Diabetes Mellitus Type 1 Flashcards
What are the typical symptoms and signs in a new diagnosis of type 1 diabetes mellitus (T1DM)?
The symptoms are typically those seen in diabetic ketoacidosis (DKA) and may develop over a longer time frame.
What are the features of diabetic ketoacidosis (DKA)?
Abdominal pain, polyuria, polydipsia, dehydration, Kussmaul respiration, and acetone-smelling breath (‘pear drops’ smell).
What investigations should be conducted for suspected T1DM?
Urine should be dipped for glucose and ketones, fasting glucose and random glucose should be measured, and C-peptide levels should be checked.
Why is HbA1c not as useful for suspected T1DM?
HbA1c may not accurately reflect a recent rapid rise in serum glucose.
What are typical C-peptide levels in patients with T1DM?
C-peptide levels are typically low in patients with T1DM.
What diabetes-specific autoantibodies are useful to distinguish between type 1 and type 2 diabetes?
Antibodies to glutamic acid decarboxylase (anti-GAD), Islet cell antibodies (ICA), Insulin autoantibodies (IAA), and Insulinoma-associated-2 autoantibodies (IA-2A).
What is the presence rate of anti-GAD antibodies in T1DM patients?
Present in around 80% of patients with T1DM.
What is the presence rate of Islet cell antibodies (ICA) in T1DM patients?
Present in around 70-80% of patients with T1DM.
What is the presence rate of Insulin autoantibodies (IAA) in young children with T1DM?
Found in over 90% of young children with T1DM but only 60% of older patients.
What are the diagnostic criteria for type 1 diabetes mellitus if the patient is symptomatic?
Fasting glucose greater than or equal to 7.0 mmol/l or random glucose greater than or equal to 11.1 mmol/l.
What are the diagnostic criteria for type 1 diabetes mellitus if the patient is asymptomatic?
The same criteria apply but must be demonstrated on two separate occasions.
What is the typical age of onset for type 1 diabetes?
Typically < 20 years, but 40% of cases may occur in patients > 30 years.
What is the typical speed of onset for type 1 diabetes?
More acute, occurring over hours to days.
What are the typical weight characteristics of patients with type 1 diabetes?
Recent weight loss is typical.
What are the typical features of type 2 diabetes?
Milder symptoms such as polyuria and polydipsia, and obesity is a strong risk factor.
What does NICE recommend for diagnosing type 1 diabetes in adults?
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.
When should further investigation for T1DM be considered in adults?
If atypical features are present, such as age 50 years or above, BMI of 25 kg/m² or above, or slow evolution of hyperglycaemia.
What is the approach for patients over 40 years suspected of type 2 diabetes?
If they respond well to oral hypoglycaemic agents, further testing for type 1 diabetes is not needed.
What is the significance of C-peptide levels and diabetes-specific autoantibodies in diagnosis?
They are the investigations of choice for those in whom there is doubt about the type of diabetes.
What is an example scenario for diagnosing T1DM?
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.
What is an example scenario for diagnosing T2DM?
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.
What is the long-term management of type 1 diabetes?
It is an important and complex process requiring input from various clinical specialties and healthcare team members.
How does a diagnosis of type 1 diabetes affect life expectancy?
It can reduce life expectancy by 13 years.
What are the guidelines released by NICE in 2015 regarding type 1 diabetes?
They provide guidance on the diagnosis and management of type 1 diabetes for clinicians.
How often should HbA1c be monitored in adults with type 1 diabetes?
Every 3-6 months.
What is the target HbA1c level for adults with type 1 diabetes?
48 mmol/mol (6.5%) or lower.
Consider factors like daily activities, aspirations, complications, comorbidities, occupation, and hypoglycaemia history.
How often should blood glucose be self-monitored?
At least 4 times a day, including before each meal and before bed.
When should more frequent blood glucose monitoring be done?
If hypoglycaemic episodes increase, during illness, before/during/after sport, when planning pregnancy, during pregnancy, and while breastfeeding.
What are the blood glucose targets for waking and before meals?
5-7 mmol/l on waking and 4-7 mmol/l before meals at other times of the day.
What type of insulin regimen is recommended for adults with type 1 diabetes?
Multiple daily injection basal-bolus insulin regimens, rather than twice-daily mixed insulin regimens.
What is the regime of choice for twice-daily insulin?
Insulin detemir.
What alternatives are available for once-daily insulin?
Insulin glargine or insulin detemir.
What type of insulin is recommended for mealtime insulin replacement?
Rapid-acting insulin analogues injected before meals, rather than rapid-acting soluble human or animal insulins.
When should metformin be considered for patients with type 1 diabetes?
If the BMI is >= 25 kg/m².
What should patients with type 1 diabetes on insulin avoid during sick days?
Patients must not stop insulin due to the risk of diabetic ketoacidosis.
How frequently should blood glucose be checked for patients with type 1 diabetes during sick days?
Blood glucose should be checked more frequently, for example, every 1-2 hours including through the night.
What additional levels should be considered for checking in type 1 diabetes patients during sick days?
Consider checking blood or urine ketone levels regularly.
What meal pattern should be maintained for patients with type 1 diabetes during sick days?
Maintain normal meal pattern if possible.
What can be done if appetite is reduced in type 1 diabetes patients during sick days?
Meals could be replaced with carbohydrate-containing drinks such as milk, milkshakes, fruit juices, and sugary drinks.
How much fluid should patients with type 1 diabetes aim to drink daily during sick days?
Aim to drink at least 3 L of fluid (5 pints) a day to prevent dehydration.
