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Year 6 Endocrinology > Diabetes Mellitus Type 1 > Flashcards

Diabetes Mellitus Type 1 Flashcards

1
Q

What are the typical symptoms and signs in a new diagnosis of type 1 diabetes mellitus (T1DM)?

A

The symptoms are typically those seen in diabetic ketoacidosis (DKA) and may develop over a longer time frame.

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2
Q

What are the features of diabetic ketoacidosis (DKA)?

A

Abdominal pain, polyuria, polydipsia, dehydration, Kussmaul respiration, and acetone-smelling breath (‘pear drops’ smell).

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3
Q

What investigations should be conducted for suspected T1DM?

A

Urine should be dipped for glucose and ketones, fasting glucose and random glucose should be measured, and C-peptide levels should be checked.

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4
Q

Why is HbA1c not as useful for suspected T1DM?

A

HbA1c may not accurately reflect a recent rapid rise in serum glucose.

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5
Q

What are typical C-peptide levels in patients with T1DM?

A

C-peptide levels are typically low in patients with T1DM.

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6
Q

What diabetes-specific autoantibodies are useful to distinguish between type 1 and type 2 diabetes?

A

Antibodies to glutamic acid decarboxylase (anti-GAD), Islet cell antibodies (ICA), Insulin autoantibodies (IAA), and Insulinoma-associated-2 autoantibodies (IA-2A).

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7
Q

What is the presence rate of anti-GAD antibodies in T1DM patients?

A

Present in around 80% of patients with T1DM.

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8
Q

What is the presence rate of Islet cell antibodies (ICA) in T1DM patients?

A

Present in around 70-80% of patients with T1DM.

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9
Q

What is the presence rate of Insulin autoantibodies (IAA) in young children with T1DM?

A

Found in over 90% of young children with T1DM but only 60% of older patients.

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10
Q

What are the diagnostic criteria for type 1 diabetes mellitus if the patient is symptomatic?

A

Fasting glucose greater than or equal to 7.0 mmol/l or random glucose greater than or equal to 11.1 mmol/l.

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11
Q

What are the diagnostic criteria for type 1 diabetes mellitus if the patient is asymptomatic?

A

The same criteria apply but must be demonstrated on two separate occasions.

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12
Q

What is the typical age of onset for type 1 diabetes?

A

Typically < 20 years, but 40% of cases may occur in patients > 30 years.

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13
Q

What is the typical speed of onset for type 1 diabetes?

A

More acute, occurring over hours to days.

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14
Q

What are the typical weight characteristics of patients with type 1 diabetes?

A

Recent weight loss is typical.

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15
Q

What are the typical features of type 2 diabetes?

A

Milder symptoms such as polyuria and polydipsia, and obesity is a strong risk factor.

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16
Q

What does NICE recommend for diagnosing type 1 diabetes in adults?

A

Diagnose on clinical grounds if presenting with hyperglycaemia and features like ketosis, rapid weight loss, age of onset below 50 years, BMI below 25 kg/m², or a personal/family history of autoimmune disease.

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17
Q

When should further investigation for T1DM be considered in adults?

A

If atypical features are present, such as age 50 years or above, BMI of 25 kg/m² or above, or slow evolution of hyperglycaemia.

18
Q

What is the approach for patients over 40 years suspected of type 2 diabetes?

A

If they respond well to oral hypoglycaemic agents, further testing for type 1 diabetes is not needed.

19
Q

What is the significance of C-peptide levels and diabetes-specific autoantibodies in diagnosis?

A

They are the investigations of choice for those in whom there is doubt about the type of diabetes.

20
Q

What is an example scenario for diagnosing T1DM?

A

A 15-year-old presents with weight loss and ketones in urine, with a random serum glucose of 14 mmol/L → T1DM, no need for further investigations.

21
Q

What is an example scenario for diagnosing T2DM?

A

A 59-year-old obese man presents with polyuria and a random serum glucose of 12.0 mmol/L → T2DM, no need for further investigations.

22
Q

What is the long-term management of type 1 diabetes?

A

It is an important and complex process requiring input from various clinical specialties and healthcare team members.

23
Q

How does a diagnosis of type 1 diabetes affect life expectancy?

A

It can reduce life expectancy by 13 years.

24
Q

What are the guidelines released by NICE in 2015 regarding type 1 diabetes?

A

They provide guidance on the diagnosis and management of type 1 diabetes for clinicians.

25
Q

How often should HbA1c be monitored in adults with type 1 diabetes?

A

Every 3-6 months.

26
Q

What is the target HbA1c level for adults with type 1 diabetes?

A

48 mmol/mol (6.5%) or lower.

Consider factors like daily activities, aspirations, complications, comorbidities, occupation, and hypoglycaemia history.

27
Q

How often should blood glucose be self-monitored?

A

At least 4 times a day, including before each meal and before bed.

28
Q

When should more frequent blood glucose monitoring be done?

A

If hypoglycaemic episodes increase, during illness, before/during/after sport, when planning pregnancy, during pregnancy, and while breastfeeding.

29
Q

What are the blood glucose targets for waking and before meals?

A

5-7 mmol/l on waking and 4-7 mmol/l before meals at other times of the day.

30
Q

What type of insulin regimen is recommended for adults with type 1 diabetes?

A

Multiple daily injection basal-bolus insulin regimens, rather than twice-daily mixed insulin regimens.

31
Q

What is the regime of choice for twice-daily insulin?

A

Insulin detemir.

32
Q

What alternatives are available for once-daily insulin?

A

Insulin glargine or insulin detemir.

33
Q

What type of insulin is recommended for mealtime insulin replacement?

A

Rapid-acting insulin analogues injected before meals, rather than rapid-acting soluble human or animal insulins.

34
Q

When should metformin be considered for patients with type 1 diabetes?

A

If the BMI is >= 25 kg/m².

35
Q

What should patients with type 1 diabetes on insulin avoid during sick days?

A

Patients must not stop insulin due to the risk of diabetic ketoacidosis.

36
Q

How frequently should blood glucose be checked for patients with type 1 diabetes during sick days?

A

Blood glucose should be checked more frequently, for example, every 1-2 hours including through the night.

37
Q

What additional levels should be considered for checking in type 1 diabetes patients during sick days?

A

Consider checking blood or urine ketone levels regularly.

38
Q

What meal pattern should be maintained for patients with type 1 diabetes during sick days?

A

Maintain normal meal pattern if possible.

39
Q

What can be done if appetite is reduced in type 1 diabetes patients during sick days?

A

Meals could be replaced with carbohydrate-containing drinks such as milk, milkshakes, fruit juices, and sugary drinks.

40
Q

How much fluid should patients with type 1 diabetes aim to drink daily during sick days?

A

Aim to drink at least 3 L of fluid (5 pints) a day to prevent dehydration.

Year 6 Endocrinology (27 decks)

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