Diabetes Type 1

Question 1

Define diabetes mellitus Type 1.

Answer 1

characterised by an inability to produce/secrete insulin due to autoimmune destruction of the beta-cells (production site of insulin) in the pancreatic islets of Langerhan.

Question 2

how is type1diabetes characterised?

Answer 2

It is characterised by an absolute insulin deficiency, state of persistent hyperglycaemia with abnormalities in carbohydrate, fat and protein metabolism.

Question 3

What percent does type 1 diabetes account for in diabetic children?

Answer 3

90-95%

Question 4

Give the triad of hyperglycaemia symptoms:

Answer 4

1) polyuria
2) polydipsia
3) weight loss

Question 5

What is the normal blood glucose range for humans?

Answer 5

4.4-6.1 mmol/L

Question 6

Give 2 way in which insulin reduces blood sugar?

Answer 6

1. It stimulates the liver and muscle to take up glucose and store it as glycogen
2. It stimulates cells to take it up and use it for metabolic processes

Question 7

What cells produce glucagon?

Answer 7

alpha Islet cells

Question 8

When is glucagon released?

Answer 8

When blood glucose levels are low

Question 9

How does glucagon release increase blood sugar (2)

Answer 9

1) it stimulates the liver to breakdown stored glycogen and convert it into glucose in the blood (glycogenolysis)
2) it stimulates the liver to convert proteins and fats into glucose (gluconeogenesis)

Question 10

Give 5 blood investigations for T1 diabetes:

Answer 10

1) FBC
2) U+Es
3) HbA1c
4) urine dip
5) insulin antibodies, anti-GAD and islet cell antibodies

Question 11

What is the epidemiology of T1?

Answer 11

he condition can develop at any age. It is estimated that over 370,000 adults are affected with T1DM within the UK and this is thought to represent about 10% of adults who suffer from diabetes.

Question 12

What is the aetiology of T1DM?

Answer 12

In T1DM, progressive beta-cell destruction leads to a decline in the amount of insulin that is able to be secreted. This continues until the relative deficiency in insulin is unable to maintain normal blood glucose leading to hyperglycaemia. This usually occurs when up to 90% of the beta-cell mass has been destroyed.

Question 13

What are the causes/risk factors of type 1 diabetes?

Answer 13

1. Genetic
2. Diet
3. Vitamin D exposure

Question 14

What other 4 counter-regulatory hormones promote glucose production within the liver?

Answer 14

1. Glucagon
2. Adrenaline
3. Growth hormone
4. Cortisol

Question 15

How does type 1 lead to polyuria, polydipsia, dehydration and electrolyte derangement?

Answer 15

The absence of insulin leads to an increase in the rate of glucose production from the liver and reduced peripheral uptake of glucose. This is exacerbated by the high levels of glucagon and other counter-regulatory hormones. This results in an osmotic diuresis leading to polyuria, polydipsia, dehydration and electrolyte derangement.
The peripheral tissue is unable uptake glucose to utilise it as energy. Weight loss occurs secondary to fluid loss and increased muscle and fat breakdown.

Question 16

What does LADA stand for?

Answer 16

Latent-onset autoimmune diabetes in adults (LADA) refers to a variant of T1DM that occur later in life.

It refers to a group of patients who have autoimmune destruction of beta cells (as evidenced by positive autoantibodies). It tends to have a gradual onset.

Question 17

What are symptoms of T1DM?

Answer 17

Polyuria & polydipsia
Weight loss
Vomiting
Lethargy

Question 18

What are the signs of T1DM?

Answer 18

Mild-moderate dehydration (dry skin, dry mucous membranes, reduced skin turgor)
BMI < 25

Question 19

What two molecules will be found in a urine dip of a T1 diabetic?

Answer 19

1) glucose
2) ketones

Question 20

What is the effect of repeatedly injecting insulin into the same spot?

Answer 20

lipodystrophy (hardening of subcutaneous fat that presents normal absorption of insulin when injected in this area)

Question 21

What is the management of T1DM?

Answer 21

Management of T1DM requires life-long exogenous insulin to prevent acute complications (e.g. DKA) and long-term sequelae (e.g CKD, IHD, Retinopathy).

Question 22

What are the two insulin delivery methods used in T1 diabetes:

Answer 22

1) basal bolus regimens of insulin
2) insulin pump

Question 23

Describe the basal and bolus components of basal bolus regimes:

Answer 23

1) basal - injection of long term insulin typically in the evening
2) bolus - injection of short acting insulin before meals or snacking

Question 24

Give an example of a long acting insulin:

Answer 24

Lantus

Question 25

Give an example of a short acting insulin:

Answer 25

Actrapid

Question 26

What is an insulin pump?

Answer 26

a small device that continuously infuses insulin at different rates depending on blood sugar

Question 27

How often should an insulin pump cannula be replaced?

Answer 27

every 2-3 days

Question 28

How old does a child need to be in order to qualify for an insulin pump?

Answer 28

12 years old

Question 29

What are the two types of glucose monitoring?

Answer 29

Real-time continuous CGM: latest blood sugars are automatically recorded and shown on a handheld device
Intermittently scanned CGM (i.e. ‘Flash’): a recording is only made when you scan a device over the sensor

Question 30

What are the two types of insulin pump?

Answer 30

1) tethered pumps (devices attached using a belt)
2) patch pumps (patches that sit on the skin and are replaced when the patch runs out of insulin)

Question 31

What are the blood glucose targets for T1DM patients?

Answer 31

On waking: fasting blood glucose 5–7 mmol/L
Before meals: blood glucose 4–7 mmol/L
Post meals: test after 90 minutes, blood glucose 5–9 mmol/L

Question 32

What is the HbA1c traget in T1DM patients?

Answer 32

Patients and clinicians should target a HbA1c < 48 mmol/L (6.5%). Factors that may demand a higher threshold include hypoglycaemic episodes, occupation and co-morbidities.

Question 33

What are some complications of T1DM?

Answer 33

1. Nephropathy — diabetic kidney disease is caused by damage to small blood vessels in the kidneys.
2. Retinopathy — diabetic retinopathy is caused by small blood vessel damage to the retina, leading to progressive loss of vision and possible blindness
3. Neuropathy — diabetes causes nerve damage through different mechanisms, including direct damage by the hyperglycemia and decreased blood flow to nerves by damaging small blood vessels
4. Diabetic foot disease often leads to ulceration and subsequent limb amputation

Question 34

What are 2 acute complications?

Answer 34

1. Hypoglycaemia
2. Diabetic ketoacidosis

Question 35

Give 9 presentations associated with hypoglycaemia:

Answer 35

1) hunger
2) tremor
3) sweating
4) irritability
5) dizziness
6) pallor
7) impairment of consciousness
8) seizures
9) comas

Question 36

How is moderate hypoglycaemia treated?

Answer 36

ingestion of rapid glucose like Lucozade and slower acting carbohydrates like biscuits

Question 37

How is severe hypoglycaemia treated?

Answer 37

1) IV dextrose (10%)
2) IM glucagon

Question 38

What is a common cause of severe hypoglycaemia in type 1 diabetics?

Answer 38

insulin overdose

Question 39

Give 3 microvascular complications of diabetes:

Answer 39

1) peripheral neuropathy
2) nephropathy
3) retinopathy

Question 40

Give 4 infectious complications of diabetes:

Answer 40

1) UTIs
2) fungal infections (candidiasis)
3) shin and soft tissue infections
4) pneumonia

Question 41

Give 4 macrovascular complications of diabetes:

Answer 41

1) stroke
2) coronary artery disease
3) peripheral ischaemia and diabetic foot disease
4) hypertension

Question 42

Describe how diabetes affects the immune system:

Answer 42

the immune system is suppressed by hyperglycaemia

Question 43

Describe how diabetes affects vascular health:

Answer 43

chronic exposure to hyperglycaemia causes damage to endothelial cells which become leaky and lose the ability to regenerate

Question 44

Give 3 methods used to monitor T1 diabetes:

Answer 44

1) HbA1C checks
2) capillary glucose testing
3) flash glucose monitoring

Question 45

What is flash glucose monitoring?

Answer 45

where a sensor on the skin measures glucose levels of the interstitial fluid