2- type 1 diabetes

Question 1

what are the 2 subtypes of type 1 diabetes?

Answer 1

• type 1A = immune mediated. most T1DM patients. auto-immune destruction of beta cell
• type 1B = non-immune mediated. patients with very low insulin production who’re prone to DKA but no beta cell dysfunction or antibody evidence (much rarer)

Question 2

what is LADA?

Answer 2

latent autoimmune disease in adults = slow burning variant of type 1A where slower progression so deficiency occurs later in life

Question 3

what is age for type 1 diabetes?

Answer 3

85% cases under 20s, peak in 10-14yr old
- some as adults, small peak in 30s due to LADA

Question 4

what is the chance of you getting diabetes if
a) 2 parents with type 1
b) 2 parents with type 2

Answer 4

a) 30%
b) 80%

• basically just saying that most people with type 1 are de novo mutation with no fam history

Question 5

what genotype has highest chance of getting type 1 diabetes?

Answer 5

50% chance of getting diabetes if HLA genes and if these HLA genes are DR3/DR4 genotype →very high chance getting type 1

Question 6

what are some environmental factors that can trigger type 1 diabetes? (alongside genetic factors)

Answer 6

• maternal factors (gestational infection, older age)
• viral infections (coxsackie B4)
• environmental toxins like alloxan
• psychological stress
• childhood stress

Question 7

what is seen on beta cell biopsy? (buzzwordy)

Answer 7

insulitis (islet of lamgerhans inflamed) with lymphocytic infiltrate

Question 8

what are symptoms & signs of type 1 diabetes?

Answer 8

• classic triad = polyuria+polydipsia+weight loss
• fatigue
• blurred vision
• thrush or UTIs (from glucose)

Question 9

what is the primary diagnostic investigation for T1DM?

Answer 9

serum glucose!!

fasting glucose = above 7 mmol
random glucose = above 11 mmol

Question 10

what antibodies can be tested ot help confirm type 1 diagnosis?

Answer 10

1. islet-antigen 2 (IA2) - decrease with age
2. Zn-T8 transporter (zinc) - very sensitive
3. GAD (glutamic acid) - increase with age, also in type 2

Question 11

what are the 2 most common management regimens for T1DM?

Answer 11

1. basal bolus regimen = bolus rapid acting 3x a day (with meals) and 1 basal (long acting) overnight
2. twice daily injections

• either with MDI (multiple daily injections) or CSII (continuous subcutaneous insulin infusion)

Question 12

why is rotating injection site important in diabetes?

Answer 12

to avoid lipohypertrophy

Question 13

what is checked in annual review assessment for type 1 diabetes?

Answer 13

• weight
• BP
• bloods - HbA1c, renal function & lipids
• retinal screening
• foot risk assessment

Question 14

what transplant can be done for diabetes (rare)?

Answer 14

• islet transplantation = pancreatic islets from cadavers, injected
• whole pancreas = usually if T1DM & end-stage kidney disease

Question 15

what are SICK day rules for T1DM?

Answer 15

when acutely unwell, body under stress & makes cortisol & steroid hormone which stimulates gluconeogenesis and also noradrenaline + adrenaline makes glycogenolysis & gluconeogenesis = means high glucose made so needs more insulin when sick

S = sugar (monitor as gets high)
I = insulin (never omit)
C = carbs, eat them
K = ketones, monitor them

Question 16

what is difference is symptoms of type 1 vs type 2?

Answer 16

type 1 develop more quickly than type 2
type 2 more likely to be asymptomatic or present with complications like diabetic retinopathy or neuropathy

Question 17

why is HbA1c not used as diagnostic investigation for T1DM?

Answer 17

because HbA1c shows level of glucose in blood over last 90 days and since type 1 comes on quite rapidly, it could be normal HbA1c
(works for type 2 as develops slower)