Management of Type 1 Diabetes

Question 1

What is the clinical presentation of type 1 diabetes?

Answer 1

polyuria, polydipsia, weight loss and ketoacidosis

Question 2

What are the different ways which insulin can be administered?

Answer 2

long acting insulin, short acting insulin, mixed long and short acting insulin, insulin pumps

Question 3

What are the different types of long acting insulin?

Answer 3

human, bovine and genetically modified (glargine and detemir)

Question 4

Why does detemir stop weight gain?

Answer 4

because the fatty acid side chain allows it to enter the brain where it can inhibit food intake

Question 5

What are the different types of short acting insulin?

Answer 5

bovine, human and genetically modified (aspart, lispro or glulisine)

Question 6

What is the basal bolus regime?

Answer 6

a dose of long acting insulin before bed and a dose of short acting insulin before meals - aims to mimic normal insulin physiology

Question 7

How do insulin pumps work?

Answer 7

delivers short acting insulin continuosly at a background rate and then a button is pressed to deliver a bolus before each meal

Question 8

How does an artificial pancreas work?

Answer 8

has a sensor for blood glucose which tells the pump when to release insulin and glucagon

Question 9

What are the issues with islet cell transplantation?

Answer 9

availability of tissue to transplant and the need for life long immunosuppression

Question 10

Which three tissues are particularly susceptible to glucose toxicity?

Answer 10

the retina, the kidney and nerves

Question 11

Why is it important to measure blood sugar in diabetic patients?

Answer 11

to ensure correct doses of insulin are being given

Question 12

What is HbA1c?

Answer 12

non-enzymatically glycosylated haemoglobin

Question 13

What does an HbA1c percentage show?

Answer 13

an integrated value of the blood sugar over the past 3 months

Question 14

What is the HbA1c target in diabetes?

Answer 14

7%

Question 15

What does it mean if patients have a low HbA1c but high blood glucose readings?

Answer 15

that the HbA1c is artificially low - probably due to high red cell turnover

Question 16

What is fructosamine?

Answer 16

another glycosylated product which can be measured if HbA1c is inaccurate - but only shows past 6-8 weeks

Question 17

What are the symptoms of a rapid fall in glucose leading to hypoglycaemia?

Answer 17

tachycardia, anxiety, dry mouth and tremor with risk of a heart attack

Question 18

What are the symptoms of an absolute glucose deficiency?

Answer 18

brain malfunction which can cause paralysis, coma and death

Question 19

What is the treatment for hypoglycaemia?

Answer 19

glucose and glucagon

Question 20

What are the precipitating causes of ketoacidosis?

Answer 20

infection, cessation of insulin, new onset diabetes, pancreatitis, AMI or unknown

Question 21

What are the presenting symptoms of ketoacidosis?

Answer 21

polyuria, polydipsia, weight loss, fruity breath, hyperventilating, drowsiness, coma

Question 22

What is the treatment of ketoacidosis?

Answer 22

IV saline, insulin and potassium

Question 23

Why is it critical to give potassium with insulin in treatment of ketoacidosis?

Answer 23

because insulin stimulates take up of potassium in the cell an so without it patient is at risk of hypokalaemia and heart arrhythmias