Diabetes mellitus type 1

Question 1

Define T1DM

Answer 1

Metabolic hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production

Question 2

Aetiology of T1DM

3

Answer 2

Caused by destruction of pancreatic insulin producing β cells

AUTOIMMUNE process

Genetically susceptible individuals + environmental trigger

Question 3

Epidemiology of T1DM

UK prevalence

Answer 3

0.25%

Question 4

Presenting symptoms & signs of T2DM

6

Answer 4

juvenile onset (<30 years)
polyuria/nocturia
polydipsia
tiredness
weight loss
DKA

Question 5

Signs of complications of T1DM

3

Answer 5

• fundoscopy: check for diabetic retinopathy
• examine feet for evidence of neuropathy (monofilament test, pulses)
• monitor BP

Question 6

Investigations for T1DM

8

Answer 6

blood glucose (fasting >7mmol/L or random >11.1mmol/L)

HbA1c

FBC (MCV, reticulocytes)

U&Es - monitor for nephropathy & hyperkalaemia

lipid profile

urine albumin creatinine ratio - to detect microalbuminuria

urine - glycosuria, ketonuria, MSU

Investigations for DKA

Question 7

Management of T1DM - glycaemic control

8

Answer 7

• advice & patient education
• short acting insulin (3x daily before meals) & long acting insulin (once daily)
• insulin pumps
• DAFNE courses (dose adjustment for normal eating)
• monitoring capillary blood glucose regularly & HbA1c every 3-6 months
• screening & management of complications
• screening & management of cardiovascular risk factors

Question 8

Types of short & long acting insulin

3 + 3

Answer 8

Short: lispro, aspart, glulisine
Long: isophane, glargine, detemir

Question 9

Treatment of hypoglycaemia

Answer 9

If reduced consciousness…
50ml of 50% glucose IV OR 1mg glucagon IM

If conscious & cooperative…
50g oral glucose + starchy snack

Question 10

Complications of T1DM

5

Answer 10

Increased risk of infection
Diabetic ketoacidosis 
Microvascular
Macrovascular
Complications of treatment

Question 11

Complications of treatment of T1DM

3

Answer 11

weight gain

fat hypertrophy at insulin injection sites

hypoglycaemia

• personality changes
• fits
• confusion
• coma
• pallor
• sweating
• tremor
• tachycardia
• palpitations
• dizziness
• hunger
• focal neurological symptoms

Question 12

Prognosis for T1DM

2

Answer 12

depends on

1) early diagnosis
2) good glycaemic control
3) compliance w/ treatment & screening

vascular disease & renal failure are main causes of inc. morbidity & mortality

Question 13

Autoantigens associated w/ T1DM

4

Answer 13

• glutamic acid decarboxylase (GAD)
• insulin
• insulinoma associated protein 2
• cation efflux zinc transporter

Question 14

Signs of associated autoimmune conditions

3

Answer 14

• vitiligo
• addison’s disease
• autoimmune thyroid disease

Question 15

Complications of T1DM - DKA

Answer 15

Can be precipitated by infection, errors in diabetes management, newly diagnosed diabetes, idiopathic

Question 16

Complications of T1DM - microvascular

3

Answer 16

Retinopathy
Nephropathy
Neuropathy

Question 17

Complications of T1DM - macrovascular

3

Answer 17

Peripheral vascular disease
Ischaemic heart disease
Stroke/TIA

Question 18

Complications of T1DM - treatment

3

Answer 18

Weight gain
Fat hypertrophy at insulin injection sites
Hypoglycaemia

Question 19

Complications of T1DM - hypoglycaemia

12

Answer 19

Personality changes
Fits
Confusion
Coma
Pallor
Sweating 
Tremor
Tachycardia
Palpitations
Dizziness
Hunger
Focal neurological symptoms