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BRS Flashcards (Y2) > Type 1 Diabetes Mellitus > Flashcards

Type 1 Diabetes Mellitus Flashcards

1
Q

What is type 1 diabetes?

A

Autoimmune condition - beta cells in pancreas are attacked and destroyed by immune system
Partial or complete deficiency of insulin production leading to hyperglycaemia
Requires long-life insulin treatment

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2
Q

Is age a good classifier of diabetes type?

A

No, type 1 diabetes can present later in life -> latent autoimmune diabetes in adults (LADA)
Type 2 diabetes mellitus can present in childhood

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3
Q

Is diabetic ketoacidosis strictly a feature of T1D?

A

No - can be a feature of T2DM

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4
Q

Aside from autoimmunity and obesity, what are some other causes of diabetes?

A

Monogenic diabetes (can present at Type 1 or 2), e.g. Maturity-onset diabetes of the young (MODY) and mitochondrial diabetes
Diabetes following pancreatic damage or other endocrine disease

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5
Q

Is Type 1 diabetes a condition of childhood/early adulthood alone?

A

No, evidence suggests it can occur throughout every decade of life
Clinicians faced with a challenge to differentiate adult-onset type 1 diabetes from large number of cases of type 2

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6
Q

Describe the stages of development of Type 1 diabetes

A
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7
Q

Describe the stages of development of type 1 diabetes with regards to the immune response

A
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8
Q

Why is the immune basis of type 1 important?

A

Increased prevalence of other autoimmune disease, e.g. hyperthyroidism
Risk of autoimmunity in relatives
More complete B-cell destruction
Autoantibodies can be useful clinically
Immune modulation offers possibility of novel treatments

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9
Q

What allele may make people genetically susceptible to type 1 diabetes?

A

HLA-DR allele
Particularly DR3 and DR4

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10
Q

Is susceptibility to diabetes controlled by a single gene?

A

No it is polygenic, however the HLA allele has the biggest odds ratio of predicting type 1 diabetes

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11
Q

What factors are implicated in the development of type 1 diabetes?

A

Enteroviral infections
Cow’s milk protein exposure
Seasonal variation
Changes in microbiota

However, causality has not been established

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12
Q

List the pancreatic autoantibodies measured for type 1 diabetes

A

Insulin antibodies
Glutamic acid decarboxylase antibodies
Insulinoma-associated-2-autoantibodies (IA-2A)
Zinc-transporter 8 (ZnT8) antibodies

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13
Q

What are the symptoms of type 1 diabetes?

A

Polyuria
Nocturia
Polydypsia
Blurring of vision
Recurrent infections, e.g. thrush
Weight loss
Fatigue

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14
Q

What are the signs of type 1 diabetes?

A

Dehydration
Cachexia
Hyperventilation
Smell of ketones
Glycosuria
Ketonuria

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15
Q

If a person doesn’t have pancreatic autoantibodies, does that rule out type 1 diabetes?

A

No, the test has a good positive predictive value but a poor negative predictive value
Some people may not have the antibodies or they may have some that haven’t been discovered

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16
Q

What are the three main ketone bodies produced during beta oxidation of fatty acids?

A

Acetone
3-hydroxybutyrate
Acetoacetate

17
Q

What are the aims of treatment in type 1 diabetes?

A

Maintain glucose levels without excessive hypoglycaemia
Restore a close to physiological insulin profile
Prevent acute metabolic decompensation
Prevent microvascular and macrovascular complications

18
Q

What are the acute complications of hyperglycaemia?

A

Diabetic ketoacidosis

19
Q

What are the chronic microvascular complications of type 1 diabetes?

A

Retinopathy
Neuropathy
Nephropathy

20
Q

What are the chronic macrovascular complications of type 1 diabetes?

A

Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease

21
Q

How is type 1 diabetes managed?

A

Self-managed:
Insulin treatment
Dietary support/structured education
Technology

Transplantation

22
Q

How does short-acting insulin compare to long acting?

A

Short acting:
- Taken with meals
- Exact molecular replicate of human insulin (actrapid)
- Can also take analogue form (e.g. Aspart)

Long acting:
- Once a day (background)
- Bound to zinc or protamine
- Can also be an analogue (e.g. Glargine)

23
Q

Why are insulin analogues used?

A

Differ by one or two amino acids
Improves absorption

24
Q

How does insulin pump therapy work?

A
  • Continuous delivery of short-acting insulin analogue via pump into subcutaneous space
  • Device can be programmed to deliver fixed units per hour through the day (basal)
  • Manually bolus for meals
25
Q

Give an example of a structured education programme for type 1 diabetes

A

DAFNE
5-day course on skills and training in self-management

26
Q

How does the closed loop pump therapy work?

A

Real-time continuous glucose sensor measures change in glucose and algorithm is used to calculate insulin requirement - insulin is then delivered
Still have to manually calculate for meals

27
Q

Describe islet cell transplants

A

Islet cells from deceased human donor isolated and transplanted into hepatic portal vein
Requires life-long immunosuppression

28
Q

Describe pancreas transplants

A

Simultaneous with kidney transplants as this results in better survival of pancreas graft
Reserved for people with end-stage kidney failure
Require life-long immunosuppression

29
Q

How do we monitor glucose levels?

A

Capillary blood glucose
Continuous glucose monitoring (allows for greater detail)

30
Q

What factors can affect HbA1c reliability?

A
31
Q

What factors are used to guide insulin doses?

A

Self-monitoring of blood glucose results at home
HbA1c results every 3-4 months

32
Q

When does DKA occur in those with established type 1 diabetes?

A

In acute illness
Missed insulin doses
Inadequate insulin doses

33
Q

What are the metabolic features of DKA?

A

pH <7.3
Increased ketones
HCO3- <15 mmol/L
Glucose >11 mmol/L

34
Q

What is one numerical definition for hypoglycaemia?

A

Blood glucose <3.5 mmol/L

35
Q

What is severe hypoglycaemia?

A

Any event requiring 3rd party assistance

36
Q

What are the adrenergic and neuroglycopaenic symptoms of hypoglycaemia?

A

Adrenergic:
- Tremors
- Palpitations
- Sweating
- Hunger
Neuroglycopaenic:
- Somnolence
- Confusion
- Incoordination
- Seizures, coma

37
Q

When does hypoglycaemia become a problem?

A

Excessive frequency
Impaired awareness
Nocturnal hypoglycaemia
Recurrent severe hypoglycaemia

38
Q

What are the risks of hypoglycaemia?

A

Seizure, coma or death
Impacts on emotional well-being, driving, day-to-day function and cognition

39
Q

Outline acute management of hypoglycaemia

A

BRS Flashcards (Y2) (79 decks)

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