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T1DM - Coggle Diagram
T1DM
Pathophysiology
beta cells of pancreas don't produce insulin (or not enough)
Cause unknown
genetic, family link
inability to convert glucose to energy
less sensitive to insulin (insulin resistance)
LADA (latent autoimmune diabetes mellitus in adults)
Immune mediated - beta cells destroyed by autoimmune process
Idiopathic - beta cell dysfunction cause unknown
Signs/symptoms
Polyuria - large amounts of urine especially at night
polydipsia - very thirsty
fatigue
wt loss - insufficient glucose in cells, body burns fat and muscle for energy
hyperglycemia (>15mmol/L) - thirst, fatigue, blurred vision, urination, lack of concentration, irritable
ketoacidosis
hypoglycemia (<4mmol/L) - shaking, trembling, weak, sweating, light headed, headache, paleness, slurred speech, unconsciousness, confusion
Biochem
FBGLs
Random plasma glucose
OGTT
HbA1c
Geno testing
Ketones (0-0.6mmol/L is normal - royal childrens hospital guidelines)
Clinical data
NIS
bowels
Medications
Rapid acting insulin - works between 2.5-20mins, greatest action 3 hrs after injection, eat immediately (NovoRapid)
short acting insulin - begins 30mins after, max effect 2-5 hrs, eat 30mins after injection, last 6-8 hrs, (Actrapid)
intermediate acting insulin (basal) - works 60-90 mins after, peak 4-12 hrs, last 16-24 hrs, used at night (humulin)
long acting insulin (basal, all day) - 24 hrs (lantus)
allergies/intolerances
dawn phenomenon - hyperglycaemia in morning
somogyi effect - insulin lowers BGLs too much, hormone release, rebound high BGLS
Risk factors
CVD - BGLS cause fat deposit in cells, restriction of arteries
kidneys - Diabetic kidney disease, diabetes increases BP=kidney damages
Feet (diabetic neuropathy) - nerve damage, delayed wound healing, foot ulcers, amputation
Eyes (diabetic retinopathy) - high BGLs weaken and damage small blood vessels in retina = blindness, haemorrhages
diabetic ketoacidosis - ketones build up from burning fat for energy, blood acidity, loss of body salts and fluid
Intervention
CHO awareness, GI, CHO distribution
Small frequent meals
diabetic diet and High protein
education on CP
Possible PESS
Nutrition related knowledge deficit
Mild-moderate malnutrition
inconsistent CHO intake
Monitors
blood gluocose monitors - finger prick tests
flash glucose monitoring - sensor on back of arm
continuous BGL monitoring device (CGM). sensor under skin
Anthro
Wt, wt loss, wt hx, muscle status, ht, BMI
POSSIBLE DDR: T1DM is a condition where your pancreas cannot produce insulin. Insulin is a hormone that transports blood glucose into your cell to be used for energy. High blood sugar can lead to nerve, eye, and kidney damage. GI is a measure of how quickly a CHO food is digested and absorbed. Low GI means a slower release of glucose.
Low GI food ideas: wholegrain breads, sourdough, muesli, high fibre cereals, reduced fat dairy, apples, apricots, avocados, kiwi fruit, oranges, strawberries, brown rice, nut butters, couscous, quinoa