Week 8 Type 1 Diabetes Flashcards
What % of diabetics have type 1?
5-10%
in type 2 diabetes, insulin secretion may be:
normal
increased
decreased
what does insulin do?
insulin is an anabolic hormone - it promotes uptake into liver, muscles, and adipose tissues and promotes synthesis of proteins, trigs, glycogen
what are the 2 types of type 1 diabetes?
- immune mediated diabetes
- idiopathic diabetes
what is the difference between immune-mediated type 1 diabetes and idiopathic type 1 diabetes?
- immune mediated
- the beta cells are destroyed by an autoimmune process - idiopathic
- the cause of the beta cell destruction is unknown
how many genes are linked to type 1 diabetes? how much inheritability do they account for?
50 genes are linked
account for 80-85% of inheritability
what are some potential triggers of type 1 diabetes?
- viral infection
- casein in cow’s milk
- vitamin D
- length of breastfeeding
risk of having celiac in those with type 1 diabetes is ______ higher compared to the general population
5-10x higher
what are the 2 main acute consequences of insufficient insulin?
- hyperglycemia
- ketonemia
what is hyperphagia
insatiable hunger
what is polydispia
excessive thirst
insulin deficiency leads to ____ glucose uptake by cells and ____ hepatic glucose output
decreased update by cells
increased hepatic glucose output
insulin deficiency leads to ____ trigs synthesis and _____ lipolysis
decreases trig synthesis, increased lipolysis
what is hypovolemia?
low extracellular fluid in the body
NEED TO REVIEW SLIDES 5-8
What is diabetic ketoacidosis?
What are the symptoms?
it is a severe form of hyperglycemia
Symptoms include:
- polyuria
- polydipsia
- polyphagia
- fruity breath
- nausea
- abdomen pain
- KUSSMAUL RESPIRATIONS
- lethargy
what are kussmaul respirations?
rapid, deep breathing - body is trying to eliminate excess CO2 and reduce acidic substances
a symptom of DKA
fruity or acetone breath is a sign of
DKA
_____ is a severe form of hyperglycemia
DKA
What is HHS?
hyperosmolar hyperglycemic state
what is the main difference between DKA and HHS?
DKA = ketoacidosis and hyperglycemia
HHS = severe hyperglycemia without ketoacidosis
DKA is acute, while HHS is gradual onset
what are the biological markers of DKA?
- pH < 7.3
- Bicarbonate < 15 mmol
- Anion gap > 12 mmol (shows if there is too much acidity in blood)
- serum of urine ketones
- Plasma glucose > 14 mmol
- Precipitating factor
what are common features of DKA and HHS?
insulin deficiency –> hyperglycemia –> urinary loss of water and electrolytes
DONT UNDERSTAND SLIDE 13
what are 3 main symptoms of hyperglycemia in DKA?
what is the main sign of hyperglycemia?
- polyuria
- polydipsia
- weakness
main sign: EXFV contraction
what are the main symptoms of acidosis in DKA?
what are the main signs?
- hunger
- nausea
- vomiting
- ab pain
Signs:
- kussmaul respiration, acetone odoured breath
why is it hard to diagnose DKA in pregnancy?
pregnant women already have high glucose
DONT UNDERSTAND SLIDE 16
what is self management education in type 1 diabetes?
an intervention that involves active patient participation in self-monitoring or decision making with the application of knowledge and skills
how do you treat type 1 diabetes?
exogenous insulin + nutrition therapy + physical activity
Insulin is classified according to 3 things:
- onset
- peak time
- duration
Insulin dose depends on 5 things:
- age
- body size
- insulin sensitivity
- hepatic function
- clinical judgment
what % of insulin taken during the day is long (basal)? What % is short?
long = 40-50%
short = 50-60%
there are 3 types of insulin delivery regimens
- fixed - set dose each meal
- flexible - changing dose
- continuous subcutaneous insulin infusion - pump
Humalog is this type of insulin:
bolus insulin
Novorapid is this type of insulin:
bolus insulin
lantus is this type of insulin
long acting basal
levemir is this type of insulin
long acting basal
tresiba and basaglar are this type of insulin
long acting basal
when does long acting insulin start to work? when does it peak?
after 90 minutes
it doesnt peak
when does rapid acting insulin start to work? when does it peak?
starts to work after 9-20 minutes
Peaks after 1-1.5 hours
when does short acting insulin start to work? when does it peak?
starts: 30 minutes
peaks: 2-8 hours
when does intermediate acting insulin start to work? peak?
start to work: 1-3 hrs
peak: 5-8 hrs
lasts up to 18 hrs
it is important to councel all type 1 diabetes patients about:
hypoglycemia: recogonition, treatment, prevention
what is the formula for insulin requirements?
EITHER
weight in lbs/4
OR
weight in kg x 0.55
What is insulin to carb ratio?
how do you know if your carb ratio is good?
how many grams of carbs 1 unit of insulin will cover.
grams of carbs eaten / units of rapid acting insulin taken
if your carb ratio is good, your blood sugar should rise 2 to 4 mmol/L 2 hours after eating.
if you have a good carb ratio, how much do you want your blood sugar to rise 2 hours ater eating?
2-4 mmol/L
what is the equation for insulin to carb ratio?
grams of carbs eat / units of rapid-acting insulin taken
how do you calculate how many insulin units you need?
of grams of carbs at a meal / the carb ratio number
what are the benefits of continuous subcutaneous insulin infusion? aka pump?
- gives small improvements to A1C compared to basal bolus injections
- gives improved treatment satisfaction and diabetes specific QOL
- reduced SEVERE hypoglycemia if there is a high baseline rate of severe hypoglycemia - but nonsevere and nocturnal hypoglycemia remain unchanged
does ontario cover insulin pump?
yes - for kids and adults with type 1
government also gives $200 in supplies
how do people qualify for pump coverage for type 1 diabetes by ontario government?
- part of diabetes education program
- prove SMBG - test 4x per day
- DKA and hypoglycemia prevention education
what are the 6 pros of CSII
- flexibility
- improved QOL
- more accurate dosing
- fewer needle pokes
- easier to plan for exercise
- easier to bolus
what are the 5 cons of CSII?
- always attached
- technology
- more education (need to know how to count carbs and manage exercise)
- cost
- troubleshooting
what are the benefits of CGM?
- improved A1C with no increase in hypglycemia
- improved QOL
also, if using sensory -augmented pump (SAP) therapy with nocturnal hypoglycemia, using SAP with low glucose suspend provides a reduction in nocturnal hypoglycemia with no A1C increase
what are 10 recommendations for managing type 1?
- use basal-bolus injections or pump
- use rapid acting insulin analogues in place of regular insulin to improve a1c and minimize hypoglycemia
- use a long acting insulin instead of intermediate acting insulin to reduce hypoglycemia (use degludec instead of detemir)
- need counselling about the risk and prevention of hypoglycemia
- do the following items to reduce hypoglycemia: use a standardized eudcation program, increased frequency of SMBG, CGM with high sensor adherence in pump patients, and less strngent glycemic targets
- in people using basal bolus who are not hitting targets, try pump with or without CGM
- pump may improve satisfaction, and pump + CGM may improve QOL
- pump patients should undergo periodic evaluations to determine if its still appropriate
- CGM can help improve or maintain A1C regardless of insulin delivery method
- if you experience nocturnal hypoglycemia and use pump and CGM, SAP with low glucose suspend may be chosen over SAP alone to reduce hypoglycemia
what are the preferred insulin routines for adults with type 1 diabetes?
basal bolus
switch to pump if glycemic targets are not met
who should be counselled about the risks of hypoglycemia?
all type 1 paitents
what is the nutrition checklist for type 1 diabetes?
- REFER for nutrition counselling
- FOLLOW canada food guide
- INDIVIDUALIZE dietary advice
- CHOOSE low glycemic index carbs
- KNOW alt diet patterns
- ENCOURAGE matching insulin to carbs for type 1
- ENCOURAGE nutritionally balanced, calorie-reduced diet
List 4 diabetes resources
- just the basics
- beyond the basics
- glyceminc index educational portal
- diabetes exchange lsit
