Type 1 DM Flashcards
What is it?
Autoimmune cytotoxic T-cell destruction of pancreatic Beta-cells, leading to reduced insulin production.
Risk factors
FH and genetics
Diagnosis:
Ketosis is one feature used for diagnosis. Why does Type 1 cause ketosis?
What is a common sign of ketosis which the patient may complain about?
Do they tend to be younger or older?
What is there a personal or FH of which might explain why they have type 1 instead of type 2?
Ketones are chemicals that build up when your body starts to burn fat for energy.
Weight loss
Younger (age<50)
Autoimmune disease
Diagnosis:
If there are no typical clinical features, why can GAD65 Ab be done?
C-peptide can also be used. Is it low or high in T1DM
It measures Islet cell AB
Low
Other investigations:
Why could you do urine albumin?
HbA1c:
- What does measure?
- Over what conc is it classed as hyperglycaemic? - mmol/mol
- How often is it measured?
Why do you do U+E?
3-6 months
Microalbuminaemia
Average blood glucose (sugar) levels for the last two to three months.
> 48 mmol/mol
High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys.
Insulin Therapy:
Where are they sent to when they are first diagnosed?
Finger prick testing (BM):
- How many times a day is it done?
Where can injections be done?
Hospital diabetes team for insulin
Finger prick - BM
4 times a day - before each meal and before bed
Outer thigh and abdomen
Insulin Therapy - Subcut - Classification:
Rapid-acting insulin analogues
- How fast is the onset?
- How before or after a meal can it be taken?
- Name of brand used? - M, H
Short=acting:
- How fast is the onset?
- How long before a meal should it be taken?
- Name of brand used? - A
Intermediate-acting:
- Onset is 2 hrs? How long does it last?
- Isophane is the name used. Why is this favoured by NICE?
Biphasic insulin:
- What is meant by biphasic?
- Name of brand used? - N, HM
5 minutes - Novorapid, Humalog They can take right before or after. ==== 30 minuted - Actrapid 20 minutes before a meal ===== 12-16 hrs It is cheap!!! ====
Has both short-acting and long-acting
Noromix
Humalog Mix50
Insulin Therapy - Subcut - Prescribing:
What is used to decide the dose?
Avoiding prescribing errors can be fatal:
- What should be done to avoid this?
Weight
- 5 units/kg/days in kids
- 3-0.4 units/kg/days in adults
Use insulin syringe marked with units even for infusion
Always write ‘unit’ not ‘u’
Use full correct name (usually brand name) including strength
Insulin Therapy - Subcut - Regimens:
Once-daily regimen:
- What type of diabetes is this used in?
- What time of the day is it taken?
Twice-daily regimen - This is used in both types:
- Main side effects - 2
Type 2 DM
Before bed - long-intermediate acting
Low glucose and morning raise glucose
Insulin Therapy - Subcut - Regimens:
Basal-bolus insulin regime (aka multiple daily injections - MDI):
- What type of diabetes is this used in?
Continuous SC insulin - Insulin pump:
- What are the indications for this? - 2
SC insulin when ill:
- Does illness increase or decrease requirements?
T1DM === MDI failed (e.g. severe hypos) HbA1C >69 ==== Requirements increases despite reduced food intake
Side effects of insulin therapy:
Main one?
Who must be contacted?
What happens at the site of injection?
Hypoglycaemia
DVLA - remember people with jobs driving a vehicle
Lipoatrophy - vary sites to reduce
