T1DM Flashcards
What is T1DM?
absolute insulin deficiency due to AI destruction of the insulin-producing beta cells in the pancreas.
Describe onset/ presentation of T1DM
Often acute (hours-days)
Presents as DKA
List 4 risk factors for T1DM
HLA-DR3 + HLA-DR4
Hashimoto thyroiditis
Coeliac
Primary adrenal insufficiency
List 4 classic symptoms of T1DM
Polyuria
Polydipsia
Weight loss
Fatigue
What investigations are performed in suspected T1DM?
Urine dip: glucose + ketones
Fasting + Random glucose
+/- C-peptide
+/- Autoantibodies
Which antibodies are commonly found in T1DM?
Anti-glutamic acid decarboxylase (Anti-GAD)
Islet cell antibodies (ICA)
What is the criteria for diagnosis of T1DM?
Symptomatic +
Fasting glucose >,7.0 mmol/l
Random glucose >,11.1 mmol/l (or after 75g OGTT)
If asymptomatic the above criteria apply but must be demonstrated on 2 separate occasions.
When should antibodies and C-peptide be checked?
If T1DM suspected but clinical presentation inc. atypical features (e.g. >,50y, BMI >, 25 kg/m², slow evolution of hyperglycaemia or long prodrome)
When can T1DM be diagnosed on clinical grounds?
Hyperglycaemia + >,1 of:
ketosis
rapid weight loss
age of onset <50y
BMI <25 kg/m²
Personal / FH AI disease
Describe use of HbA1c in T1DM
Monitor every 3-6 months
Adult target: ,< 48 mmol/mol (6.5%)
Describe self-monitoring in T1DM
At least 4x/day, inc. before each meal + before bed
More frequent monitoring if:
freq of hypoglycaemic episodes increases
Illness
Before, during + after sport
When planning pregnancy, during pregnancy + while breastfeeding
Describe management of T1DM
Individual care plan set up by diabetes specialist team
Structured education e.g. DAFNE (dose-adjustment for normal eating)
Lifestyle management
Diabetes UK support site
What are blood glucose targets in T1DM?
5-7 mmol/l on waking
4-7 mmol/l before meals at other times of the day
3 types of insulin regimen
Multiple daily injection basal–bolus insulin regimens
Mixed (biphasic) regimen
Continuous insulin infusion (pump) therapy
Describe rapid and short acting insulins
Quick onset + short duration of action
Rapid acting insulin onset and duration of action. 2 examples
Onset: 15 mins
Duration: 2–5h
Humalog (insulin lispro)
+
Novorapid (insulin aspart).
Short acting insulin onset and duration of action. 1 example
Onset: 30–60 mins
Duration: up to 8h
Actrapid
Intermediate acting insulin onset, maximal effects window and duration of action. 1 example
Onset: 1–2h
Max. effects: 3–12h
Duration: 11–24h
Humulin I, Insuman Basal, + Insulatard.
Long acting insulin duration of action and time to reach steady state constant level of insulin. 2 examples
Duration: 24h
Steady-state level achieved after 2–4 days to produce a constant level of insulin.
Lantus (insulin glargine)
Levemir (insulin detemir),
Describe multiple daily injection basal-bolus insulin regimens. What are the benefits of this
Short/ rapid-acting insulin before meals
+
>,1 separate daily injections of intermediate/ long-acting insulin to cover basal requirement.
Offers greater flexibility for blood glucose control.
Describe the mixed (biphasic) insulin regimen
1, 2 or 3 insulin injections per day of short/ rapid-acting insulin mixed with intermediate-acting insulin.
Describe continuous subcutaneous insulin infusion (insulin pump) therapy
Programmable pump + insulin storage reservoir that gives a regular/ continuous amount of insulin (usually in the form of a rapid/ short-acting insulin) by a SC needle or cannula.
Which insulin regimen is first line in adults with T1DM?
Multiple daily injection basal-bolus regimen
Long acting: Insulin detemir BD
+
Rapid acting before meals
What should T1DM patients be provided with?
Insulin injection device
Needles for pen injectors
Sharps bin
Blood glucose meter, test strips + lancets
Ketone meter, test strips, lancets
Glucose/ glucagon kit for hypos
