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
Describe sick day rules in T1DM
DO NOT STOP INSULIN (risk DKA)
Check BMs more frequently, every 1–2h including through the night
Consider checking blood/ urine ketones regularly
Describe nutrition advice for T1DM when unwell
If appetite reduced: Carbohydrate-containing drinks (milk, milkshakes, fruit juices + sugary drinks)
Aim 3L fluid per day to prevent dehydration
Which site has the fastest absorption rate of insulin?
Abdomen
What should patients be advised about injection sites in T1DM?
Check injection sites regularly
Rotate to prevent lipohypertrophy + cutaneous amyloidosis
