Type I Diabetes Mellitus Flashcards by Wasim Silmi

diabetic ketoacidosis is more common in what type of diabetes?

1 but can present in both

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What 3 endocrine diseases can cause diabetes and how?

Pheochromocytoma, Cushing’s Syndrome and Acromegaly through inducing hyperglycaemia

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Type 1 diabetes is fundamentally ..

autoimmune destruction of beta islet cells and so insulin deficiency

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Type 2 diabetes is fundamentally …

Resistance to insulin developing which leads to beta islet exhaustion and then failure

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What is measured as a marker of insulin function?

C peptide

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Which diabetes type has a bigger genetic influence

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what is an indicator that a patient will develop diabetes

Loss of 1st phase insulin

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which type of diabetes has been described as a relapsing/remitting disease?

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why is the immune basis of T1 diabetes important? (2)

Increased prevalence of other autoimmune disease is associated with people who have autoimmune T1DM

And having T1DM can mean you family are predisposed to other autoimmune diseases

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How can detecting Auto‐antibody levels be clinically useful (2)

to see how the disease is progressing and to confirm the autoimmune basis of the diabetes

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Factors affecting risk of diabetes?

Genes, location, time of year, other environmental factors

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Which alleles increase risk of diabetes significantly?

DR3 and DR4

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Which chromosome is the HLA-DR gene on

Chromosome 6

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Markers that can be used to diagnose which type of diabetes? (4)

Islet cell antibodies (ICA)- group O human pancreas
Insulin antibodies (IAA)
Glutamic acid decarboxylase antibodies (GADA)- widespread neurotransmitter
Insulinoma-associated-2 autoantibodies (IA-2A)- receptor like family

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Symptoms of diabetes? (7)

Polyuria
Nocturia
Polydipsia
Blurring of vision
Thrush
Weight loss
Fatigue

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Signs of diabetes? (6)

Dehydration
Cachecia
Hyperventilation
Smell of ketones
Glycosuria
Ketonuria

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Why do diabetic patients get thrush

Increased risk of infections

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Why do diabetic patients Hyperventilate

they have metabolic acidosis so the body tries to get rid of the acid by blowing off CO2

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What is Kussmaul breathing

they have metabolic acidosis so the body tries to get rid of the acid by blowing off CO2

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Where is glucose stored

Muscle, liver and adipose tissue

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Insulin has a negative effect on: (4)

Hepatic glucose output
Protein breakdown in the muscle
Glycerol being taken out from the fatty tissue into the periphery to be converted to glucose in the liver
FA being taken out of adipose to be converted to acetyl CoA in the liver

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Insulin has a positive effect on:

Glucose being taken up by the muscle

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Hormones that increase hepatic glucose output: (4)

Catecholamines
Cortisol
Glucagon
Growth Hormone

Mechanism of Diabetic Ketoacidosis?

Glucose isn’t taken up into cells and utilised so a lot of our energy comes from fatty acids
So the lipid in the adipocytes is broken down
Normally, you get glycerol coming out of the adipocytes and going to the liver but in the case of insulin deficiency, you get FATTY ACIDS coming out of the adipocytes into the circulation
Fatty acids then go to the liver where they are converted to ketones and glucose (this process is normally inhibited by insulin)

What is needed to not die in T1DM

exogenous insulin

Sign of T1DM?

 KETONES IN THE BLOOD OR URINE

Insulin is needed in T1DM to prevent long term complications such as: (4)

Retinopathy Nephropathy Neuropathy Vascular Disease

DIET ADVICE IN T1DM: (2 + AND 2 -)

- Reduce calories as fat - Reduce calories as refined carbohydrate - Increase calories as complex carbohydrate - Increase soluble fibre

When do you administer short acting insulin

WITH MEALS

When do you administer long acting insulin

BACKGROUND (at various times)

Which is actual human insulin, Long or short acting insulin

Short

What machine would you give someone with very severe T1DM

INSULIN PUMP

Pros of an insulin pump?

don’t have to inject multiple times, gives better control

Con of insulin pump?

- Does NOT measure glucose, so it isn't like a feedback loop and can also just stop working

How is an islet cell transplant performed? What must the patient take?

Islet cells are harvested, isolated and injected into the liver There is a risk of rejection so patients must be on immunosuppressants for life

Who is eligible for a liver islet cell transplant

long term type 1 diabetes mellitus with complications and occurrences of severe hyopglycaemia that can't be controlled by the instant pump

What is used to monitor blood glucose in diabetics? What blood glucose is it reflective of

Capillary monitoring | Venous

Which is more accurate, measurement from a capillary glucose monitor or capillary prick glucose measurement

capillary prick glucose measurement

Long‐term blood glucose control is monitored by measuring...

HbA1c

How does HbA1c monitoring of glucose work

More glucose, more HbA1c attaches to red blood cells through irreversible covalent bonds

What time period does HbA1c measure glucose over

3 months

What can cause inaccuracies in Hb1Ac test? (2)

- Haemoglobinopathy/renal failure | - haemolytic anaemia

Lower HbA1c is associated with a lower risk of complication, particularly XX

microvascular complication

ACUTE COMPLICATIONS OF T1DM- KETOACIDOSIS:

- Hyperglycaemia | - Metabolic acidosis

HYPOGLYCAEMIA- PLASMA GLUCOSE BELOW...

3.6mmol/L

- Reccurent hypos result in ....

LOSS OF WARNINGS e.g. not clear to the patient that their glucose is falling very low

When is a hypoglycaemic episode common in diabetics?

- Can occur at any time but often a clear pattern - Pre-lunch is common - Nocturnal is very common but not often recognised

What can cause hypoglycaemia? (5)

- Unaccustomed exercise - Missed meals - Inadequate snacks - Alcohol - Inappropriate insulin regime

Cortisol increases blood glucose by...

encouraging protein breakdown in muscle to be used in the liver

catecholamines increases blood glucose by... (3)

Increasing hepatic glucose output Increasing glycerol output from adipocytes increasing FA output from triglycerides in adipocytes

Glucagon increases blood glucose by... (2)

Increasing hepatic glucose output | Increasing fatty acid metabolism in liver to produce acetyl CoA

GH increases blood glucose by... (2)

Increasing glycerol output from adipocytes | increasing FA output from triglycerides in adipocytes

Hypoglycaemia signs (6)

``` Palpitations Tachycardia Tremor Sweating Palor/cold extremities Anxiety ```

Hypoglycaemia symptoms (5)

``` Drowsiness Confusion Altered behaviour Focal neurology Coma ```

Treating hypoglycaemia

If conscious feed ! Glucose and complex carbs If unconscious administer IV dextrose and glucose, avoid concentrated glucose