Diabetes Mellitus - Type 1 Flashcards

1
Q

Define Type 1 Diabetes Mellitus

A

Chronic metabolic hyperglycaemic condition caused by absolute insufficiency of pancreatic insulin production, causing impaired carbohydrate, protein and fat metabolism

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2
Q

Aetiology of Type 1 Diabetes Mellitus

A

Destruction of the pancreatic insulin-producing beta cells -> absolute insulin deficiency

Often autoimmune process against beta cells (90%)

Hyperglycaemia arises when 90% of the beta cells have been destroyed

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3
Q

Epidemiology of Type 1 Diabetes Mellitus

A

Accounts for 5-10% of all diabetic cases
Accounts for >85% of diabetes cases under 20
Highest incidence children 10-14

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4
Q

Symptoms of Type 1 Diabetes Mellitus

A

Patient: young, lean appearance

Polyuria, polydipsia
Weight loss
Nocturia
Fatigue
Blurred vision 

+symptoms of complications:
DKA (abdo pain, nausea + vomiting, drowsiness, confusion, coma)
Neuropathy (painless leg ulcers, loss of sensation)

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5
Q

Signs of DKA and neuropathy due to Type 1 Diabetes Mellitus on examination

A
DKA: 
Tachypnoea, Kussmaul breathing (deep + rapid)
Ketotic breath
Dry mucous membranes
Reduced skin turgor 
Neuropathy:
Painless leg ulcers
Loss of sensation (monofilament+vibration)
Weak/absent dorsalis pedis pulse
Cranial nerve palsy 
Diplopia
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6
Q

Investigations for Type 1 Diabetes Mellitus

A

Fasting plasma glucose >6.9
Random plasma glucose >11.1
Oral glucose tolerance test >11.1
HbA1c >48

Urinary ketones: T1DM 
ABPI: suggests PAD 
Urinary albumin excretion: may be increased (end-organ damage)
ECG: ?ischaemia
Fundoscopy: retinopathy 

Fasting C peptide: low or undetectable
Autoimmune markers: +ve
Fasting lipid profile: normal
Serum creatinine + eGFR: ?renal insufficiency

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7
Q

Conservative Management for Type 1 Diabetes Mellitus

A
Smoking cessation
Physical activity 
Nutritional advice (DAFNE programme)
Self-monitoring of blood glucose levels (at least 4x a day)
Hypoglycaemia avoidance 

HbA1c monitoring every 3-6 months

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8
Q

Medical management for Type 1 Diabetes Mellitus

A

Insulin therapy

  1. Basal-bolus (2x daily insulin detemir) + rapid acting insulin before meals (lispro, aspart, glulisine)
  2. Continuous SC insulin infusion (insulin pump_
  3. Mixed insulin regimens
  4. sliding scale (hospital use)
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9
Q

Complications of Type 1 Diabetes Mellitus

A

Microvascular: retinopathy, neuropathy, nephropathy

Macrovascular: cardiovascular, cerebrovascular, peripheral vascular disease

Hypoglycaemia with insulin therapy

Diabetic Ketoacidosis

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10
Q

What is hypoglycaemia define as and how is it managed

A

Plasma glucose < 3 mmol/L = severe

Able to swallow -> 50g oral fast-acting glucose e.g. lucozade, sugar, 3 dextrose tablets

Reduced consciousness -> IM glucagon ± IV glucose

No improvement after 10 mins -> IV glucose (dextrose)
-> when safe switch to oral carbohydrate

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11
Q

What are the stages of Type 1 Diabetic retinopathy + their management

A
  1. Background retinopathy
    Hard exudates | Microaneurysms | blot haemorrhages
    => Warn about warning signs + improve glucose control
  2. Pre-proliferative
    Cotton wool spots/soft exudates
    => Pan-retinal photocoagulation
  3. Proliferative
    Visible new vessels on disk or elsewhere
    => Pan-retinal photocoagulation
  4. Maculopathy
    Hard exudates near the macula | microaneurysms | blot haemorrhages
    Can threaten direct vision
    => Grid photocoagulation
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12
Q

Describe Type 1 Diabetic nephropathy and its management

A

HTN + progressively increasing proteinuria and deteriorating kidney function
Histological: mesangial expansion, BM thickening, glomcerulosclerosis

=> diabetic control | BP control | RAAS inhibition = ACEi | Smoking cessation

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13
Q

Describe the different types of Type 1 Diabetic neuropathy

A

Peripheral: longest nerves supply the feet, common in taller people, no sense of injury -> infection -> does not heal

Mononeuropathy: sudden motor loss (wrist, foot drop, CN palsy)

Autonomic: loss of sympathetic/parasympathetic innervation to system

Mononeuritis multiplex: random combo of peripheral nerve lesions

Radiculopathy: pain over spinal nerve, often dermatomes

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14
Q

Prognosis for Type 1 Diabetes Mellitus

A

Untreated = fatal due to DKA
Poor control = risk factor for many chronic complications
Intensive glycaemia control decreases complication rates, even if for a few years
Cardiovascular disease is the major cause of death

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