Diabetes Mellitus (type 1) Flashcards
Definition
· Metabolic hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production
Aetiology/Risk factors
· Caused by destruction of pancreatic insulin-producing beta cells
· Autoimmune process
· Occurs in genetically susceptible individuals with an environmental trigger
· Autoantigens associated with T1DM: o Glutamic acid decarboxylase (GAD) o Insulin o Insulinoma-associated protein 2 o Cation efflux zinc transporter
Epidemiology
· 0.25% prevalence in the UK
Presenting symptoms
· Juvenile onset (< 30 yrs) · Polyuria/nocturia · Polydipsia · Tiredness · Weight loss
Can present with DKA symptoms
Signs on physical examination
· Signs of complications:
o Fundoscopy - check for diabetic retinopathy
o Examine feet for evidence of neuropathy (monofilament test, pulses)
o Monitor BP
· Signs of associated autoimmune conditions
o Vitiligo
o Addison’s disease
o Autoimmune thyroid disease
Investigations
· Blood Glucose - fasting blood glucose > 7 mmol/L or random blood glucose > 11.1 mmol/L
· HbA1c
· FBC - MCV, reticulocytes
· U&Es - monitor for nephropathy and hyperkalaemia
· Lipid profile
· Urine albumin creatinine ratio - used to detect microalbuminuria
· Urine - glycosuria, ketonuria, MSU
Management plan
· Glycaemic Control
o Advice and patient education
· Short-acting insulin (three times daily before meals):
§ Lispro
§ Aspart
§ Glulisine
· Long-acting insulin (once daily):
§ Isophane
§ Glargine
§ Detemir
o Insulin pumps
o DAFNE courses (dose adjustment for normal eating)
o Monitor
· Regular capillary blood glucose tests
· HbA1c every 3-6 months
o Screening and management of complications
o Treatment of hypoglycaemia
· If reduced consciousness: 50 ml of 50% glucose IV OR 1 mg glucagon IM
· If consciousness and cooperative: 50 g oral glucose + starchy snack
o Screening and management of cardiovascular risk factors
Possible complications (microvascular)
Retinopathy
Nephropathy
Neuropathy
Possible complications (macrovascular)
Peripheral vascular disease
Ischaemic heart disease
Stroke/TIA
Possible complications (of treatment)
o Weight gain
o Fat hypertrophy at insulin injection sites
o Hypoglycaemia · Personality changes · Fits · Confusion · Coma · Pallor · Sweating · Tremor · Tachycardia · Palpitations · Dizziness · Hunger · Focal neurological symptoms
Prognosis
· Depends on early diagnosis, good glycaemic control and compliance with treatment and screening
· Vascular disease and renal failure are the main causes of increased morbidity and mortality
