Flashcards in T1DM Deck (9):
AI destruction of beta cells in islets of langerhans of the pancreas. Insulin deficient.
Often presents in teens after viral infection.
Usually starts young. HLA D3/4 linked.
Ketosis if very bad
DKA- switch to burning fat whch produces acidic ketone bodies (acetoacetate, beta hydroxybutyrate) via lyase and HMG coA reductase. Vomiting, dehydration, tachypnoea, confusion, coma. Treat with fluids and electrolytes. Insulin once K corrected. Triggered by infection, MI, stroke, cocaine, missed dose, alcohol.
Vascular effects even if mildly raised LT.
Macrovascular- atheroma, stroke, MI, renovascular disease, limb ischaemia.
Micro- retinopathy, nephropathy, neuropathy, impotence.
Random glucose over 11.1 mmol/L
Fasting over 7
HbA1c over 6.5%- is glycosylation of terminal vabline of Hb, measures glucose over last 3 months.
Normal is 7.8, 6.1, 6.
Long term insulin with bm monitoring.
Rapid acting bolus with meals.
Long acting for baseline control and overnight.
Adjust with exercise, calorie intake and according to fingerprick glucose.
Peripheral neuropathy from alcoholism
Endocrine tumour producing GH, GCs, glucagon
-ultra fast eg humalog, novorapid.
-short acting eg humulin S
-intermediate acting eg isophane insulin.
-pre mixed with ultra fast component eg novomix.
-long acting recombinant human insulin analogues eg glargine.
-very long acting eg degludec.
AE- weigth gain, hyper/hypoglycaemia, lipodystrophy at injection site, pain on injection, allergy to preservative.
Vary injection site
-BD biphasic regimen- 2x per day premixed by pen.
-QDS- ultra fast before meals, bed time long acting.
-once daily before bed long acting.