T1DM

Question 1

what is T1DM

Answer 1

autoimmune against B cells of islets of langerhans in pancreas

Question 2

what type of insulin deficiency is in T1DM

Answer 2

absolute

Question 3

symptoms T1DM

Answer 3

weight loss // polydipsia // polyuria // blurred vision // DKA = abdo pain, vomiting, reduced consiousness, ketonuria

Question 4

how does polyuria and dipsia occur in diabetes

Answer 4

glycosuria ‘drags’ water out in urine by osmosis

Question 5

what glucose levels indicate diabetes

Answer 5

fasting > 7 // random or after glucose tolerance > 11.1 // if symptomatic 1 off is diagnostic, if asymptomatic 2 is diagnostic

Question 6

when can T1DM be diagnosed on a clinical basis in a person presenting with hyperglycaemia

Answer 6

ketosis // rapid weight loss // <50 // BMI <25 // FH autoimmune disease

Question 7

when would hyperglycaemia in a suspected new diagnosis of T1DM need further testing + what testing is done

Answer 7

atypical eg 50+, BMI 25+, slow onset hyperglycaemia // C peptide and antibodies

Question 8

antibodies in T1DM

Answer 8

low C peptide!!! // anti-GAD // ICA // IAA // IA2

Question 9

HbA1c in T1DM

Answer 9

not as useful - >6.5% (48mmol)

Question 10

how often should HbA1c be measured in T1DM + what level is aimed for

Answer 10

3-6 months // <48 or 6.5%

Question 11

how often is monitoring of blood glucose recommended T1DM

Answer 11

minimum 4x/day // before each meal and before bed

Question 12

glucose targets T1DM

Answer 12

5-7 on waking // 4-7 before meals

Question 13

what is the optimal insulin regime for T1DM

Answer 13

basal-bolus (basal as a long acting, bolus as a top up when required at meals throughout the day)

Question 14

what is the twice daily insulin (basal) regime of choice

Answer 14

detemir

Question 15

what is the once daily insulin regime (alternative to twice daily)

Answer 15

glargine or detemir

Question 16

what insulin should be taken before bed

Answer 16

rapid acting analogues

Question 17

if insulin is not enough to control T1DM what adjuvant can be given

Answer 17

metformin (if BMI >25)

Question 18

onset, peak, duration of rapid acting insulin analogues

Answer 18

onset = 5mins // peak = 1hr // duration = 3-5 hours

Question 19

examples rapid acting insulin analogues

Answer 19

NovaRapid or Humalog

Question 20

onset, peak, duration of short acting insulin

Answer 20

onset = 30mins // peak = 3 hours // duration = 6-8hrs

Question 21

examples of short acting insulins + what are they

Answer 21

actarapid // Humulin S // come from human insulins

Question 22

examples intermediate insulins

Answer 22

isophane

Question 23

onset, peak, duration of long acting insulin analogues

Answer 23

onset = 1-2hrs // peak = flat profile // duration = 24hours

Question 24

examples long acting insulin analogues

Answer 24

determir (levemir) + glargine (lantus) // basal regime

Question 25

biggest SE of insulin

Answer 25

hypogylcaemia

Question 26

hypogylcaemia symptoms

Answer 26

sweating, anxious, blurry vision, confused, agitated

Question 27

mx of hypoglycaemia in a conscious patient

Answer 27

10-20g carb // lucozade, 3 glucose tablets, glucose gel

Question 28

what emergency kit should all patients on insulin have

Answer 28

glucagon

Question 29

what medication can reduce hypoglycaemic awareness

Answer 29

BB

Question 30

lipodystrophy symptoms

Answer 30

atrophy or lump of s/cut fat

Question 31

how is lipodystrophy prevented

Answer 31

rotating injection site

Question 32

how can lipodystrophy affect insulin mx

Answer 32

erratic absorption

Question 33

when are T1DM started on statins

Answer 33

over 40 + nephropathy OR diagnosed 10+ years ago

Question 34

what is obese class 1-3

Answer 34

1 = 30-35 // 2 = 35-40 // 3 = >40

Question 35

what meds can be used in obesity

Answer 35

orlistat + liraglutide

Question 36

action orlistat

Answer 36

pancreatic lipase inhibitor

Question 37

indications starting orlistat

Answer 37

BMI 28 with 2+ risk factors // BMI 30+ // continued weight loss

Question 38

how long is orlistat used for

Answer 38

<1 year

Question 39

action Liraglutide

Answer 39

GLP1 mimetic