Diabetes Mellitus: Type 1

Question 1

Define T1DM

Answer 1

metabolic hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production

Question 2

Describe the aetiology of T1DM

Answer 2

AI destruction of pancreatic insulin-producing beta cells

Question 3

List 4 auto antigens are associated with T1DM?

Answer 3

Glutamic acid decarboxylase (GAD)
Insulin
Insulinoma-associated protein 2
Cation efflux zinc transporter

Question 4

Who does T1DM occur in?

Answer 4

Genetically susceptible individuals with an environmental trigger

Question 5

Describe the epidemiology of T1DM

Answer 5

0.25% prevalence in the UK

Question 6

List 5 presenting symptoms/ signs of T1DM

Answer 6

Juvenile onset (< 30 yrs)  
Polyuria/ nocturia 
Polydipsia 
Tiredness 
Weight loss

Question 7

Which signs of autoimmune conditions should you look for in a suspected T1DM patient?

Answer 7

Vitiligo
Addison’s disease
AI thyroid disease

Question 8

Which 7 investigations are carried out for T1DM?

Answer 8

Blood Glucose
HbA1c  
FBC  
U+Es
Lipid profile  
Urine albumin creatinine ratio 
Urine

Question 9

What blood glucose results are seen in T1DM?

Answer 9

Fasting BG > 7 mmol/L

Random BG > 11.1 mmol/L

Question 10

What are demonstrated by HbA1c, FBC and U+Es?

Answer 10

Hb1AC: glycaemic control in past 2-3 months
FBC: reticulocyte count (high: high erythrocyte turnover leads to misleading high Hb1AC)
U+E: nephropathy (glycosuria, ketnouria, proteinuria)

Question 11

Describe the management plan for T1DM

Answer 11

1. Advice + patient education on diet, DAFNE courses
2. SC insulin: Short acting TD before meals. Long acting BD
3. Insulin pumps: better coverage but more expensive
4. Tx of hypos with IM glucagon + glucose

Question 12

What must be regularly monitored by patients with T1DM?

Answer 12

Capillary blood glucose

Symptoms e.g. thirst

Question 13

What must be regularly checked for patients with T1DM?

Answer 13

HbA1c
Screening + management of complications: fundoscopy, diabetic foot exam + renal function tests
Screening + management of CVD risk factors

Question 14

How are hypos treated in T1DM patients?

Answer 14

Reduced consciousness: 50ml of 50% glucose IV OR 1 mg glucagon IM
Conscious + cooperative: 50g oral glucose + starchy snack

Question 15

List 3 potential microvascular and 3 potential macrovascular complications of T1DM

Answer 15

Diabetic retinopathy
Nephropathy
Neuropathy

Peripheral vascular disease
Ischaemic heart disease
Stroke/ TIA

Question 16

What does T1DM increase risk of?

Answer 16

Infection

Question 17

What side effects may be seen as a result of taking insulin?

Answer 17

Weight gain
Fat hypertrophy at insulin injection sites
Hypoglycaemia- Nausea, tremor, confusion

Question 18

What may mask an overdose of insulin?

Answer 18

B blockers
Autonomic neuropathy
Adaptation to recurrent episode

Question 19

Describe the prognosis in T1DM

Answer 19

Depends on early dx, good glycaemic control + compliance with tx + screening
Vascular disease + renal failure are the main causes of increased morbidity + mortality