonadism
  • Pernicious anaemia
  • Vitiligo
  • Autoimmune polyglandular syndromes
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14
Q

Symptoms associated with T1 diabetes

  • 4 T’s - what are they?
  • Other symptoms include:
    • Problem with Vision - what is this?
    • What kind of infections?
    • Keto…
    • Diabetic KA
    • (Death…)
A
  • Thirsty, going to toilet, tired, becoming thinner (polydipsia, poluria, lethargy, weight loss)
  • Other symptoms include:
    • Problem with Vision - what is this - blurred vision
    • What kind of infections - candida infections
    • ketosis / ketoacidosis
    • Diabetic KA
    • (Death…)
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15
Q

What are Ketone bodies?

A

Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat instead of the sugar glucose for energy.

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16
Q

What are the 3 ketone bodies?

A

The ketone bodies – acetone, acetoacetate, and beta-hydroxybutyrate – are toxic acidic chemicals.

17
Q

How are ketone bodies excreted?

A

They build up in the blood and then spill over into the urine. The body can also rid itself of acetone through the lungs. This gives the breath a fruity odor.

18
Q

People with diabetic ketoacidosis can be detected on their breath, how?

A

Breath smells like pear drops - due to acetone

19
Q

Is there a clear test for T1 Diabetes?

A

no

20
Q

Diagnosis of T1 Diabetes (specifically T1)

  • Is age relevant?
  • Onset?
  • Phenotype
  • What histories do we check?
  • Weight …
  • Keto..
  • What antibodies do we check for?
  • What do we use to check if the person is actually making insulin?
A
  • Yes - typically see younger people with T1 over T2 diabetes
  • Yes - rapidity of onset is a clue
  • Phenotype
  • Past medical history, Family History
  • Weight loss
  • Ketosis
  • GAD/IA2/Zinc transporter 8 antibody positive
  • C-peptide to check if person is making insulin
21
Q

C-peptide is produced in what molar ratio with insulin?

A

1:1 molar ratio

22
Q

If you are unsure whether someone has T1 or T2 diabetes, what can you measure?

A
  • C-peptide
  • Need adequate stimulus for secretion
23
Q

Insulin and T1 Diabetes

  • Necessary for …
  • Peptide hormone needs to be given …
    • The most common route is …
    • Also can be … or through the …
  • Various types:
    • Primary … (animal, human, analogue)
    • Duration of … (addition of protamine, altered solubility, fatty acid chain)
    • … : (100, 200, 300, 500 units/ml)
A
  • Necessary for survival
  • Peptide hormone needs to be given parenterally
    • Most common - Subcutaneously
    • Inhaled
    • Mucous membranes
  • Various types:
    • Primary structure (animal, human, analogue)
    • Duration of action (addition of protamine, altered solubility, fatty acid chain)
    • Strength: (100, 200, 300, 500 units/ml)
24
Q

What is the device shown for?

A
  • Giving insulin (pen device)
  • Small fine needle on one end
  • Dose up insulin in units (amount of insulin)
  • Given subcutaneously - soft tissue areas
25
Q

Injection sits for insulin - where are they?

A

Soft tissue sites - given subcutaenously

26
Q

Physiological Insulin Secretion

  • When does the body secrete insulin?
  • When does insulin spike?
  • People with T1 diabetes should administer insulin when?
A
  • Body usually constantly secretes low level of insulin
  • When we eat - increase saliva - release of insulin
  • people with T1 diabetes should give a background level of insulin (long slow acting) and then injections before each meal (change amount according to what you are eating)
27
Q

Typical Insulin Regime

  • (1) … (2)… regimen
    • Rapid acting insulin pre-meal (2)
    • Long acting background insulin (1)
  • … regimen
  • Rapid acting insulin reflects … intake
A
  • Basal bolus regimen
    • Rapid acting insulin pre-meal (bolus)
    • Long acting background insulin (basal)
  • Balanced regimen
  • Rapid acting insulin reflects CHO intake
28
Q

Factors Affecting Blood Glucose

  • 8 factors - list
A
  1. Diet
  2. Injection site
  3. Temperature
  4. Exercise
  5. Illness
  6. Stress
  7. Alcohol
  8. Menstrual Cycle
29
Q

Hypoglycaemia - symptoms

  • Autonomic symptoms include … (3)
  • Neuroglycopaenic symptom … (1)
  • Can be … or …
  • … hypoglycaemia is inevitable with good control
  • Loss of warning signs
A
  • Autonomic symptoms include
    • palpitation, sweating, tremor
  • Neuroglycopaenic symptom … (1)
    • confusion
  • Can be mild or severe
30
Q

What is this showing?

A

Subcutaneous insulin pump

  • expensive, hard to learn how to use
  • can use it more physiologically - alter basal insulin if sick/exercise etc
31
Q

Transplantation

  • … transplant
    • almost always SPK (…) or PAK (…)
  • … … therapy
    • Edmonton protocol
    • UK programme
  • Which is less invasive?
A
  • Pancreas
    • almost always SPK (simultaneous pancreas kidney) or PAK (pancreas after kidney)
  • Islet Cell therapy
    • Edmonton protocol
    • UK islet cell programme
    • Islet less invasive
32
Q

Monitoring T1 Diabetes

  • Glucose monitoring at least … times a day
  • Test also in 3 scenarios/conditions - what are they?
A
  • Glucose monitoring at least 4 times a day
  • Test also in 3 scenarios/conditions - what are they?
    • Driving
    • Unwell
    • Hypoglycaemic
33
Q

What is this test?

A

Finger prick test - glucose monitoring

34
Q

What are ways of monitoring blood glucose levels? (2)

A
  • Finger prick test
  • Continuous glucose monitoring system - CGMS
35
Q

What is this showing?

A

Flash Continuous blood glucose monitor

36
Q

What is this showing?

A

Ambulatory glucose profile - trend for glucose range

37
Q

What is ‘time in range’ monitoring? (for T1 diabetes)

A

Time in Range (TIR) ​​indicates the percentage of how long your glucose value was within the target range during a defined period

38
Q

Ketone monitoring

  • Acetoacetate can be found in the …
  • Beta-hydroxybutyrate can be found in the …
A
  • Acetoacetate can be found in the urine
  • Beta-hydroxybutyrate can be found in the blood
39
Q

Monitoring - as a clinician (T1 Diabetes)

  • Clinicians will monitor how sugary someones … are at least … a year
  • This is known as someones … (glycated …)
    • Reflects glucose over last … months
    • Weighted towards last … weeks
    • Affected by lifespan of …
A
  • Clinicians will monitor how sugary someones red blood cells are at least twice a year
  • This is known as someones HbA1c (glycated haemoglobin)
    • Reflects glucose over last 3 months
    • Weighted towards last 6 weeks
    • Affected by lifespan of red cell

Year 2 Medicine (162 decks)

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